LEPROSY OF THE EYE 343 



tion of new cells, a free formation of scales, and in the end ulce'ration 

 and secondary infection occur. 



The cells of the rete mucosum are very often filled with granules of 

 brown pigment. Spots without pigment (morpluea alba) are much 

 less common, and are usually the result of burns, etc. 



The roots of the hairs are destroyed by the free formation in their 

 neighbourhood of new leprous tissue ; the bacilli rarely pass into them, 

 but are commonly found amongst the cells of the root-sheaths ; they 

 may even pass along the hair to the surface of the skin. By this means 

 the bacilli can reach the exterior even when the skin appears intact. 



The sebaceous glands, the arrectores pilorum, and even the sweat 

 glands, are affected in the same way as the hairs. Lie states that the 

 bacilli are rarely found in the sweat glands. 



In Lie's opinion, though the bacilli are more prevalent in the cells, 

 they can occur in the lymph spaces. He takes up a middle position 

 in this much-discussed question. He considers that the well-known 

 ' globi ' (lepra cells) are principally cells laden with bacilli, but the 

 very large ones, which can almost be seen with the naked eye, he 

 considers not to be cells. 



The Lids and Conjunctiva. The actual skin of the lids remains 

 unaffected till late in the disease, even when the eyebrows are filled 

 with nodules. After a time it is affected, and then chiefly at the 

 border ; the hairs here begin to fall out, just as we have described. 

 This loss of hair not infrequently occurs without any demonstrable 

 change in the lid margins. Lie explains these cases by the presence 

 of the lepra bacilli in the conjunctiva. 



The nodules in the conjunctiva tend to form scales, and subse- 

 quently ulcerate. The newly-formed leprous tissue occurs in two 

 layers, immediately under the epithelium and in the deeper layers. 

 The cylindrical epithelial cells disappear, being partly destroyed by 

 ulceration, and partly replaced by round cells ; along with this 

 papillary outgrowths and epithelial down-growths are commonly seen. 

 The tarsus is affected by the deeper infiltration. 



The conjunctival affection often takes the form of a diffuse catarrh, 

 with numerous papillae, very rich in cells. 



The Globe. A direct spread of the diseased process from the 

 neighbouring parts is rare. Infection is much more common from 

 the blood or lymph stream, and in this the peculiar arrangement of 

 the vessels at the corneo-scleral margin and its neighbourhood takes 

 an important part. It is here that bacilli are most commonly 

 found. 



