LEPROSY OF THE EYE 345 



In the same manner the episclera and the sclera can be affected. 

 The frequency of an affection of the uvea is of great importance in 

 many cases of leprosy. The commonest starting-point is the root of 

 the iris, in the angle of the anterior chamber. 



Lie never saw isolated nodules in the iris unconnected with the 

 angle. In the ciliary body the bacilli commonly lie along the pig- 

 niented muscle fibres, whose radial and circular arrangement is shown 

 in the distribution of the bacilli. A spread to the choroid occurs along 

 the radial fibres. The free occurrence of the bacilli in the nerves of 

 the suprachoroid appears very remarkable, as is also their connexion 

 with the vessels of the stratum proprium and the choriocapillaris. 



Generally the leprous changes in the choroid cannot be seen with 

 the ophthalmoscope, as they are usually in its anterior part ; and in 

 those cases where the choriocapillaris, and with it the retina, is more 

 severely affected, the changes which have taken place in the anterior 

 segment of the eye are so great that the ophthalmoscope cannot be 

 used. As a matter of fact, choroidal nodules are very rarely seen 

 in lepers ophthalmoscopically. (Bistis, Zcnt. f. Aug., November, 

 1899 ; Trantas, Butt, de Congres Fran^. d'Oph., 1899, p. 275.) 



Changes in the retina are uncommon, and not obvious. Occa- 

 sionally masses of exudation occur in the ora serrata, and the lepra 

 bacilli are enclosed in them and lie in the pigment cells. 



The rest of the retinal destruction is due to changes in the chorio- 

 capillaris. 



Lie found the lepra bacilli in the optic nerve only once, in the 

 absence of other changes. 



The lens is often secondarily cataractous, but the bacilli are never 

 found in it ; nor do they occur in the vitreous. 



The ciliary nerves are often affected with a leprous neuritis, con- 

 sidered by Lie and Levaditi to be ascending. 



In comparison with the characteristic and readily determined features 

 of the tubercular form, the maculo-ancesthetic form very poorly repays 

 examination, being only available for research in a later stage, when 

 the bacilli are no longer to be found in the nerves and the spots. 



Lie, and also Franke and Delbanco, however, were fortunate in 

 having the opportunity of examining a comparatively recent case 

 of this variety. In Lie's case it was a keratitis pannosa. 



In the conjunctiva bulbi there was a diffuse infiltration with 

 numerous bacilli, which also lay amongst the desquamating epi- 

 thelial cells. 



The anterior three-quarters of the cornea was infiltrated, with scanty 



