A 72-year-old woman was initially seen with a right corneal mass of 3 months' duration (Figure 1) with long-standing bilateral lagophthalmos secondary to facial nerve palsy and left corneal scar. Histological examination of this excised corneal mass revealed a diffuse infiltrate of foamy macrophages, singly and in clumps, with some lymphocytes and plasma cells (Figure 2). Wade-Fite stain showed the presence of numerous acid-fast bacilli (Figure 3). The diagnosis was inflammatory corneal leproma in lepromatous leprosy. Systemic review disclosed resorption of toes and thickened peripheral nerves but no cutaneous leproma. She was referred to a dermatologist and was treated with dapsone and rifampin.
Yuen HKL, Liu DTL, Lam DSC. Corneal Leproma as an Initial Feature of Lepromatous Leprosy. Arch Ophthalmol. 2006;124(11):1661-1662. doi:10.1001/archopht.124.11.1661