Bakhat Samer Khan, Abid Nawaz, Muhammad Daud Khan.
Periocular Leishmaniasis (Report of 3 cases).
Pak J Ophthalmol Jan ;18(4):116-8.

We report three patients with periocular Lelshmaniasis, who were and managed at Khyber Institute of Ophthalmic Medical Sciences, HMC Peshawar. Two cases had received treatment with antibiotic drugs, including antituberculous therapy. The third case was clinically diagnosed as squamous cell carcinoma. All cases were found to have Lelshmaniasis on investigation. They were positive for Giemsa stain. All the cases resolved with residual periocular scarring after being treated with antilelshmanlasis drugs.

An 11 years old Afghan boy presented to eye OPD with two ulcerative lesions, one around left eye and the other on the left leg. These lesions had been present for 4 years. He had reduced vision and pain in left eye for 3 years. Examination revealed a left periocular lesion of 3cm x 1.5 cm. The lesion on left leg was 3cm x 2cm. These lesions were painful and pruritic. The edges were raised. The surrounding skin was dusky red. The visual acuity was 6/6 and hand movement in the right and left eye respectively. The right eye was normal. Left eye besides the chronic periocular lesion had conjunctival hyperaemia and chemosis. Cornea had a large ulcer while the posterior segment was difficult to examine. This patient had used systemic antibiotic and antituberculous drugs for 9 months. He had also used an antibiotic and steroid skin ointment off and on. On investigation he has eosinophilia 18% and Mountox test was positive. Biopsy from the leison revealed chronic non specific granulomatous reaction. Smear from leg ulcer was positive for Leishmaniasis. This patient was treated with the antiparasitic drug injection Glucantine 20 mg/kg body weight for 14 days, systemic steriods 20 mg daily and antibiotic and cycloplegic eye drops. His periocular and leg ulcers healed and his visual acuity in left. eye improved to 6/36. He is due for lid reconstruction in six months.

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