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Cataracts, however, were not the whole story in blindness among lepers. Many lepers at Vellore didn’t suffer from cataracts, yet were losing their sight from eye ulcerations. Did the bacillus leprae produce the infection and the resultant ulcerations and blindness? Or, as in the ease of fingers and toes, was the loss of function a by-product in which other causes had to be identified and eliminated.

The latter line of reasoning proved to be fruitful. Human eyes are constantly exposed to all sorts of irritations from dust and dirt in the air. The eyes deal with these invasions almost without a person being aware of the process. Thousands of times a day the eyelids close and open, washing the surface of the eye with soothing saline fluid released by the tear ducts. Paul Brand and his colleagues believed this washing process didn’t take place in lepers because there was a loss of sensation on the eye surface caused by the atrophy of nerve endings. This hypothesis was easily and readily confirmed. They observed the eyes of lepers when subjected to ordinary irritations. There was, as they had suspected, no batting of the eyelids; therefore, there could be no washing process. The big problem, then, was to get the eyelids working again.

Why not educate leper’s to make a conscious effort to bat their eyes? There being no impairment of a leper’s ability to close his eyes at will, it ought to be possible to train lepers to be diligent in this respect. But experiments quickly demonstrated the disadvantages of this approach. Unless a leper concentrated on the matter constantly, it wouldn’t work. And if he did concentrate, he could think of almost nothing else. No; what was needed was a way of causing eyelid action that would clean the eyes automatically.

In the case of fingers or toes, it was possible to educate lepers in stress tolerances and to give them protective gloves or shoes. How to keep dirt and foreign objects from getting into the eye? Eye goggles might be one answer but they were not airtight, were cumbersome, would fog up because of the high humidity, and were too easily lost. Something more basic would have to be found.

The answer, again, was found in reconstructive surgery. Paul Brand and his team devised a way of hooking up the muscles of the jaw to the eyelid. Every time a leper opened his mouth the new facial muscles would pull the eyelids and cause them to close, thus washing the eyeball. In this way, a leper could literally talk and eat his way out of oncoming blindness. Countless numbers of lepers have their sight today because of this ingenious use of surgery in facilitating the use of nature’s mechanism to get rid of dirt and dust in the eyes.

Excerpted from ‘Anatomy of an Illness’ by Norman Cousins, pg 115-117