The 22nd Kellersberger Memorial Lecture, 1997. Preventing loss of sight from leprosy

Multidrug treatment of leprosy is being dramatically successful in sterilising the infection. However complications are still occurring, spoiling the result in some patients by residual damage, including to the eye. Prevention of this damage is imperative. It is stressed that eye complications will only lead to loss of sight if they are neglected. The lesions caused by leprosy in the eye are briefly described. The dangerous lesions are lagophthalmos causing corneal exposure, and iritis causing pupil block glaucoma. Frequency of the lesions were very common in the past, but seem to be becoming much less so, though good epidemiological studies are sparse. Cataract, mostly not caused by leprosy, is the commonest cause of loss of vision. Prediction of complications would facilitate prompt treatment, but despite some clues, prediction is at present inadequate and all cases must be watched. The management of complications is discussed: studies of the indications and outcome of surgery for lagophthalmos, and of intraocular lens implantation for cataract are priorities. If knowledge is to be put into practice to prevent blindness, training of front line staff and organisation of the service is central. Experience of these practical aspects in Uganda in recent years is described.