Multidrug therapy does not eliminate the risk of ocular disability in leprosy

Whilst multidrug therapy can provide a microbiological cure for leprosy infection, it does not reverse nerve damage that is already established, nor remove the risk of the occurrence of future ocular complications. Ocular conditions associated with leprosy such as lagophthalmos, reduced corneal sensation, exposure keratopathy, uveitis and other sight and eye threatening conditions may be present at diagnosis, develop during treatment, or even progress long after treatment has already been completed. Existing guidance already recommends eye assessment during treatment, but continuity after treatment varies between settings. This viewpoint therefore argues for implementing these recommendations through a minimum pathway which links assessment during treatment to risk-stratified follow-up after treatment completion, clear referral responsibilities, supported self-care and monitoring, and routine assessment of visual outcomes in paper or electronic records. To be successful these measures should be integrated within existing leprosy, primary-care and eye-care services, with links to non-communicable disease programmes where these can support long-term care. Achieving zero disability due to leprosy requires recognising that treatment completion is not the end of ocular risk.