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SUMMARY Twenty men with moderate infection of Onchocerca volvulus were studied in a doublemasked, controlled clinical trial to compare the safety and efficacy of oral diethylcarbamazine (DEC) with topical DEC lotion. Visual acuity and colour vision did not alter during the 6 months of observation, although 2 patients receiving DEC lotion and 3 patients receiving oral DEC developed either visual field constriction or optic atrophy. Fluffy corneal opacities were common in both groups. Intraocular microfilariae also appeared in both groups but to a greater extent in those receiving DEC lotion. New chorioretinal changes developed in 4 men receiving lotion and in only 1 receiving tablets. It is concluded that DEC lotion offers no advantage over tablets in the treatment of ocular onchocerciasis and in fact may be associated with more ocular complications than the conventional oral treatment.Onchocerciasis, or river blindness, is the disease caused by the filarial parasite Onchocerca volvulus. It is characterised by the presence of relatively few adult worms encapsulated in subcutaneous nodules and invasion of the body, especially the skin and the eyes, by millions of microfilariae. The main disability caused by onchocerciasis is blindness, either from corneal or chorioretinal scarring, or from the sequelae of anterior uveitis. The pathological changes seen with onchocerciasis appear to be related directly or indirectly to the death of microfilariae.While recent efforts have resulted in an improved understanding of the clinical presentation and natural history of onchocerciasis, methods of treating the disease remain unsatisfactory. Suramin sodium is the only clinically acceptable drug that kills the adult worms of Onchocerca volvulus. Its usefulness, however, is severely limited because it must be given intravenously, and it has a number of toxic side effects.' Diethylcarbamazine (DEC), on the other hand, has relatively few intrinsic toxic side effects.2 But, although it promotes killing of microfilariae in vivo, it has no demonstrable effect on adult worms

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