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Summary Out of 742 out-patients screened for ocular disease, 177 (24%) had eye lesions due to leprosy. These were more in the lepromatous spectrum of the disease and showed increasing trend with age of patient and duration of the disease. Madarosis was the commonest lesion (76%). The serious and sight threatening lesions like lagophthalmos, corneal anaesthesia, corneal opacities and ulcers, iritis and complicated cataracts constituted 8·22% of the lesions. Blindness due to corneal opacity and complicated cataract developed in 6 patients, constituting 3·4% of eye lesions with a prevalence rate of 0·8% among all the leprosy patients. Although the blinding lesions occurred in a very small percentage of patients, most of these are preventable through early recognition and institution of appropriate treatment. The simple techniques of examination to detect protentially sight threatening lesions should be taught to all leprosy workers to prevent blindness among leprosy patients.Estimates from India on the magnitude of ocular complications in leprosy vary from 5 to 80%.1.2 Such wide variations may be due to the differences in methodology of assessment, populations studied, sampling designs and definitions adopted. Without a scientifically designed study, it is difficult to establish the role of clinical or epidemiological factors in ocular lesions of leprosy.A study was carried out on an un selected sample of patients seeking care for leprosy and not just for eye problems. The eyes of these patients were carefully examined using standardized techniques. This paper presents the types and extent of ocular lesions in leprosy and discusses the ocular disease from the point of view of disability and morbidity. Materials and methodsSeven hundred and forty-two consecutive leprosy patients seen at the general out-patient clinic of the Schieffelin Leprosy Research and Training Centre, Karigiri, were included in this study.Each patient was examined carefully and the findings on age, sex, occupation, type of leprosy, 0305-75 1 8/89/060033 +06 $0 1 ·00 © British Leprosy Relief Association

Summary The examination of 143 leprosy patients revealed that 91 had ocular lesions attributable to leprosy and of these 13 were blind. The commonest lesion was madarosis and the commonest cause of blindness was chronic iritis (3 1 % of all blind patients). Lagophthalmos remains an important condition and fo und in 25% of patients while corneal lesions account for a large number of ocular problems in leprosy (exposure keratitis 31 %, interstitial keratitis 8%). Most affected is the 40--60 year, age group and most of the affected patients had long-term disease. Lepromatous patients were also encountered more frequently (70%) among the involved patients. A large number of patients also suffered from gross deformities (53%) and even more so amongst the blind (77%). This study does point out the importance of careful and regular examination of the eyes of leprosy patients by all involved with the care of these unfortunate people.As early as 1873, Hansen and Bull drew attention to the high incidence of ocular complications in leprosy in their book The leprous disease of the eye where they commented that there is no disease which so frequently gives rise to disorders of the eye as leprosy does.1 In spite of this early awareness there is still considerable ignorance of many aspects of the problem . Good studies of the subject are fe w and far between. Several prevalence surveys have been carried out but there is still no standard method of classifying the lesions and this makes their comparison difficult.The incidence of ocular leprosy is known to vary according to climate, sex, race, type of leprosy and skin pigmentation. One study2 has demonstrated a prevalence in Malaysia of 16· 3% while another has shown that 96% had ocular manifestations in Panama,3 both studies being amongst institutionalized patients.

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