BACKGROUND Leprosy is a chronic granulomatous infectious disease caused by Mycobacterium leprae. Several ocular manifestations occur before and during multi drug therapy (MDT) and they can continue to occur even after the completion in bacteriologically cured patients. Blindness is a catastrophic event that can occur by several mechanisms at any stage. We need to learn and recognise the early signs and symptoms of ocular complications, so that we can treat the patient early. We need to evaluate the pattern of ocular manifestation in leprosy patients on MDT (Multi Drug Therapy). METHODS A cross-sectional study was conducted over a duration of six months on diagnosed cases of leprosy and those cured from leprosy. Data was collected by clinical history with slit lamp examination, fundus examination, and laboratory investigation. RESULTS Total 30 patients were included in the study in which 13 patients were on MDT, 7 newly detected cases and 10 treated cases. 22 were males and 8 were females with male - female ratio of 2.75:1. Average age of presentation was 46 years with range from 18 - 80 years. 56 % had ocular manifestations in this study. Ocular lesions were more in cases who had leprosy for ≥ 16 years. Visual acuity ranged from 6 / 6 to PL + ve. Lagophthalmos was noted in 4 cases, cataract in 6 cases, exposure keratitis in 2, chalky white deposits on cornea in 2, spheroidal degeneration in 2, iris atrophy in 2, and pterygium in 2 cases. CONCLUSIONS Patients who completed treatment for MDT require periodic monitoring to detect ocular morbidity early and to prevent visual loss. KEYWORDS Leprosy, Multidrug Therapy, Exposure Keratitis, Lagophthalmos

Introduction: Calotropis is a member of the milkweed or Asclepiadeae family. The latex of Calotropis gigantea (C gigantea) contains cardiac glycosides, fatty acids and calcium oxalate. The sap of Calotropis procera (C procera) produces acidic latex. Toxic effect of latex manifests after a few hours with diminution of vision due to corneal oedema with folds in Descemet’s membrane. Aim: To evaluate the ocular toxicity by the latex of calotropis procera and calotropis gigantea due to accidental exposure. Materials and Methods: This was a prospective observational study conducted for a duration of six months (September 2018 to February 2019) on 18 patients with alleged accidental exposure to calotropis latex. The patients were examined in the Department of Ophthalmology, Mandya Institute of Medical Sciences (MIMS), Mandya, Karnataka, India. After a thorough saline wash under topical anaesthesia, visual acuity was measured by using Snellen’s chart, then patients were subjected for slit lamp biomicroscopy examination, Intraocular Pressure (IOP) measurement and undilated fundus examination and the findings were noted. Demographic details like age and sex, activity at time of injury, mode of injury were noted and follow-up was done for a period of 30 days. Data were analysed using Epi info software and descriptive statistics like mean and percentage were calculated. Results: Total 18 patients reported with calotropis associated eye toxicity, among which 11 (61.1%) were of C gigantea and seven (38.9%) were of C procera. Out of total, seven (38.9%) were males and 11 (61.1%) females. A total of 14 (77.8%) patients presented within 24 hours of injury. Eleven (61.1%) patients had involvement of both the eyes. The main symptoms were burning, irritation, foreign body sensation and diminution of vision. Best Corrected Visual Acuity (BCVA) varied from 6/9 to 6/60. Corneal oedema or striate keratopathy was the most common sign. Corneal oedema resolved in one week in case of C procera with use of topical corticosteroids except in three cases of C gigantea which took two weeks. Conclusion: C procera and C gigantea causes significant corneal oedema and ocular morbidity. By simple health education and occupational precaution, we can prevent ocular morbidity.