Multidrug therapy does not eliminate the risk of ocular disability in leprosy
- 1Department of Global Health, Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany
Abstract
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. Author summary: Leprosy can damage the nerves responsible for eyelid closure and corneal sensation. This can leave the eye exposed to dryness, injury and infection, and the reduced sensation may prevent the person affected from recognising that damage is occurring. These risks do not necessarily end when multidrug therapy is completed. Although eye examinations are already recommended during treatment, people affected by leprosy may have difficulty accessing continued eye care afterwards. This viewpoint therefore makes the case for linking these assessments to a clear plan for continued care. Those with lagophthalmos, reduced corneal sensation, previous eye disease or other risk factors should continue to receive regular follow-up even after treatment completion. Leprosy programmes should also record whether referrals are completed and whether vision is maintained. Links with existing eye-health and non-communicable disease programmes could support lifelong care where needed, including for disabilities caused by other neglected tropical diseases. These would help ensure that people released from treatment are not subsequently lost to vital sight-preserving care.
Related
- Disability Inequality in Short- and Long-Term Mortality After Multidrug-Resistant Tuberculosis
- Nursing care of a child with cerebral palsy and multidrug-resistant bacterial pneumonia treated with bacteriophage therapy: a case report
- Hormone Replacement Therapy and Disability Progression in Women with Multiple Sclerosis
- Baricitinib as Salvage Therapy for Multidrug-Resistant Chronic Graft-Versus-Host Disease.
- Early best available antibiotic therapy for multidrug-resistant gram-negative bloodstream infections: a target trial emulation
BibTeX
@article{willis2026multidrug,
title = {{Multidrug therapy does not eliminate the risk of ocular disability in leprosy}},
author = {Matthew Willis},
journal = {PLOS Neglected Tropical Diseases},
year = {2026},
month = nov,
doi = {10.1371/journal.pntd.0014859},
url = {https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014859},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Multidrug therapy does not eliminate the risk of ocular disability in leprosy
AU - Matthew Willis
PY - 2026
DA - 2026/11/06
JO - PLOS Neglected Tropical Diseases
DO - 10.1371/journal.pntd.0014859
UR - https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014859
AB - 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. Author summary: Leprosy can damage the nerves responsible for eyelid closure and corneal sensation. This can leave the eye exposed to dryness, injury and infection, and the reduced sensation may prevent the person affected from recognising that damage is occurring. These risks do not necessarily end when multidrug therapy is completed. Although eye examinations are already recommended during treatment, people affected by leprosy may have difficulty accessing continued eye care afterwards. This viewpoint therefore makes the case for linking these assessments to a clear plan for continued care. Those with lagophthalmos, reduced corneal sensation, previous eye disease or other risk factors should continue to receive regular follow-up even after treatment completion. Leprosy programmes should also record whether referrals are completed and whether vision is maintained. Links with existing eye-health and non-communicable disease programmes could support lifelong care where needed, including for disabilities caused by other neglected tropical diseases. These would help ensure that people released from treatment are not subsequently lost to vital sight-preserving care.
SN - 1935-2735
ER -