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5. Eye diseases
Xerophthalmia (vitamin A deficiency)
The te r m xe r op htha lm ia c ov e r s a ll the oc u la r m a nife s ta tions of v ita m in A
d e fic ie nc y.
X e r op htha lm ia c a n p r ogr e s s to ir r e v e r s ib le b lind ne s s if le ft u ntr e a te d .
I n e n d e m ic a r e a s , v ita m in A d e fic ie n c y a n d xe r op h t h a lm ia a ffe c t m a in ly
c h ild r e n
(p a r tic u la r ly thos e s u ffe r ing fr om m a lnu tr ition or m e a s le s ) a nd p r e gna nt
w om e n.
D is or d e r s d u e to v ita m in A d e fic ie nc y c a n b e p r e v e nte d b y the r ou tine
a d m inis tr a tion
of r e tinol.
Clinical features 5
– Th e fir s t s ign is he m e r a lop ia (c r e p u s c u la r b lin d n e s s ) : the c hild c a nn ot
s e e in d im
light, m a y b u m p into ob je c ts a nd / or s how d e c r e a s e d m ob ility.
– The n, othe r s igns a p p e a r gr a d u a lly:
•C on ju n c tiv a l xe r os is : b u lb a r c on ju n c tiv a a p p e a r s d r y, d u ll, th ic k,
w r in kle d a nd
ins e ns itiv e
•B itot‟s s p ots : gr e yis h foa m y p a tc he s on the b u lb a r c onju nc tiv a , u s u a lly in
b oth e ye s
(s p e c ific s ign, how e v e r not a lw a ys p r e s e nt).
•C or ne a l xe r os is : c or ne a a p p e a r s d r y a nd d u ll
•C or ne a l u lc e r a tions
•K e r a tom a la c ia (the la s t a nd m os t s e v e r e s ign of xe r op htha lm ia ): s ofte ning
of the
c or ne a , follow e d b y p e r for a tion of the e ye b a ll a nd b lind ne s s (e xtr e m e
care m u st b e
ta ke n d u r ing op htha lm ic e xa m ina tion d u e to r is k of r u p tu r ing c or ne a ).
Treatment
It is e s s e ntia l to r e c ognis e a nd tr e a t e a r ly s ym p tom s to a v oid the
d e v e lop m e nt of s e v e r e
c om p lic a tions . V is ion c a n b e s a v e d p r ov id e d tha t u lc e r a tions a ffe c t le s s tha n
a thir d of
the c or ne a a nd the p u p il is s p a r e d . E v e n if d e fic ie nc y ha s a lr e a d y le d to
ke r a tom a la c ia
a nd ir r e v e r s ib le los s of s ight, it is im p e r a tiv e to a d m inis te r tr e a tm e nt, in or d e r
to s a v e
the othe r e ye a nd the life of the p a tie nt.
– Retinol (vitamin A) P O
R e ga r d le s s of the c linic a l s ta ge :
C hild r e n fr om 6 to 1 2 m onths (or u nd e r 8 kg): 1 0 0 0 0 0 IU onc e d a ily on D 1 ,
D 2 a nd D 8
C hild r e n ov e r 1 ye a r (or ov e r 8 kg): 2 0 0 0 0 0 IU onc e d a ily on D 1 , D 2
a nd D 8
A d u lts (e xc e p t p r e gna nt w om e n): 2 0 0 0 0 0 IU onc e d a ily on D 1 ,
Xerophthalmia (vitamin A deficiency)
The te r m xe r op htha lm ia c ov e r s a ll the oc u la r m a nife s ta tions of v ita m in A
d e fic ie nc y.
X e r op htha lm ia c a n p r ogr e s s to ir r e v e r s ib le b lind ne s s if le ft u ntr e a te d .
I n e n d e m ic a r e a s , v ita m in A d e fic ie n c y a n d xe r op h t h a lm ia a ffe c t m a in ly
c h ild r e n
(p a r tic u la r ly thos e s u ffe r ing fr om m a lnu tr ition or m e a s le s ) a nd p r e gna nt
w om e n.
D is or d e r s d u e to v ita m in A d e fic ie nc y c a n b e p r e v e nte d b y the r ou tine
a d m inis tr a tion
of r e tinol.
Clinical features 5
– Th e fir s t s ign is he m e r a lop ia (c r e p u s c u la r b lin d n e s s ) : the c hild c a nn ot
s e e in d im
light, m a y b u m p into ob je c ts a nd / or s how d e c r e a s e d m ob ility.
– The n, othe r s igns a p p e a r gr a d u a lly:
•C on ju n c tiv a l xe r os is : b u lb a r c on ju n c tiv a a p p e a r s d r y, d u ll, th ic k,
w r in kle d a nd
ins e ns itiv e
•B itot‟s s p ots : gr e yis h foa m y p a tc he s on the b u lb a r c onju nc tiv a , u s u a lly in
b oth e ye s
(s p e c ific s ign, how e v e r not a lw a ys p r e s e nt).
•C or ne a l xe r os is : c or ne a a p p e a r s d r y a nd d u ll
•C or ne a l u lc e r a tions
•K e r a tom a la c ia (the la s t a nd m os t s e v e r e s ign of xe r op htha lm ia ): s ofte ning
of the
c or ne a , follow e d b y p e r for a tion of the e ye b a ll a nd b lind ne s s (e xtr e m e
care m u st b e
ta ke n d u r ing op htha lm ic e xa m ina tion d u e to r is k of r u p tu r ing c or ne a ).
Treatment
It is e s s e ntia l to r e c ognis e a nd tr e a t e a r ly s ym p tom s to a v oid the
d e v e lop m e nt of s e v e r e
c om p lic a tions . V is ion c a n b e s a v e d p r ov id e d tha t u lc e r a tions a ffe c t le s s tha n
a thir d of
the c or ne a a nd the p u p il is s p a r e d . E v e n if d e fic ie nc y ha s a lr e a d y le d to
ke r a tom a la c ia
a nd ir r e v e r s ib le los s of s ight, it is im p e r a tiv e to a d m inis te r tr e a tm e nt, in or d e r
to s a v e
the othe r e ye a nd the life of the p a tie nt.
– Retinol (vitamin A) P O
R e ga r d le s s of the c linic a l s ta ge :
C hild r e n fr om 6 to 1 2 m onths (or u nd e r 8 kg): 1 0 0 0 0 0 IU onc e d a ily on D 1 ,
D 2 a nd D 8
C hild r e n ov e r 1 ye a r (or ov e r 8 kg): 2 0 0 0 0 0 IU onc e d a ily on D 1 , D 2
a nd D 8
A d u lts (e xc e p t p r e gna nt w om e n): 2 0 0 0 0 0 IU onc e d a ily on D 1 ,
