Categories
Ocular System

Xerophthalmia

All ocular manifestations of Vitamin A deficiency.

All ocular manifestations of Vitamin A deficiency.

  • M/C cause of preventable childhood blindness

Classification

New Xerophthalmia Classification (Modification of 1982 classification)

  • PRIMARY SIGNS
    • X1A: Conjunctival Xerosis
    • X1B: Bitot’s spots
    • X2: Corneal Xerosis
    • X3A: Corneal ulceration/keratomalacia (<1/3 corneal surface)
    • X3B: Corneal ulceration/keratomalacia (>1/3 corneal surface)
  • SECONDARY SIGNS
    • XN: Night Blindness
    • XS: Corneal scar
    • XF: Xerophthalmic Fundus

Clinical Features

  1. XN (Night Blindness)
  2. X1A (Conjunctival Xerosis)
    • Patches of dry, lustreless, non-wettable conjunctiva
  3. X1B (Bitot’s spots)
    • Raised, silvery white, foamy, triangular patch of keratinised epithelium
    • Situated on bulbar conjunctiva in interpalpebral area
  4. X2 (Corneal Xerosis)
    • Punctate keratopathy
    • Haziness and/or granular pebbly dryness
  5. X3A&B (Corneal ulceration/keratomalacia)
  6. XS (Corneal scar)
    • Healed corneal ulcer
  7. XF (Xerophthalmic Fundus)
    • Seed-like, raised, whitish lesions scattered uniformly over the part of fundus at the level of optic disc

Management

  1. Local ocular therapy
  2. Vitamin A therapy
    • All patients > 1 year (except women of reproductive age)
      1. 200,000 IU Vit A oral
      2. 100,000 IU Vit A IM
        • On diagnosis, following day, after 4 weeks
    • Children < 1 year and/or <8kg weight
      • ½ of above
    • Women of reproductive age (pregnant or not)
      1. XN, X1A&B
        • 100,000 IU Vit A oral (1 sugar coated tablet)
          • 2 weeks
      2. X2
        • Full dosage schedule (like 1st)
  3. Treatment of underlying conditions
    • Other nutritional disorders, diarrhoea, dehydration, electrolyte imbalance, infections, parasitic conditions

Prophylaxis:

  1. Short-term approach
    • Revised schedule of Vitamin A supplementation under Child Survival and Safe Motherhood (CSSM)
      • 1st dose (1 lakh IU) 9 months + measles
      • 2nd dose (2 lakh IU) 18 months + Booster OPV/DTP
      • 3rd  dose (3 lakh IU) 2 years
  2. Medium-term approach
    • Food fortification
  3. Long-term approach
    • Balanced diet

Further reading

  • Bitot’s spots in vitamin A deficiency (2016) Available at: http://ocular-surface.org/clinical-case/bitots-spots-vitamin-deficiency (Accessed: 11 December 2016)

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