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
- XN (Night Blindness)
- X1A (Conjunctival Xerosis)
- Patches of dry, lustreless, non-wettable conjunctiva
- X1B (Bitot’s spots)
- Raised, silvery white, foamy, triangular patch of keratinised epithelium
- Situated on bulbar conjunctiva in interpalpebral area
- X2 (Corneal Xerosis)
- Punctate keratopathy
- Haziness and/or granular pebbly dryness
- X3A&B (Corneal ulceration/keratomalacia)
- XS (Corneal scar)
- Healed corneal ulcer
- XF (Xerophthalmic Fundus)
- Seed-like, raised, whitish lesions scattered uniformly over the part of fundus at the level of optic disc
Management
- Local ocular therapy
- Vitamin A therapy
- All patients > 1 year (except women of reproductive age)
- 200,000 IU Vit A oral
- 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)
- XN, X1A&B
- 100,000 IU Vit A oral (1 sugar coated tablet)
- 2 weeks
- 100,000 IU Vit A oral (1 sugar coated tablet)
- X2
- Full dosage schedule (like 1st)
- XN, X1A&B
- All patients > 1 year (except women of reproductive age)
- Treatment of underlying conditions
- Other nutritional disorders, diarrhoea, dehydration, electrolyte imbalance, infections, parasitic conditions
Prophylaxis:
- 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
- Revised schedule of Vitamin A supplementation under Child Survival and Safe Motherhood (CSSM)
- Medium-term approach
- Food fortification
- 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)