The term xerophthalmia is now reserved (by a joint WHO and USAID Committee, 1976) to cover all the ocular manifestations of vitamin A deficiency, including not only the structural changes affecting the conjunctiva, cornea and occasionally retina, but also the biophysical disorders of retinal rods and cones functions.

Clinical features:

Ø  Vitamin A deficient diet is the main reason especially in young growing children of developing countries. It is usually associated with protein energy malnutrition.

Ø  In some cases, decreased absorption of vitamin A due to gastro-intestinal disorders like lipid malabsorption or chronic alcoholism can occur.

Clinical Presentation can be as:

-  Nyctalopia- night blindness is the earliest presenting symptom.

-  Conjunctival xerosis

-  Bitot spot: It is a metaplastic keratinisation of conjunctiva.

-  Persistent epithelial defect (usually in chronic alcoholics) and corneal ulcer

-  Keratomalacia: a diffuse corneal necrosis occurring in severe vitamin A deficiency.

Severe xerophthalmia is a medical emergency, so treatment should begin as early as possible. Treatment: Aimed at restoring vitamin A level to normal and addressing associated protein energy malnutrition.

1.  Oral vitamin A:

0-6 month of age:50,000 IU (on 0 day, 1st day & after 4 weeks) 6-12 month of age: 1 lakh IU (on 0 day, 1st day & after 4 weeks)

More than 1 year of age : 2 lakh IU (on 0 day, 1st day & after 4 weeks)

2.  Intramuscular water soluble vitamin A is given to children with persistent vomiting or severe malabsorption.

3.  Topical preservative free lubricating eye drops and antibiotic drops (e.g. moxifloxacin eye drops 1 to 6 hourly) to prevent secondary infection can be given.

Patient education:

u  Regular consumption of Vitamin A rich foods particularly fresh dark green leafy vegetables which constitute very rich and cheap sources.

u  Pregnant women and lactating mothers should also consume Vitamin A rich diet regularly.

u  Breast feeding including feeding of new born with rich colostrum.

u  High dose universal distribution schedule for prevention of Vitamin A deficiency.

-  Infants less than 6 months of age – 50,000 IU orally

-  Infants 6-12 months of age - 100,000 IU orally.

-  Children more than 12 months - 200,000 IU orally every 4-6 months till 5 years of age. Mothers - 200,000 IU orally within 8 weeks of delivery.