VITAMIN A DEFICIENCY

XEROPHATHALMIA

CONTENTS:

• Xerophthalmia

• Definition

• Condition

• Epidemiology

• Global epidemiology

• Major nutritional deficiency

• Causes

• Symptoms

• Classification (explanation)

• Medical status and diet

• risk factors

• W.H.O recommended doses

• Treatment

• Surgery

• Clinical checkup

• Prevention

• Nutritional education

• sources

XEROPHTHALMIA

INTRODUCTION:

Xerophathalmia is a medical condition in which the eye fails

to produce tears. It is mainly caused by vitamin A

deficiency.

DEFINITION:

“an abnormal dryness of the eyeball produced usually by

Long-continued inflammation and subsequent atrophy of

the

Conjunctiva.”

MEDICAL CONDITION

CONDITION:

• The condition is not congenital

• develops over the course of a few months

• as the lacrimal glands fail to produce tears

• appearance of Bitot's spots.

EPIDEMIOLOGY:

AGE:

children below 6 years of age

SEX:

boys are at greater risk

Season:

more in pre-monsoon ( due to shortness of vitamin A sources)

and in winter due to chest infection, increase in demand for vitamin A

GLOBAL EPIDEMIOLOGY:

• It usually affects children under SIX years old and

"accounts for 20,000-100,000

• new cases of childhood blindness each year in the

developing countries.

GLOBAL EPIDEMIOLOGY:

• Blinding xerophathalmia is largely limited to developing

countries , especially those in Africa, Asia and Western

Pacific, Southern Asia

NUTRITIONAL DEFICIENCY

MAJOR NUTRITIONAL DEFICIENCY:

• Protein energy malnutrition

• Vitamin A deficiency disorder

• Iron deficiency disorder

CAUSES

CAUSES:

Ecological, political and social causes:

• Political stability

• Population density

• Land type, fertile,

• Climate , drought

• Health services

CAUSES:

a. Diarrhea

b. Measles

c. Nutritional status

d. Intestinal parasites and other infections

e. Increasing demand (measles and pregnancy)

f. malnutrition

SIGN AND SYMPTOMS

SIGNS:

• Cornea and tissue of the eye become dry , wrinkled and

thickened

SYMPTOMS:

• loss of goblet cells

• Less mucin production

• Night blindness

• The conjunctiva becomes dry, thick and wrinkled.

• If untreated, it can lead to corneal ulceration and

ultimately to blindness as a result of corneal damage

CLASSIFICATION

WHO CLASSIFICATION OF XEROPHTHALMIA:

Primary signs:

Conjunctival xerosis

Bitot’s spot with conjunctiva xerosis

Corneal ulceration and xerosis

Keratomalacia

WHO CLASSIFICATION OF XEROPHTHALMIA:

Secondary signs:

• night blindness

• Xerophathalmia fundus

• Xerophthalmia scars

Diseases

CONJUNCTIVAL XEROSIS

Conjunctival Xerosis:

Dryness of eye surfaces which is caused by deficiency of

tears, or it may be associated with vitamin A deficiency

BITOT’S SPOT:

• Bitot's spots are tiny specks of keratin protein that flakes

off the inside of the eyelid.

• A malfunction of the goblet cells leads of a deficiency of the

protective mucus that carries away keratin and other debris

and keeps the lenses clear.

CORNEAL ULCER

Corneal Ulcer:

• A corneal ulcer is a corneal epithelial defect due to

invasion by bacteria, fungi , viruses etc

keratomalacia:

Keratomalacia is an eye disorder that involves drying. It is

due to vitamin A deficiency and usually insufficient

protein and calories in the diet

KERATOMALACIA:

• Condition:

1. Night blindness

2. Extreme dryness of the eyes

3. Dry, foamy and silver deposits

4. Wrinkling of eye

NIGHT BLINDNESS:

NIGHT BLINDNESS:

• it is the in ability to see well at night or in poor light

XEROPHTHALMIA FUNDUS

XEROPHATHALMIA FUNDUS:

• Pale yellow spots near the course of the retinal vessels

and in the retinal periphery

• Disappear with 2- 4 months of vitamin A therapy

Xerophthalmia scars

XEROPHTHALMIA SCARS:

• Both eyes have scars

• It is the indication of blindness in a community

MEDICAL STATUS AND DIET

MEDICAL STATUS AND DIET:

• Control respiratory and GIT infection

• Rehydration

• Children with xerophathalmia are severely ill , and

dehydrated

• Proper treatment will save their sight and health

RISK FACTOR FOR XEROPHATHALMIA

• Poverty

• Lack of adequate diet

• alcoholism

• cystic fibrosis

• liver disease

• chronic diarrhea

• radioiodine treatment for thyroid cancer,

OTHER FACTORS:

• Protein energy malnutrition

• Measles

• Malaria

• Ulcers

• Herpes simplex

• Intestinal parasites

W.H.O RECOMMENDED DOSES

• Immediately on diagnosis (day 1)

200,00 IU. Oral vitamin A doses

• The following day (day 2)

200,00 IU. Oral vitamin A dose

• Four weeks later (week 4)

200,00 IU vitamin A orally

NOTE:

• Preventive doses of vitamin A are also given to pregnant

women and those who are breast feed their child, but

small massive doses

If massive dose is not available then child should not eat

food rich in vitamin A

TREATMENT

TREATMENT:

• Care of the eye

• Protein energy malnutrition

• Doses of vitamin A

• Vitamin A capsule

• surgery

TOPICAL TYPICAL TREATMENT”

• Antibiotics

• Antiviral agents

• Padding an eye

• Closing the eyes

• No steroids

SURGERY:

1. Corneal grafting

2. Conjunctiva flaps

CORNEAL GRAFTING:

• the cornea is removed and replaced with healthy corneal

tissue from an individual who has died donated their

cornea for transplantation

CONJUNCTIVA FLAPS”

• provide support for weakened cornea

• are readily performed and highly successful

• useful for providing support to deeper corneal defects

• Most commonly used for deep corneal ulcers

• are very useful for the management of

• serious sight threatening corneal ulcers

CLINICAL CHECKUP

CLINICAL CHECKUP:

• Dietary counseling:

mothers should be taught how to prepare diets rich

in vitamin A

• Admiration of Vitamin A:

vitamin A supplements according age at 4 -6 months

in endemic and hyper endemic areas

PREVENTION:

1. Massive doses of vitamin A (with polio vaccine)

2. Food fortification ( to improve nutrition)

• Wheat flour

• Cooking oils

3.Agriculture and horticulture:

• Orange color fruits and vegetables

• Green leafy vegetables

NUTRITIONAL EDUCATION:

• Radio

• Television

• Books

• Newspaper

• Social media

• Educational centers

• Seminars

NUTRITIONAL EDUCATION:

SOURCES

SOURCES:

• High vitamin A foods include sweet potatoes,

• carrots,

• dark leafy greens,

• lettuce,

• dried apricots,

• fish, liver, and tropical fruits.