Date post: | 21-Jan-2018 |
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Healthcare |
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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.