Xeropthalmia introduction, classification ,treatment and prevention

1. XEROPHTHALMIA

2. INTRODUCTION
 The term xerophthalmia ( xeros- dry, ophthalmia-
eye) refers to the eye disease specifically caused by
vitamin A deficiency. Xerophthalmia means dryness
of the eye in which eye fails to produce tears.
 Xerophthalmia is most preventable cause of
blindness in children at the age of 3 to 6 years.

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

4. CAUSES
• The most common cause of xerophthalmia is vitamin
A or lupus and rheumatoid arthritis.
• Medication such as nasal decongestants,
tranquilizers, antihistamines
• Some chemical burn
• Thickness and dryness caused due to trauma, local
disease, diarrhea, and infection and from previous
injury of cornea.

5. WHO classification
• XN Night blindness
• XIA conjunctival xerosis
• XIB Bitot’s spot
• X2 corneal xerosis

6. • X3A corneal ulceration/ keratomalacia
affecting less than one- third corneal surface
• X3B corneal ulceration/ keratomalacia
affecting more than one-third corneal surface
• XS corneal scar due to xerophthalmia

7. CLINICAL FEATURES
Night blindness : inability to see in dim light due
to impairment in dark adaptation.
Conjunctival xerosis:
First clinical sign
Dryness or lack of luster
Loss of ability to retain moisture no matter
whether tears are present or absent loss of
transparency, thickening

8. Clinical features contd……
Corneal xerosis
 The corneal surface has a rough, dull and dry fine
pebbly appearance and lacks luster.
 Later, corneal ulceration may develop and healing
corneal scar may affect vision
Bitot’s spot
• Triangular, pearly-white or yellowish, foamy spots on
the bulbar conjunctiva
• Are bilateral and on either side or cornea

9. Clinical features contd……
Keratomalacia
• Consists of characteristic softening of the entire
thickness of a part or, more often, the whole of
the cornea
• Leading to deformation or destruction of the
eyeball
• The process is a rapid one, the corneal structure
melting into a cloudy gelatinous mass.
• Vision is lost
• Major cause of blindness

10. Clinical features contd……
Corneal scar
• Healing of stromal defects results in corneal scars of
different densities and sizes which may or may not
cover the pupillary area.
Xerophthalmic fundus
• It is characterized by typical seed-like, raised, whitish
lesions scattered uniformly over the part of the
fundus at the level of optic disc.

11. Conjunctival xerosis

12. Bitot’s spot

13. Keratomalacia

14. TREATMENT
• Local ocular therapy : for conjunctival xerosis;
artificial tears ( 0.7% hydroxypropyl methyl cellulose
or 0.3% hypromellose) should be instilled every 3-4
hours.
• Vitamin A therapy: treatment schedules apply to all
stages of active xeropthalmia.
• Treatment of underlying conditions: such as PEM and
other nutritional disorder, diarrhea, dehydration and
electrolyte imbalance, infection and parasitic
condition should be considered simultaneously.

15. Prophylaxis
WHO recommended schedule, which is universally
recommended is as follows;
• Infants 6-12 months old and older children weighing
less than 8 kg – 100, 000 IU orally every 3-6 months.
• Children over 1 year and under 6 years of age-
200,000 IU orally every 6 months.
• Infants less than 6 months old, who are not being
breastfed- 50,000 IU orally should be given before
they attain every 6 months.

16. Precaution from xerophthalmia
• The prevention of xerophthalmia intake of vitamin by
fortification of food items such as in cooking oil,
addition of vitamin A, skimmed milk etc.
• Eat dark green leafy vegetables, pork, fish liver, beef,
mango, papaya, eggs, butter, broccoli and apricots
and drink lot of plenty water.

17. References
• Sharma M, Paudel K, Gautam R.Comprehensive
Text book of Medical Surgical Nursing.3rd ed.
Ghattekulo: Samiksha publication; 2020.
• Mandal GN. Textbook of medical surgical
nursing(adult nursing).7th ed. kathmandu : Safal
publication;2077.
• Khurana A K. Comprehensive ophthalmology.7th
edition. Jaypee Brothers medical publishers
(p)Ltd; 2015