A short presentation on xerophthalmia,Vit A deficiency being a major cause of preventable childhood blindness in Nepal.Thanks for watching.

1. Xerophthalmia
-Kshitiz Raj Pokhrel
-MBBS,KUSMS DH

2. • Xerophthalmia
-refers to spectrum of ocular disease caused by lack
of vitamin A
-late manifestation of severe deficiency
-Vit A deficiency primary cause of childhood
blindness in nepal

3. Etiology
• Vitamin A deficiency
1. Dietary deficiency-less intake,severe dieting
2. Defective metabolism
-malabsorption
-malnutrition
-chronic alcoholism
Associated with PEM and infections esp in
children

4. Vitamin A metabolism
• Vitamin A
-fat soluble essential vitamin
• Sources:
1)Animal:
-fish liver,liver,milk,egg,dairy product
-contains active vit A

5. 2)Plant:red and yellow fruits,dark green leafy
vegetables
-contains carotene(pro vit A)
-converts into retinol in intestinal wall

8. Vitamin A functions
-vision(synthesis of retinal photoreceptor proteins)
-maintenance of body’s epithelial surfaces
-immune function
-skeletal growth
-fertility (male and female)
-hemopoiesis
-anti oxidant

9. Blood
pho
totr
ans
duc
tio
n

10. WHO Classification 1982
XN Night Blindness
X1A Conjunctival Xerosis
X1B Bitot’s spots
X2 Corneal xerosis
X3A Corneal ulceration/keratomalacia
<1/3 of corneal surface
X3B Corneal ulceration/keratomalacia
>1/3 of corneal surface
XS Corneal scar due to xerophthalmia
XF Xerophthalmic fundus

11. Clinical Features
1.XN(Night blindnes) (Nyctalopia)
-earliest symptom in children
-eye discomfort,loss of vision
-detailed history to elicit
-offers as a screening tool to identify
xerophthalmia

12. 2.X1A(Conjunctival Xerosis)
-one or more patches of dry,lustreless,non wettable
conjunctiva
-loss of goblet cells,squamous metaplasia and
keratinization
-emerging like sand banks at receding tide
-in interpalpebral area of the temporal quadrants and
often the nasal quadrants
-later,entire bulbar conjunctiva affected
-xerosis,conjunctival thickening,wrinkling and
pigmentation

14. 3.X1B(Bitot’s spots)
-raised,silvery white,foamy,triangular patch of
keratinised epithelium
-bulbar conjunctiva in the interpalpebral area
-b/l and temporal,sometimes nasal

16. 4.X2(Corneal Xerosis)
-punctate keratopathy (earliest change)-lower
nasal quadrant
-xerosis and keratinization
-haziness
-lustreless cornea,granular pebbly dryness

18. 5.X3A and X3B(Corneal
ulceration/keratomalacia)
-stromal defects due to colliquative/liquefactive
necrosis
-peripheral small ulcers(1-3mm),circular,steep
margins,sharp demarcation
-eventually large ulcers involving entire cornea
-can result in perforation

19. -X3A <1/3 of corneal surface-heals with
appropriate therapy
- X3B>1/3 of corneal surface-may result in
blindness

21. 6.XS(Corneal Scars)
-stromal defects-corneal scars of different densities
and sizes
-pupillary area may/maynot be involved

23. 7.XF(Xerophthalmic fundus)
-seeds like,raised,whitish or yellowish dot like
lesions scattered uniformly over the fundus at the
level of optic disc

25. Evaluation

26. Treatment
1.Local Ocular Therapy
-artificial tears(0.7% hydroxypropyl methyl
cellulose,0.3% hypromellose) 3-4 hrly
-keratomalacia-as for bacterial corneal ulcer

27. 2.Vitamin A therapy
-all stages of active xerophthalmia(XN-X3B)
-oral form recommended
-IM inj(severe diarrhoea,repeated vomiting)

28. Vitamin A therapy
Age Vitamin A dose Frequency
>1 year of age(except
women of reproductive
age)
2,00,000 IU vit A orally
or 1,00,000 IU IM
At diagnosis,next day
tand after 2 weeks same
dose
<1 year of age(children
of any age<8 kg)
Half the above dose Same
Women of reproductive
age(XN,X1A,X1B)
10,000 IU vit A orally Once Daily for 2 weeks
Women of reproductive
age(corneal
xerophthalmia)
2,00,000 IU vit A orally
or 1,00,000 IU IM
At diagnosis,next day
tand after 2 weeks same
dose

29. 3.Treatment of underlying cause and
associated conditions
-PEM
-nutritional disorders
-diarrhoea and dehydration
-infections
-alcoholism

30. Prophylaxis
• 1.Short Term Approach(Vit A
supplementation)
Age Vit A Dose Frequency
>1 year-<6 years 2,00,000 IU
orally
6 monthly
6-12
months(older
children <8 kg)
1,00,000 IU
orally
3-6 monthly
<6 months 50,000 IU orally Upto 6
months,once
Lactating mothers 20,000 IU orally Once at delivery
or during next 2
months

31. 2.Medium Term Approach
-food fortification
3.Long Term Approach
-health promotion and education
All 3 approaches combined gives the best result

32. References
• Comprehensive Ophthalmology by A.K
Khurana,6th edition
• Kanski’s Clinical Ophthalmology
• https://www.ncbi.nlm.nih.gov/pubmed/286137
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