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DESCRIPTION
Xerophthalmia is a major cause of preventable blindness in children the world over and still remains a problem in the developing countries. In India alone, there are over 200,000 children blinded from this condition. It is most commonly occurs in children during the ages of 3 to 6 years of age. It is an inflammation of the cornea (the clear covering of the eye) that is associated with nutritional deficiency resulting in general malnutrition, diarrhea and especially a deficiency of vitamin A. A deficiency of vitamin A weakens the cornea and if caught before the cornea is perforated, high doses of vitamin A and a change in diet can prevent further damage and allow the eye to heal. If discovered too late, the child will be permanently blind.
Although xerophthalmia is most prevalent with children, it can also occur in adults with severe malnutrition or in other health problems in which lack of vitamin A in their diets is a factor.
SYMPTOMS
Night blindness may occur and is often an early manifestation of the disorder. The conjunctiva and the cornea becomes dry (Xerosis) with the development of characteristic triangular or oval spots, called Bitot's spots.
Xerosis of the cornea is seen initially as a mild haziness inferiorly. This is followed by corneal ulceration and/or infection with full thickness dissolution known as keratomalacia - there may be extrusion of the intraocular contents.
TREATMENT
Vitamin A therapy and a protein-rich diet are essential.
Topical antibiotics are given to prevent secondary bacterial infection. Keratomalacia is irreversible and causes permanent corneal scarring.
Diet supplements rich in vitamin A or beta-carotene should be provided in high risk areas to prevent the condition. High doses of vitamin A should be avoided during pregnancy because of the risk of vitamin A embryopathy.
WHO International Vitamin A Treatment for Xerophthamia The following signs and symptoms of Xerophthalmia indicate vitamin A deficiency:
1. Night Blindness Difficulty seeing in the dark. 2. Xerosis (Dry Eyes) The white of the eye loses its shine and begins to wrinkle. 3. Bitot's Spots Patches of little gray bubbles on the whites of the eye. 4. Corneal Ulceration Dullness or damage to the cornea. 5. Keratomalcia Soft or bulging cornea.
Xerophthalmia
Emergency Patient Care By A Health Care Provider
In order to treat or prevent a secondary bacterial infection, which would compound corneal damage, apply an antibiotic eye ointment, e.g. tetracycline or chloramphenicol. Protect the eye with an eye shield in order to prevent trauma. In the case of young children, it may be necessary to restrain arm movements while applying the shield.
Vitamin A must be administered orally immediately upon diagnosis.
For treatment of xerophthalmia according to the schedule shown below.
To Give Vitamin A To Small Children:
When giving vitamin A, cut open a capsule at the narrow end. Squeeze the correct amount of vitamin A into the child's mouth. If a child spits up most of the vitamin A immediately, give one more dose (but record only a single dose). Do not ask a child to swallow a capsule. It is preferable that the child receive the dose from the health worker, although in some cases it may be given to the mother to be given later. Throw away any half-used capsule -it is too messy to try and use again.
Discard all used vitamin A capsules in a plastic bag or container. All used capsules should be disposed of safely (buried or burned), in order to avoid children or animals accidentally ingesting the capsules.
Record the treatment with vitamin A on the child's health card.
Parents should be aware that:1. Three doses of vitamin A supplement must be given for best results.
2. Improvements after taking vitamin A supplements may take several days to become evident.
Xerophthalmia children with severe protein-energy malnutrition need to be referred to a hospital and carefully monitored. Their vitamin A status is unstable and may rapidly worsen, even when treated with recommended doses.
Women with Xerophthalmia
Women of reproductive age with night blindness or Bitot's spots should be treated with a daily oral dose of 5,000-10,000 IU of vitamin A for at least 4 weeks. Such a daily dose should never exceed 10,000 IU, although a weekly dose not exceeding 25,000 IU may be substituted.
All women of reproductive age, whether or not pregnant, who exhibit severe signs of xerophthalmia (i.e. acute corneal lesions) should be treated with three dose treatment.
HOLISTIC RECOMMENDATIONS & NUTRITION
CONSIDERATIONS
See Bitot's Spots for more information.
NUTRITIONAL SUPPLEMENTS
Unless otherwise specified, the dosages recommended here are for adults. For a child between the ages of 12 and 17, reduce the dose to 3/4 the recommended amount. For a child between 6 and 12 years of age, use 1/2 the recommended dosage, and for a child under the age of 6, use 1/4 the recommended amount.
Nutrients Supplement Suggested Dosage Comments Vitamin A 25,000-50,000 IU daily. If you are pregnant, do not exceed 10,000 IU daily. Specifically for dry eyes. Use emulsion form for easier assimilation and greater safety at higher doses. Nature's Way Natural Vitamin A, 10,000 IU, 100 Softgels, Nature's Way Natural Beta Carotene 25,000 IU, 100 Softgels Vitamin C 2,000-14,000 mg daily, in divided doses. Improves circulation and aids in healing process. Works with other nutrients to heal dry eyes. People are generally deficient in vitamin C due to poor diet which does not include enough good quality fruits and vegetables. Nature's way Vitamin C w/Rosehips, 100% Natural, 1000 mg, 250 Caps, Nature's Way Vitamin C w/Bioflavonoids, 100% Natural, 500 mg, 250 Caps Vitamin B6 (pyridoxine) 50 mg daily. Nutrients that work well together to heal dry eyes. Nature's Way Vitamin B-6 (Pyridoxine), 100% Natural with HCl, 100 mg, 100 Caps Zinc 50 mg daily. Do not exceed a total of 100 mg daily from all supplements. Use zinc gluconate lozenges or OptiZinc for best absorption. Nature's Way Chelated Zinc, 100% Natural, 30 mg, 100 Caps
LINKS
- Vitamin A deficiency & the prevalence of xerophthalmia in Southern Rwanda
- A prevalence of study of xerophthalmia in the Philippines
- Malnutrition & xerophthalmia in rural communities of Ethiopia
- Risk factors for Xerophthalmia in Under-six children in urban slums
- Keratomalacia & Xerophthalmia
BOOKS
Nutritional Blindness: Xerophthalmia and Keratomalacia
-- by Alfred Sommer
TYPES OF EYE PROBLEMS & DISORDERS
Maintaining Healthy Eyes
NOTIFY YOUR MIDWIFE OR HEALTH CARE PROVIDER IF...
You or a family member (such as a child) is having problems distinguishing colors or find colors confusing. This member may need to be tested for colorblindness.
You or a family member are having problems with vision and/or you suspect an infection. Call your health care provider immediately if you experience severe eye pain or a sudden change in your vision, such as loss of vision or double vision.
You have any increase of symptoms. You may need frequent changes in your eyeglass prescription. If you have blurred or double vision that develops slowly; are having a problem seeing because of daytime glare or have difficulty driving at night because of glare from headlights, you need to see your health care provider.
You have any unexpected or unusual symptoms. There may be underlying health issues that need to be addressed.
Are having vision problems that are affecting your ability to perform daily activities.
Call your child's health care provider if your baby does not look directly at or respond readily to faces or large, colorful objects by age 2 to 3 months or if your child scowls, squints, or shields his or her eyes more than expected when in sunlight, or light seems to hurt your child's eyes.
You and your family members should have your eyesight checked regularly by your health care provider to rule out any problems and to receive a prescription for contacts or eyeglasses, if they are needed. Preserve you vision... it is very important.
Prescription for Nutritional Healing: The A-To-Z Guide To Supplements
-- by Phyllis A. Balch, James F. Balch
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