Xerophthalmia: Definition, Risk factors and Treatments.

Xerophthalmia: Definition, Risk factors and Treatments-Xerophthalmia is a medical condition in which the eye film is reduced and the eye is incapable of producing tears. This appears when there is something wrong with lacrimal glands and their main function, meaning to produce tears, is affected. Xerophthalmia is also known as the dry eye syndrome or conjunctivitis arida and it can affect the quality of life to an extensive level.

The tears are very important to the health of our eyes, because they actually keep it lubricated. Without eye film, we would never be protected against particles and debris coming from the outside. This is why having healthy tear film also guarantees healthy eyes, meaning a good vision as well.

Stages of xerophthalmia

Severe xerophthalmia is virtually confined to infants and young children and usually associated with protein-energy malnutrition. The stages are classified by the WHO as follows.

Night blindness (XIN) is the earliest symptom but not elicited in infants.

In conjunctival xerosis (XIA) one or more patches of dry non-wettable conjunctiva emerge “like sand banks at receding tide” when the child ceases to cry. It is caused by keratinising squamous metaphasia of the conjunctiva.

Bitot’s spots (XIB) are glistening white plaques formed of desquamated thickened epithelium, usually triangular and firmly adherent to the underlying conjunctiva.

Corneal xerosis (X2) is a haziness or a granular pebbly dryness of the cornea on routine light examination, beginning in the inferior cornea.

Corneal ulceration (X3A) or keratomalacia (X3B).

Causes of xerophthalmia

These are the most common causes that leads to the appearance of xerophthalmia:

Vitamin A deficiency (Primary cause)

Aging

Poor closure of the eyelids

Previous injuries or traumas (accompanied by scarring)

Autoimmune disorders (rheumatoid arthritis, sjogren’s syndrome, lupus)

Radiotherapy (often transient but cases of permanent damage have been reported)

Medication (medication for nasal congestion, sedatives, medication against allergies, such as anti-histamines)

Chemical burns

Who’s at risk for xerophthalmia?

The major risk for xerophthalmia is poverty and lack of adequate diet, especially a lack of animal products. Infants and children are at greater risk. The younger the child, the more severe the effects of vitamin A deficiency.

Children require a lot of vitamin A in order to grow. Vitamin A deficiency also affects the ability to survive common childhood infections and diseases, such as diarrhea, measles, and respiratory infections.

Other risk factors affect a much smaller number of people in the United States and other countries. The following are risk factors because they affect a person’s ability to absorb vitamin A:

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• Alcoholism
• Cystic fibrosis
• Diseases such as celiac disease that limit the absorption of nutrients
• Liver disease, such as cirrhosis
• Chronic diarrhea
• Radioiodine treatment for thyroid cancer, which may produce nonpermanent symptoms of xerophthalmia

Symptoms of xerophthalmia

The earliest symptoms of Xerophthalmia include mild irritation, hot discomfort, Bitot’s spot, corneal xerosis and a desire to blink continuously. There are some common symptoms of xerophthalmia are:

Night blindness:

The night blindness is first symptoms of vitamin A deficiency. It means unable to see the object in the evening, during night or in dim light.

Conjunctival xerosis:

This means dryness of the conjunctiva eye become dry and non wettable.

Bitot’s spots: Bitot’s spots are foamy triangular spots that are pearly or yellow in color which is seen either the cause of cornea.

Corneal xerosis: This is a serious form of vitamin A deficiency. In this cornea becomes dry, opaque, dull and non wettable.

Keratomalacia:

If vitamin A deficiency is untreated then this condition is called keratomalacia. In this the eye can be lost, eye collapses, and vision is lost. keratomalacia are the leading causes of blindness.

Simple irritation

Burning sensation

Redness

Itch – Sustained sensation of sand in the eyes

Blurry vision that improves with blinking

Increase in symptoms after reading, watching TV or working at a computer

Difficulty in wearing contact lenses Lacrimation

Intense eye irritation from smoke or wind

Diagnosis of xerophthalmia

The diagnosis will involve a physical examination. In addition, the doctor is likely going to ask about your diet and the symptoms you are getting.

A blood test can help to check the amount of vitamin A in your blood.

An examination at the slit lamp can show atrophy and dryness of the conjunctiva in case of xerophthalmia.

In some cases, corneal ulcers that arise due to xerophthalmia has been attributed to bacterial infection and in some cases antibiotics has been prescribed.

How can we prevent xerophthalmia?

There are a number of approaches to the prevention of vitamin A deficiency in children.

Education in nutrition is required to encourage breast feeding. Colostrum and breast milk contain vitamin A.

Weaning foods should be rich in vitamin A, for example, mango or papaya. Dark green leafy vegetables (DGLV) may be given at one year and older.

Encourage the planting of small gardens with advice as to which fruits and vegetables should be grown. Examples are shown top right – mango, papaya, dark green leafy vegetables and carrots.

Overcooking and drying fruits in the sun both reduce the vitamin A content of foods.

Vitamin A capsules 200,000 IU may be given every 3 to 6 months to children aged 1 to 6 years of age who are at high risk.

A programme of measles immunization should be planned and carried out.

Foods may be fortified with vitamin A, for example, by fortifying a widely used food such as sugar and milk which has been prepared from powdered milk fortified with vitamin A and vitamin D.