How Common is Xerophthalmia?

Xerophthalmia is a common condition, with 2.8 million children affected by it.

What are signs and symptoms of Xerophthalmia?

The signs and symptoms of Xerophthalmia include: - Night Blindness: Difficulty seeing in low light, which is often the first sign of vitamin A deficiency. - Conjunctival Xerosis (X1A): Dry eye syndrome, leading to a loss of wet and glossy appearance of the conjunctiva. - Bitot Spots (X1B): White, opaque deposits on the inside lining of the eyelids. - Corneal Xerosis (X2): Dry and unclear appearance of the cornea, which can progress to corneal melting. - Corneal Ulceration and Keratomalacia (X3A and X3B): Breakdown and softening of the cornea due to tissue death. - Corneal Scar (XS): Scarring of the cornea, usually bilateral and may accompany severe malnutrition, diarrhea, or respiratory infection. - Xerophthalmic Fundus (XF): Functional and structural changes in the back inner surface of the eye (retina) due to prolonged vitamin A deficiency. These signs and symptoms can vary in severity and may indicate different stages of Xerophthalmia. It is important to recognize and address these symptoms to prevent vision loss and further complications.

How do you get Xerophthalmia?

Xerophthalmia can be caused by two main factors: not getting enough Vitamin A in the diet and problems with the way the body handles Vitamin A.

What else can Xerophthalmia be?

The other conditions that a doctor needs to rule out when diagnosing Xerophthalmia are: - Underactive thyroid (Hypothyroidism) - Disease caused by parasites in the eye (Parasitic eye disease) - A bacterial eye infection also known as Trachoma

What kinds of test are needed for Xerophthalmia?

The types of tests that may be needed to diagnose xerophthalmia include: - Blood tests to measure the level of vitamin A in the blood - Dark adaptometry test to assess how well the eyes adjust to low light - Night vision threshold test to evaluate vision in dark conditions - Impression cytology to examine cells collected from the surface of the eye - Electroretinogram to measure the electrical responses of light-sensitive cells in the eyes.

How is Xerophthalmia treated?

Xerophthalmia, or dry eyes, can be treated by addressing underlying diseases such as liver diseases or inflammatory bowel disease. Additionally, it is important to address issues related to alcoholism in order to effectively treat xerophthalmia caused by non-dietary factors.

Are there long term effects of Xerophthalmia?

The prognosis for xerophthalmia can vary depending on the severity of the condition and the stage at which treatment is initiated. However, if left untreated or if the condition progresses to corneal ulcers, complete vision restoration is not always guaranteed. In some cases, xerophthalmia can lead to partial or total blindness, and it can also impact a child's growth and increase the risk of other health problems and even death.

Xerophthalmia

What is Xerophthalmia?

Xerophthalmia is a term that refers to a group of eye signs and symptoms that result from a deficiency in Vitamin A. This condition can include dryness of the conjunctiva and cornea (the outermost layer of the eye), Bitot’s spots (foamy patches on the white of the eye), keratomalacia (softening of the cornea), night blindness, and eye diseases related to damage of the retina (the part of your eye that receives light and sends images to your brain). Even now, xerophthalmia is a serious problem in developing countries and is a primary cause of blindness that can be avoided.

In addition to various eye symptoms, this condition can also cause more frequent illnesses, higher risk of death, and can negatively affect a child’s growth. It’s therefore crucial to diagnose and treat xerophthalmia promptly, especially in vulnerable populations.

What Causes Xerophthalmia?

Xerophthalmia, a condition that leads to dry eyes, can be caused by two main factors. Firstly, it can happen due to not getting enough Vitamin A in the diet. This is more common in poorer countries and can sometimes even spread like an epidemic, especially among young children.

The second cause of Xerophthalmia is not directly related to how much Vitamin A you eat. Instead, it can come about due to problems with the way the body handles Vitamin A, such as issues with metabolizing (processing) it or storing it. This cause is not as common and can show up at random. Certain conditions may lead to these problems, including long-term liver disease often due to alcoholism, surgeries in the upper digestive tract, bowel inflammation, and pancreatitis, which is a disease that inflames the pancreas.

Risk Factors and Frequency for Xerophthalmia

Vitamin deficiencies can cause varied health issues, but xerophthalmia, which is due to a lack of Vitamin A, probably stands out the most. This condition has reached epidemic levels, even causing significant worry among health professionals.

The World Health Organization (WHO) estimates that about 254 million children have a Vitamin A deficiency and 2.8 million children have xerophthalmia.
Xerophthalmia is the most common cause of childhood blindness, with 350,000 new cases occurring each year.
Not only does xerophthalmia cause blindness, but it also impacts growth, and can lead to other health problems, and even death.
A study followed up on children with corneal xerophthalmia (a specific form of the disease) and found that only 40% were alive after one year. Of the survivors, 25% were totally blind and 50% to 60% were partially blind.
If the rate of Bitot’s spots (an early sign of Vitamin A deficiency) in children under six-years-old is 0.5% or more, the WHO sees it as a significant public health threat.
Approximately 45% of the global population of children with both Vitamin A deficiency and xerophthalmia are in South and Southeast Asia.
Some research has shown a higher prevalence of xerophthalmia in children who also have anemia, which could be tied to a poor diet.

Signs and Symptoms of Xerophthalmia

Xerophthalmia is a condition linked to vitamin A deficiency and is classified by the World Health Organization (WHO) into several clinical signs. Below is a simplified explanation of these signs:

Night Blindness: This constitutes difficulty seeing in low light and is often the first sign of vitamin A deficiency. It is a reliable indicator of low vitamin A levels in the body.
Conjunctival Xerosis (X1A): Also known as dry eye syndrome, this condition leads to a loss of wet and glossy appearance of the conjunctiva (inside lining of eyelids) due to changes in tissue proteins and decreased mucin secretion.
Bitot Spots (X1B): These are white, opaque deposits that appear on the inside lining of the eyelids, usually composed of shed, keratinized epithelial cells.
Corneal Xerosis (X2): This leads to a dry and unclear appearance of the cornea (transparent front part of the eye), progressing to possible corneal melting. High-dose Vitamin A can help prevent vision loss at this stage.
Corneal Ulceration and Keratomalacia (X3A and X3B): Keratomalacia is when part or all of the cornea breaks down and becomes soft, as a result of necrosis (tissue death).
Corneal Scar (XS): Scarring due to severe vitamin A deficiency is usually bilateral (affecting both eyes) and may accompany severe malnutrition, diarrhea, or respiratory infection. Other causes of corneal scarring should also be considered.
Xerophthalmic Fundus (XF): This is observed in prolonged vitamin A deficiency, where the back inner surface of the eye (retina) undergoes functional and structural changes.

Testing for Xerophthalmia

Diagnosing xerophthalmia, a severe dry eye condition, involves looking at your symptoms, your health history, and the results of certain medical tests. If you’ve been having problems with dry eyes that haven’t gotten better with usual treatments, your doctor might want to learn more about your diet, your daily life, and how much alcohol you usually drink.

To confirm a diagnosis of xerophthalmia, the doctor may also test the level of vitamin A in your blood. Vitamin A is crucial for maintaining the health of your eyes, and people with xerophthalmia often have low levels of it. A healthy level is usually over 0.70 micromoles per litre.

In addition to blood tests, the doctor may suggest further tests to verify if you’re having trouble seeing in low light, a condition often associated with vitamin A deficiency. Dark adaptometry and night vision threshold tests can examine how your eyes adjust to darker surroundings and how well you can see during the night, respectively.

For an even more comprehensive evaluation, other methods such as an impression cytology, which examines cells collected from the surface of your eye, or an electroretinogram, a test that measures the electrical responses of light-sensitive cells in your eyes, could be recommended. These help the doctor to make an accurate diagnosis.

Treatment Options for Xerophthalmia

The World Health Organization (WHO) suggests giving high doses of Vitamin A, usually taken by mouth, for certain health conditions. This is usually given over a couple of days and then repeated a few weeks later. Other treatments, like using bottle-free artificial tears and antibiotics, are often used if the patient has an additional bacterial infection.

Many countries, especially those that are still developing, include giving Vitamin A to children as part of their public health programs. Supplementing nutrition, improving health, and educating people form a three-part plan to manage dietary Vitamin A deficiency. It’s important to teach people about the significance of incorporating Vitamin A-rich foods into their meals.

In cases where the dry eyes, also known as xerophthalmia, are caused by non-dietary factors, it’s necessary to treat underlying diseases like liver diseases over inflammatory bowel disease. In this context, it’s also crucial to address issues related to alcoholism.

Several medical conditions that could be diagnosed include:

Underactive thyroid (Hypothyroidism)
Disease caused by parasites in the eye (Parasitic eye disease)
A bacterial eye infection also known as Trachoma

What to expect with Xerophthalmia

Beginning treatment in the initial stages can help restore sight, but patients with corneal ulcers often need surgery. Even after this procedure, it’s important to note that complete vision restoration isn’t always guaranteed. It’s reported that each year, between 20,000 to 100,000 new instances of blindness still occur in several areas across Africa.