Xerophthalmia refers to the group of eye signs and symptoms associated with severe Vitamin A deficiency. Vitamin A serves various essential functions in the eye and its deficiency can adversely affect the health of eyes. It is a major problem in developing countries and is a leading cause of preventable blindness worldwide.
It can affect people of any age but children between the age of 2 to 6 years are more prone to this deficiency. The disease can be caused either due to improper consumption, metabolism, or storage of Vitamin A.
This disease can be easily prevented and treated by taking a proper dose of Vitamin A through diet and supplements. Immunization against certain diseases such as measles which serve as a precipitating factor for xerophthalmia can also help in preventing Vitamin A deficiency in children.
Overview
Key Facts
Symptoms
Causes
Risk factors
Diagnosis
Specialist to visit
Prevention
Home-care
Complications
FAQs
References
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Frequently Asked Questions
Night blindness which is very commonly seen in xerophthalmia can be genetic in nature. Studies suggest that there are two major types of night blindness as per the genetic cause. These types have very similar signs and symptoms.
The term xerophthalmia covers all the ocular manifestations of vitamin A deficiency. Xerophthalmia can progress to irreversible blindness if left untreated. However, with prompt treatment the eye conditions can be reversed till the stage of corneal xerosis.
Vitamin A has been shown to be useful in helping with night vision. Vitamin A is a precursor of rhodopsin, the photopigment found in rods within the retina of our eye that helps us to see at night.
Most people with vitamin A toxicity have a headache and rash. Consuming too much vitamin A over a long period of time can cause coarse hair, partial loss of hair (including the eyebrows), cracked lips, and dry, rough skin.
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Key Facts
Usually seen in
Children between 2 to 6 years of age
Gender affected
Both men and women
Body part(s) involved
Eyes
Mimicking Conditions
Acanthamoeba keratitis
Onchocerciasis
Trachoma
Allergic conjunctivitis
Viral conjunctivitis
Dry eye syndrome
Retinitis pigmentosa
Bitot spots
Hypothyroidism
Necessary health tests/imaging
Physical exam
Blood test: Serum Vitamin A, Serum retinol binding protein & serum zinc
Dark adaptometry and night vision threshold tests
Electroretinogram (ERG)
Impression cytology
Treatment
Vitamin A supplementation
Zinc supplementation
Topical treatment
Antibiotics
Related NGOs
Ophthalmologist
Symptoms Of Xerophthalmia
The symptoms of xerophthalmia depend upon the severity of deficiency and age of the patient and gradually progresses through the following stages:
Night blindness (impaired sensitivity of the eye to light)
This is the first sign of xerophthalmia in which the person is not able to see in dim light and may bump into objects and/or show reduced mobility.
Conjunctival xerosis
It is characterized by the dull, dry, thick, wrinkled appearance of the conjunctiva. It develops due to changes in mucin secretion that lubricates the conjunctiva.
Bitot spots
It refers to whitish, foamy, opaque deposits on the conjunctiva.
Corneal xerosis
Cornea appears dull, dry and hazy in appearance.
Corneal ulceration or Keratomalacia
Corneal xerosis often leads to ulcers and softening of the cornea. It can even perforate and destroy the cornea of the eyes..
Corneal scars
Scarring of the cornea is a late and severe symptom of xerophthalmia.
Xerophthalmic fundus
It refers to the structural changes in the fundus (the inside, back surface of the eye).
Causes Of Xerophthalmia
Vitamin A is an essential nutrient and is responsible for the following central functions of the eyes:
A form of vitamin A, called retinal, combines with a protein called opsin to form rhodopsin, an essential light absorbing molecule needed for vision in dim light and color sensitivity.
Vitamin A also plays an important role in maintaining a clear vision by supporting the functioning of the cornea which is the protective outer layer of the eye
Vitamin A helps to stimulate the lacrimal glands to produce moisture in the eyes and avoid issues like dry eyes.
The deficiency of Vitamin A is the main cause of xerophthalmia. The causes of the deficiency include:
A. Inadequate dietary intake of Vitamin A
Low intake of dietary sources of Vitamin A can be attributed to:
Insufficient food supply
Chronic alcoholism
Highly selective eating
Difficulty in swallowing
Mental illness
Here are the ways you can help and support a friend or family member who is coping with mental illness which might be highly affecting their diet pattern.
B. Impaired absorption of Vitamin A
The leading causes of insufficient absorption of Vitamin A are diseases affecting the pancreatic, liver, and intestines like:
Chronic liver disease (progressive damage of liver for more than 6 months)
Inflammatory bowel disease (inflammation in the digestive tract)
Pancreatitis (inflammation of the pancreas)
Celiac disease (hypersensitivity to certain foods leading to impaired digestion)
Pancreatic insufficiency (improper functioning of the pancreas)
Short bowel syndrome (improper absorption of nutrients from food)
Chronic diarrhea
Upper gastrointestinal surgery
Giardiasis (intestinal infection accompanied by fever and diarrhea)
Abetalipoproteinemia (impaired absorption of fats and vitamins)
C. Reduced storage of Vitamin A
The reduced storage of Vitamin A due to the following reason can also cause xerophthalmia.
Liver diseases
Cystic fibrosis (inherited disorder that mainly affects lungs and digestive system)
Risk Factors For Xerophthalmia
The following factors can trigger Vitamin A deficiency and eventually lead to xerophthalmia:
Age
Infants and children are more prone to xerophthalmia due to their higher need of Vitamin A for the growth and development. Children are also more prone to intestinal infections that may impair the absorption of Vitamin A.
Worried about the health of your child? Know some easy and practical ways to ensure that your child does not develop nutritional deficiencies.
Malnutrition
Malnutrition can lead to multiple vitamin deficiencies including Vitamin A deficiency. People living in developing countries are more prone to xerophthalmia due to more chances of malnutrition.
Malnutrition, especially zinc deficiency, decreases the level of active Vitamin A in the body and increases the chances of developing xerophthalmia.
Pregnancy
Pregnant and lactating women are at higher risk of developing xerophthalmia due to increased chances of Vitamin A deficiency in this period. Neonates born to Vitamin A deficient mothers are at higher risk of developing xerophthalmia.
Poor lactation
Breast milk provides various essential nutrients to neonates that are required for normal growth and development. It also protects the infants from various infections in the initial years of life. Inadequate breastfeeding in infants younger than 6 months also increases the risk of xerophthalmia.
Medical conditions
Some diseases such as chronic liver disease, liver cirrhosis, diarrhea, inflammation of the pancreas, and inflammatory bowel disease make the person more vulnerable to xerophthalmia.
Comorbidities
The various diseases such as pneumonia, jaundice, vomiting, and septicemia also increase the risk of xerophthalmia.
Low socioeconomic status
Poor people are more prone to Vitamin A deficiency as they cannot afford proper meals to fulfill their nutritional requirements.
Lack of education
People who are not properly educated about the importance of proper nutrition are more prone to nutritional deficiences like those of Vitamin A.
Alcoholism
The excessive consumption of alcohol lowers the level of Vitamin A in the body and predisposes to xerophthalmia.
Diagnosis Of Xerophthalmia
A thorough dietary, medical, social history including alcohol intake is taken from the patient having signs of xerophthalmia. In case of specific indications of night blindness or severe xerophthalmia, treatment with Vitamin A is started immediately. The diagnosis is mostly based on the symptoms.
Physical exam
The doctor first examines the eyes of the patient for any signs such as dry eyes and spots that are characteristic of xerophthalmia. The physical exam also includes assessment of jaundice.
Blood tests
Serum Vitamin A/retinol
This test measures the level of Vitamin A in the body. The ocular symptoms related to Vitamin A deficiency have been shown to develop at concentrations <10mcg/dL.
Serum retinol binding protein
Vitamin A is transported to the tissues in the form of retinol after binding with the retinol binding protein (RBP). The level of RBP reflects retinol concentration which in turn gives an idea about Vitamin A status. The normal level of serum RBP is 30-75 ug/ml.
Serum zinc
The decreased level of zinc is also associated with xerophthalmia. The normal levels of serum zinc are 75-120 mcg/dL.
Dark adaptometry and night vision threshold tests
These tests are used to diagnose night vision defects.
Electroretinogram (ERG)
ERG measures the electrical activity of the retina in response to a light stimulus, non-invasively. ERGs are recorded using an electrode placed in contact with the cornea.
Impression cytology
In this, the specimens of the conjunctiva (clear tissue covering the white part of the eye) are studied for the presence of goblet cells (highly specialized cells that produce and secrete mucins, responsible for hydration and lubrication of eyes). A decrease in the amount of these cells is also an indicator of Vitamin A deficiency.
Specialist To Visit
Any patient who is experiencing visible symptoms such as dry eyes, must consult the doctor immediately.
The diagnosis of xerophthalmia is done by an ophthalmologist, a physician specializing in diseases and surgery of the eye.
If you are facing any eye-related problems, consult our medical professionals.
Prevention Of Xerophthalmia
All the following factors that maintain an adequate level of Vitamin A play a role in preventing xerophthalmia:
Consuming adequate Vitamin A
The best way to prevent xerophthalmia is to take an adequate amount of Vitamin A through a healthy balanced diet rich in Vitamin A food sources such as carrots, milk, fish, eggs, green vegetables, yams, and sweet potatoes.
People who are on restrictive diets or facing some issues in getting adequate amounts of Vitamin A, should take the recommended dose of Vitamin A supplements.
Appropriate intake of Vitamin A is also very important during pregnancy and lactation to build stores of retinol in the liver.
Environmental sanitation
The chances of Vitamin A deficiency increases in the presence of certain diseases such as respiratory tract infections, tuberculosis, diarrhea, and worm infestations. Proper sanitation of the living environment helps in reducing the prevalence of these diseases.
Hygiene is a critical measure of how a person lives his life. Someone who gives importance to self-hygiene not only feels comfortable in his/her own skin but also helps others around him to work in comfort. Here are 5 simple tips to maintain hygiene at the workplace.
Vaccination
Certain vaccine-preventable diseases such as measles serve as a precipitating factor for xerophthalmia. Immunization helps in the elimination of such factors and may help in preventing xerophthalmia.
Home-care For Xerophthalmia
1. Consume Vitamin A rich food
People should consume food rich in Vitamin in their diet such as:
Carrots
Broccoli
Fish
Fortified cereals
Beef
Liver
Eggs
Chicken
Mangoes
Whole milk
Green leafy vegetables
2. Wear glasses
Wearing glasses is a good practice as it reduces the pressure from the eyes and is helpful for the people suffering from night blindness. It also helps the eyes to focus in a better way.
3. Avoid looking directly in the dark
The people suffering from night blindness should avoid looking at the dark source directly as it may adversely affect the pupil (black center of the eye).
4. Eyes exercises
Patients having xerophthalmia should keep their eyes in motion by looking in different directions, focusing at different points and blinking their eyes. It serves as an eye exercise and helps in the recovery of the eyes.
5. Adaptation to darkness
The people who are at initial stage of xerophthalmia i.e night blindness should try to adapt to darkness by sitting in a dark room for 20-30 minutes daily. They should also wear a sleep mask while sleeping. This will make the eyes comfortable in darkness and also help to prevent severe eye disorders.
6. Eye massage
Eye massage is a very powerful tool to improve the overall health of the eyes. It should be done only under the supervision of an expert as improper technique can damage the eye lens. To do eye massage:
Put slight pressure on both the eyes with the palms
Keep that pressure for around 5-10 seconds
Vision will turn white instead of black for a slight moment
When the black vision comes back, open the eyes
This will significantly improve vision in the dark
Regular eye massage can prevent night blindness to some extent
Complications Of Xerophthalmia
Vitamin A deficiency can cause various complications due severe malnutrition. It also increases the chances of mucosal infections. Keratomalacia and night blindness can also be life threatening in children.
High doses of Vitamin A can treat early symptoms such as conjunctival xerosis and night blindness. Corneal xerosis may however sometimes lead to permanent vision loss.
Did you know?
Vitamin A also nourishes the skin cells and promotes a healthy and glowing skin. A healthy dose of Vitamin A also prevents skin cancer by maintaining the production of new skin cells. Know more such benefits of Vitamin A.
Did you know?
A child is exposed to thousands of germs every day through the food he eats, air he breathes, and things he puts in his mouth. Vaccines use very small amounts of substances (antigens) that help your child’s immune system to recognize and learn to fight serious diseases. Learn in detail about vaccination in children.
