Xerophthalmia

🧁 Xerophthalmia

🔍 Definition

Xerophthalmia is a spectrum of ocular changes due to vitamin A deficiency, primarily affecting the conjunctiva and cornea, leading to dryness, ulceration, and potential blindness.

It is most commonly seen in malnourished children, especially in developing countries.

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🧬 Etiology (Causes)

Cause	Examples
Primary vitamin A deficiency	Inadequate dietary intake
Secondary deficiency	Malabsorption (e.g., celiac, diarrhea), liver disease
Increased demand	Rapid growth, infections (measles)

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🌍 Epidemiology

• Common in children aged 6 months to 6 years

• Major cause of preventable blindness in developing nations

• Associated with protein-energy malnutrition

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🧠 WHO Classification of Xerophthalmia

Stage	Description
XN	Night blindness (first symptom)
X1A	Conjunctival xerosis – dry, dull conjunctiva
X1B	Bitot’s spots – foamy white patches on conjunctiva
X2	Corneal xerosis – dry, hazy cornea
X3A	Corneal ulceration/keratomalacia < 1/3 cornea
X3B	Corneal ulceration/keratomalacia > 1/3 cornea
XS	Corneal scarring (from healed ulcer)
XF	Xerophthalmic fundus – mottled retina (rare)

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👀 Clinical Features

Symptom / Sign	Explanation
Night blindness (XN)	Early, functional symptom due to rod dysfunction
Dry conjunctiva (X1A)	Loss of goblet cells → dryness
Bitot’s spots (X1B)	Keratinized, white foamy lesions (often temporal)
Corneal dryness (X2)	Loss of tear film → hazy, non-shiny cornea
Keratomalacia (X3A/B)	Corneal melting → perforation if untreated
Corneal scarring (XS)	Permanent vision loss

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🧪 Diagnosis

• Clinical – based on signs and symptoms

• History of malnutrition or measles

• Low serum retinol levels (<0.70 µmol/L) – confirmatory

• Response to Vitamin A – improvement supports diagnosis

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💊 Treatment

🔹 WHO Vitamin A Therapy (for children)

Age Group	Vitamin A Dose	Frequency
< 6 months	50,000 IU orally	Day 1, 2, and at 4 weeks
6–12 months	100,000 IU orally	Same schedule
> 12 months	200,000 IU orally	Same schedule

🚨 Topical antibiotics (e.g., chloramphenicol) are added for keratomalacia to prevent secondary infection.

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🥕 Prevention

• Routine Vitamin A supplementation

• Promote breastfeeding

• Weaning with vitamin A-rich foods (e.g., green leafy vegetables, carrots, mangoes)

• Control of infections – especially measles

• Health education

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⚠️ Complications

• Corneal perforation

• Endophthalmitis

• Permanent blindness

• Death (vitamin A deficiency increases child mortality)

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📋 Quick Summary Table

Feature	Xerophthalmia
Cause	Vitamin A deficiency
Early symptom	Night blindness
Classic sign	Bitot's spots
Severe stage	Keratomalacia (corneal melting)
Treatment	High-dose oral vitamin A
Prevention	Supplementation & dietary education

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🧠 Mnemonic: “XERO = Xtra Eye Risk from Ocular dryness”

• X – Xerosis (dryness)

• E – Eye spots (Bitot’s)

• R – Rod dysfunction (night blindness)

• O – Opacity (scarring/ulcer)