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PubMed1986

Prevalence and severity of xerophthalmia in southern Malawi.

The first population-based study of xerophthalmia in Africa was conducted in the Lower Shire River Valley of Malawi in the autumn of 1983. A total of 5,436 children under six years of age were examined by three survey teams over an eight-week period. The prevalence of active xerophthalmia was 3.9%. Rates for night blindness and active corneal disease were more than five times the World Health Organization criterion for a problem of public health importance. Xerophthalmic corneal scarring occurred at a rate of 5.9/1,000, more than 10 times the World Health Organization criterion. All cases of bilateral blindness in this age group were considered to be due to vitamin A deficiency. Given recent evidence from Asia linking even subclinical vitamin A deficiency to increased risk of mortality and morbidity, this disease is not only a leading cause of blindness in this area, but may have an important impact on child survival as well.

Child, Preschool↗
PubMed1993

Xerophthalmia, vitamin A supplementation and morbidity in children.

The relationship between ocular manifestation of vitamin A deficiency and children's anaemic/morbidity status as well as the efficacy of vitamin A prophylaxis in preventing these conditions was determined. The prevalence of xerophthalmia in morbid children with anaemia and history of worm infestation, measles, and diarrhoea was higher as compared to their non-morbid counterparts. The relative risk (RR) of anaemic children with eye signs was significantly higher (1.5), but the chances of having anaemia were similar in both vitamin A receivers and non-receivers. The RR of history of worm infestation, measles, and severe diarrhoea was 1.4, 1.0, and 1.2, respectively, in children with eye signs and 1.2, 0.8, and 1.3, respectively in children who did not receive vitamin A prophylaxis. The RR for occurrence of diarrhoea along with vitamin A deficiency was as high as 1.9. It appears xerophthalmia and anaemia co-exist and vitamin A supplementation helps in curbing these conditions among 1-6-year-old children.

Child↗
PubMed1986

Age specific xerophthalmia rates among displaced Ethiopians.

The recent famine in Ethiopia has resulted in the dislocation of millions of people. Many of these individuals have moved to refugee camps in Sudan or to feeding centres within Ethiopia. A total of 1325 children up to the age of 15 years were examined by an ophthalmologist in January 1985 at several sites in these two countries. The rates of Bitot's spots were three times greater in those between the ages of 7 and 10 compared with those under 7. Rates of corneal xerosis were comparable for each group. Previously, xerophthalmia was considered predominantly to affect children aged under 6. These data document the presence of the disease in older children and raise questions regarding future modifications in the prevention and treatment of xerophthalmia.

Adolescent↗
PubMed1992

[Xerophthalmia in liver cirrhosis. Correct diagnosis after 15 years].

The clinical features of xerophthalmia are described in a 60-year-old patient, who was known to have alcoholic cirrhosis. In this patient, vitamin A deficiency, which presumably had been overlooked for 15 years, was confirmed by determination of the serum vitamin A level. After substitutive vitamin A therapy, superficial punctate keratitis and conjunctival xerosis disappeared completely. Although xerophthalmia has only sporadically been described in developed countries, we point out that the possibility of a vitamin A deficiency should also be considered in cases of recurrent conjunctival and corneal lesions.

Corneal Ulcer↗
PubMed2000

Dietary practices and xerophthalmia in under-fives in Jimma town, southwest Ethiopia.

OBJECTIVES: To assess parent's knowledge about children's need for plant sources of vitamin A; to determine the dietary practice with regard to vitamin A intake; to estimate the prevalence of xerophthalmia and; to forward appropriate recommendations. DESIGN: A cross-sectional study. SETTING: The study was conducted in Jimma town, southwest Ethiopia, with a total population of about 88,867 from February to April 1995. PARTICIPANTS: Eight hundred and thirty one randomly selected children between the ages of six and 59 months formed the study population. MAIN OUTCOME MEASURES: The dietary intake of cheap and easily available vitamin A rich foods is assessed and prevalence of xerophthalmlia determined. RESULTS: Only eighty per cent of the children were getting green vegetables, fruits or carrots once weekly or more. The major reasons given for not including vegetables, fruits and carrots in the diet were "cannot afford" (39%), "not available" (33%), and "child too young" (16%). Out of 628 children examined, four (0.6%) were found to have xerophthalmia; three (0.48%) classified as XIB and one (0.16%) as X2. CONCLUSION: The dietary intake of plant sources of vitamin A in the studied community is far from adequate. Moreover, vitamin A deficiency is found to be a significant public health problem in young children in Jimma town. Periodic vitamin A supplementation, preferably combined with immunisation, should be a priority action, and parents need to be educated about vitamin A deficiency and its prevention.

Child Nutrition Disorders↗
PubMed1990

Microvascular submandibular gland transfer for the management of xerophthalmia; an experimental study.

Free submandibular salivary gland transfer was investigated as a method of treatment for xerophthalmia. Xerophthalmia was created in rabbits by surgical removal of the lacrimal gland and the incidence of corneal ulceration was seen to correlate with the decrease in tear secretion. Microvascular transfer of the submandibular salivary gland to drain saliva into the conjunctival fornix prevented the development of corneal ulceration in 63% of the cases.

Amylases↗
PubMed1991

Xerophthalmia in Ethiopia: a nationwide ophthalmological, biochemical and anthropometric survey.

A total of 6636 children, aged from 6 months to 6 years and selected throughout the country using a multi-staged stratified sample design, were examined for signs of xerophthalmia. The concentrations of retinol and of beta-carotene were measured in 742 children, including those with xerophthalmia and every twentieth of the remaining children. Anthropometric measurements were made on 2909 of the children. Bitot's spots were seen in 1.0% of all children, with a higher prevalence in the pastoral (1.6%) and cropping (1.1%) agro-ecological zones than in the zones characterized by cash crops (0.4%) and 'ensete' (false banana, Ensete ventricosum) (0.0%). One case of corneal xerosis and 2 cases of corneal scar were also seen. Serum retinol levels were in the 'deficient' range (less than 0.35 mumol l-1) in 16% and 'low' (0.35-0.69 mumol l-1) in 44% of children. Serum retinol and clinical signs did not show any correlation with occupation and education of head of household, household size or anthropometric measurements. More stunting than wasting was observed, with peak prevalence of these signs of malnutrition being observed in the second year of life.

Agriculture↗
PubMed1989

[Xerophthalmia caused by self-induced deficiency disease].

Xerophthalmia is no longer seen in Europe since the 19th century. We report the case of a female patient, aged 33, of french nationality, who presented a clinical picture of major vitamin A deficiency, self-induced and with ocular complications. An untreated long standing depressive condition appeared to be the major etiologic factor. Perforation of a desmetocele necessitated penetrating keratoplasty. Histologic corneal and conjunctival aspects are reported. Oral prescription of vitamin A resulted in considerable clinical improvement. Only 3 similar cases have been previously reported. Clinical manifestations of xerophthalmia are described along with preventive and curative therapy.

Adult↗
PubMed1986

A simple surveillance system for xerophthalmia and childhood corneal ulceration.

A simple cost-effective surveillance system is described for reporting cases of xerophthalmia and childhood corneal ulceration. The system is suitable for use by ophthalmic auxiliaries in developing countries.Presented are the results of a 2-year surveillance involving 15 hospitals in 11 areas of the United Republic of Tanzania. Cases of xerophthalmia in its early stages (characterized by night blindness or Bitot's spots) were found in all areas surveyed. Of almost 300 cases of unilateral and bilateral corneal ulceration, 46% and 79%, respectively, followed a recent infection with measles. The single most important cause of bilateral corneal ulceration was vitamin A deficiency. The surveillance system has proved to be particularly useful as a first step in defining the type and distribution of serious corneal disease in children.

Child↗
PubMed1980

Xerophthalmia in vitamin A-deficient rabbits. Clinical and ultrastructural alterations in the cornea.

Xerophthalmia developed in the eyes of rabbits maintained on a vitamin A-deficient diet for 4 to 6 months. The earliest clinical change, a lusterless graying of the central corneal epithelium, was noted after 16 to 18 weeks on the diet. Multiple small punctate epithelial erosions appeared in the interpalpebral fissure zone within 7 to 10 days after the lusterless graying became evident. The erosions gradually became confluent, and a striking dry, glazed, peau d'orange appearance was noted. Polycystic microbullae appeared in the epithelium in some eyes. Thick keratinized epithelial plaques developed in all eyes 1 to 2 weeks after the appearance of severe peau d'orange. Electron microscopy of corneas with lusterless graying of the epithelium revealed swelling of the most superficial epithelial cells with flattened and shorter microvillous projections. In corneas with punctate epithelial erosions and keratinized plaques, microvilli were absent or decreased in number on superficial cells, and multilayered, keratinized epithelial cells were present on the surface of the cornea. The stroma appeared essentially normal with minimal edema at all stages when examined by electron microscopy. Intercellular edema was present in the endothelium in early- and late-stage xerotic corneas but could not be detected clinically. No significant clinical or microscopic alterations were seen in the corneas of control rabbits on normal diet or in rabbits on the vitamin A-deficient diet supplemented with vitamin A. The alterations seen in the corneas of vitamin A-deficient rabbits are similar to those which have been described in vitamin A-deficient humans. Rabbit therefore appears to be a good model for further studies of xerophthalmia.

Animals↗
PubMed1997

[Nonsteroidal anti-inflammatory agents: their topical use in the treatment of xerophthalmia secondary to Sjögren's syndrome].

The authors, in a case-control study, analyzed the topical application of nonsteroidal anti-inflammatory drug (flurbiprofene drops) in patients affected by keratoconjunctivitis sicca in Sjögren's syndrome. The variation of break-up-time values, and xerophthalmia grade were analyzed. A mild increase of mean values of break-up-time (two seconds in the treated group), and a mild decrease of xerophthalmia grade were found.

Administration, Topical↗
PubMed1979

Lissamine green staining in the clinical diagnosis of xerophthalmia.

Lissamine green staining of the conjunctiva, a new and widely heralded aid for diagnosing early xerophthalmia, was found to be a reasonably specific but inadequately sensitive test for practical use. While 82% of clinically normal children failed to show staining, so did 57% with night blindness, 29% with vitamin A responsive Bitot's spots, and, most significantly, 26% with severe, vitamin A related corneal involvement. The test also failed to distinguish vitamin A responsive "Bitot's spots" from nonresponsive ones.

Adolescent↗
PubMed1981

Topical retinoic acid in the treatment of experimental xerophthalmia in the rabbit.

The purpose of this study was to evaluate the efficacy of topical retinoic acid (tretinoin) in the treatment of various stages of xerophthalmia caused by vitamin A deficiency. At the beginning of treatment, rabbits with similar disease in both eyes were given a normal diet and therapeutic doses (25,000 IU) of systemic vitamin A. One eye of each was treated with 0.1% retinoic acid in sesame oil one time per day. The other eye received sesame oil alone. Eyes with moderate disease (advanced keratinization and plaque formation) responded more quickly to topical retinoic acid (clear within three days) than did eyes treated with sesame oil (clear within seven days). No difference in time of response could be observed in corneas with milder or more severe disease (stromal infiltration and corneal vascularization).

Administration, Oral↗
PubMed1982

Protein deficiency and treatment of xerophthalmia.

In a controlled clinical trial of massive-dose vitamin A therapy for xerophthalmia, holo-retinol-binding protein (holo-RBP) response was related to baseline protein status. Corneal healing was more commonly delayed or transient in children with protein-energy malnutrition (PEM), despite the vast majority achieving holo-RBP levels incompatible with severe corneal destruction. Correction of PEM is essential to ensuring a sustained clinical cure, and repeated massive vitamin A therapy is advisable until that occurs.

Administration, Oral↗
PubMed1984

Treatment of xerophthalmia with retinol, tretinoin, and etretinate.

Topical retinol, tretinoin (all-trans-retinoic acid) and etretinate (a synthetic retinoid) were used in rabbits to treat experimental xerophthalmia due to vitamin A deficiency. Both 0.2% retinol and 0.1% and 0.2% tretinoin effectively reversed abnormal corneal epithelial keratinization within one to two days and restored corneal clarity within two to four days following topical application three times per day. Etretinate was ineffective in the concentration used (0.2%). In addition, application of tretinoin to one eye effectively reversed xerophthalmic changes in the other eye. Retinol did not have an effect on the other eye.

Administration, Topical↗
PubMed1978

Topical retinoic acid in the treatment of corneal xerophthalmia.

Eight children with corneal xerophthalmia (x2 or x3A) received standard high-protein diets and massive systemic vitamin A therapy. Retinoic acid, 0.1% in oil, was applied daily to one eye, and oil alone to the other. Topical retinoic acid proved safe and effective in speeding corneal healing, especially during the first critical days.

Administration, Topical↗
PubMed1982

Goblet cell response to vitamin A treatment for corneal xerophthalmia.

In 11 patients with active corneal xerophthalmia, conjunctival biopsies were obtained at various intervals after massive-dose systemic vitamin A therapy. Goblet cells began to repopulate the inferonasal quadrant of the conjunctivas after two weeks, and they reached normal concentrations after one month. Corneal healing proceeded much more rapidly than that, suggesting that a full complement of mucus-secreting conjunctival goblet cells is not essential for restoration and maintenance of normal corneal appearance.

Child↗