Xerophthalmia

Xero means dry and ophthalmia means eyes. Xerophthalmia means dry eyes due to excessive dryness of the cornea and conjunctiva.

Depiction of a person suffering from Dry Eye Syndrome

Cause

It is a condition caused by vitamin A deficiency and if left uncorrected, can lead to blindness.

Dry mouth is the feeling that there is not enough saliva in the mouth. Everyone has a dry mouth once in a while—if they are nervous, upset or under stress. But if you have a dry mouth all or most of the time, it can be uncomfortable and can lead to serious health problems. It can also be a sign of certain diseases and conditions.

Xerophthalmia characteristics

Xerophthalmia is characterized by keratinized conjunctival plaque, which had been the result of a vitamin A deficiency. The overarching condition xerophthalmia, includes conjunctival xerosis.

Clinical course

If left untreated, the vitamin A deficiency and its affects on the corneal conjunctivae, leave the conjunctival membrane dry and roughened. This is usually preceded by the formation of Bitot’s spots due to the accumulation of foamy material on the cornea.

Other causes of dry eyes and dry mucus membranes: medications, and diseases such as Sjögren’s Syndrome - the main symptoms of Sjögren’s syndrome are dry mouth and dry eyes.

Vitamin A

Vitamin A deficiency

Vitamin A deficiency is common in many developing countries, often because residents have limited access to foods containing preformed vitamin A from animal-based food sources and they do not commonly consume available foods containing beta-carotene due to poverty.

Epidemiology

According to the World Health Organization, 190 million preschool-aged children and 19.1 million pregnant women around the world have a serum retinol concentration below 0.70 micromoles/L. In these countries, low vitamin A intake is most strongly associated with health consequences during periods of high nutritional demand, such as during infancy, childhood, pregnancy, and lactation.

• In developing countries, vitamin A deficiency typically begins during infancy, when infants do not receive adequate supplies of colostrum or breast milk.
• Chronic diarrhea also leads to excessive loss of vitamin A in young children, and vitamin A deficiency increases the risk of diarrhea.
• The most common symptom of vitamin A deficiency in young children and pregnant women is xerophthalmia. One of the early signs of xerophthalmia is night blindness, or the inability to see in low light or darkness.
• Vitamin A deficiency is one of the top causes of preventable blindness in children.
• People with vitamin A deficiency (and, often, xerophthalmia with its characteristic Bitot’s spots) tend to have low iron status, which can lead to anemia. Vitamin A deficiency also increases the severity and mortality risk of infections (particularly diarrhea and measles) even before the onset of xerophthalmia.

Groups at risk

The following groups are among those most likely to have inadequate intakes of vitamin A.

Premature Infants

In developed countries, clinical vitamin A deficiency is rare in infants and occurs only in those with malabsorption disorders. However, preterm infants do not have adequate liver stores of vitamin A at birth and their plasma concentrations of retinol often remain low throughout the first year of life. Preterm infants with vitamin A deficiency have an increased risk of eye, chronic lung, and gastrointestinal diseases.

Infants and Young Children in Developing Countries

In developed countries, the amounts of vitamin A in breast milk are sufficient to meet infants’ needs for the first 6 months of life. But in women with vitamin A deficiency, breast milk volume and vitamin A content are suboptimal and not sufficient to maintain adequate vitamin A stores in infants who are exclusively breastfed

Pregnant and Lactating Women in Developing Countries

Pregnant women need extra vitamin A for fetal growth and tissue maintenance and for supporting their own metabolism

People with Cystic Fibrosis

Most people with cystic fibrosis have pancreatic insufficiency, increasing their risk of vitamin A deficiency due to difficulty absorbing fat

Vitamin A deficiency

Diagnosis

Diagnosis is with history, physical examination and measurement of vitamin A level in the blood.

Vitamin A RDA

Life Stage	Recommended Amount
Birth to 6 months	400 mcg RAE
Infants 7–12 months	500 mcg RAE
Children 1–3 years	300 mcg RAE
Children 4–8 years	400 mcg RAE
Children 9–13 years	600 mcg RAE
Teen boys 14–18 years	900 mcg RAE
Teen girls 14–18 years	700 mcg RAE
Adult men	900 mcg RAE
Adult women	700 mcg RAE
Pregnant teens	750 mcg RAE
Pregnant women	770 mcg RAE
Breastfeeding teens	1,200 mcg RAE
Breastfeeding women	1,300 mcg RAE

Sources of vitamin A

Vitamin A is found naturally in many foods and is added to some foods, such as milk and cereal. You can get recommended amounts of vitamin A by eating a variety of foods, including the following:

• Beef liver and other organ meats (but these foods are also high in cholesterol, so limit the amount you eat).
• Some types of fish, such as salmon.
• Green leafy vegetables and other green, orange, and yellow vegetables, such as broccoli, carrots, and squash.
• Fruits, including cantaloupe, apricots, and mangos.
• Dairy products, which are among the major sources of vitamin A for Americans.
• Fortified breakfast cereals.

Vitamin A supplements

Vitamin A is available in dietary supplements, usually in the form of retinyl acetate or retinyl palmitate (preformed vitamin A), beta-carotene (provitamin A), or a combination of preformed and provitamin A. Most multivitamin-mineral supplements contain vitamin A. Dietary supplements that contain only vitamin A are also available.

Xerophthalmia Resources
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