Xerophthalmia is a serious eye condition in which the conjunctiva and cornea become abnormally dry due to a vitamin A deficiency. Studies show that around 2.8 million children worldwide suffer from xerophthalmia. If not treated, xerophthalmia can progress to corneal damage, which is permanent and may lead to blindness, and early detection is required. 

This comprehensive guide explores xerophthalmia, how nutritional deficiencies can trigger it, its symptoms, and how to treat it with appropriate intervention to prevent vision loss.

What is Xerophthalmia? 

The Greek root ‘xero’ (dry) and ‘ophthalmia’ (eye) together make up the word xerophthalmia, meaning ‘dry eye.’ This is a more significant issue beyond simple eye dryness and includes a series of ocular manifestations caused by a vitamin A deficiency. The deficiency may result from a low intake of vitamin A or decreased metabolism of vitamin A. 

If left untreated, xerophthalmia progresses from dryness to night blindness, corneal lesions, and ultimately blindness. This preventable condition predominantly affects populations in developing regions with little nutritional resources and responds well to Vitamin A supplementation if diagnosed early. 

The severity of xerophthalmia indicates vitamin A’s critical role in ocular health and vision.

Causes of Xerophthalmia

Vitamin A deficiency is the primary cause of xerophthalmia. It is a crucial nutrient to maintain ocular surface integrity and visual functions. The two main pathways to vitamin A deficiency are inadequate dietary intake and impaired absorption or utilisation.

• Vitamin A Deficiency

Inadequate vitamin A levels are the fundamental cause of xerophthalmia, which damages corneal epithelium and retinal function.

• Malabsorption Disorders

Conditions of the gastrointestinal tract, such as celiac disease, cystic fibrosis, and inflammatory bowel disease, prevent sufficient vitamin A absorption despite intake, known as a malabsorption disorder. 

• Infections

Acute infections, particularly measles, deplete vitamin A reserves quickly and can precipitate xerophthalmia in needy individuals.

Risk Factors of Xerophthalmia

There are several factors that contribute to the risk of xerophthalmia, including:

1. Socioeconomic Status 

Poverty increases the odds of poor nutrition because it eliminates access to diverse, nutrient-rich foods. 

2. Age 

Young children are at a heightened risk because they require more vitamin A for growth and often have restricted diets. 

3. Geographic Location 

Marked prevalence occurs in developing African and Southeast Asian regions with limited dietary diversity.

4. Medical Conditions 

Susceptibility is increased due to impaired vitamin A metabolism by chronic liver disease, pancreatic insufficiency, and persistent diarrhoea. 

5. Alcoholism 

Alcoholism can lead to a deficiency even when a person is eating normally, inhibiting vitamin A storage and utilisation. Various thyroid disorder treatments can also modify standard absorption mechanisms for vitamin A.

Symptoms of Xerophthalmia 

Xerophthalmia presents with an evolving cascade of ocular manifestations culminating in such severe complications as corneal opacity, cataracts, and blindness. Some of the symptoms include:

• Night Blindness (Nyctalopia)

The earliest symptom is often impaired vision in dim light and the inability to adjust between light and dark environments. 

• Conjunctival Xerosis 

With decreased tear production, the conjunctiva becomes dry, loses its standard lustre, and becomes wrinkled and thickened with loss of normal conjunctival resistance. 

• Bitot’s Spots 

They are pathognomonic, foamy, triangular, silver-grey, conjunctival lesions composed of keratin debris and bacteria. 

• Corneal Xerosis 

As epithelial cells become keratinised, the cornea loses transparency and becomes dry and dull. 

• Corneal Ulceration 

Without intervention, ulcerations caused by the breakdown of corneal integrity can become painful and rapidly progress.

• Keratomalacia 

It consists of corneal softening, liquefaction, and possible perforation—a life-threatening emergency for which immediate treatment is necessary. 

• Xerophthalmic Fundus 

In severe, chronic cases, retinal changes may appear as decreased pigmentation or a patchy appearance, leading to scarring.

Diagnosis of Xerophthalmia

Diagnosis of xerophthalmia consists of several facets, including: 

• Clinical Examination 

Slit lamp biomicroscopy examination of the entire eye to examine characteristic changes in the ocular surface. 

• Medical History 

Dietary patterns, socioeconomic factors, and potential malabsorption conditions that may be associated with vitamin A deficiency.

• Serum Retinol Measurement 

Quantifying vitamin A levels from blood tests with values below 20 μg/dL strongly suggests deficiency. 

• Impression Cytology 

Conjunctival cells were collected and examined to find squamous metaplasia, a type of cellular change associated with vitamin A deficiency. 

• Dark Adaptation Testing 

Night vision function evaluation to detect early functional impairment before structural changes.

• Conjunctival Transfer Test 

Conjunctival response to pressure with delayed normalisation of assessment, indicating xerophthalmia.

Treatment Options for Xerophthalmia 

Since xerophthalmia develops due to the lack of Vitamin A, the main treatment options involve:  

1. Vitamin A Supplementation 

• High-Dose Therapy 

According to World Health Organisation (WHO) protocols, treatment of xerophthalmia depends upon immediate high-dose vitamin A supplementation. 

• Administration Routes 

Typically, treatment starts with a trial of oral supplements, but if the condition is severe or if malabsorption exists, then intramuscular injection is necessary.

• Standard Dosing Protocol 

200,000 IU (International Units) are to be repeated after 24 hours and 4 weeks in children over 12 months of age. After the same schedule, children less than 12 months will receive 100,000 IU. 

• Maintenance Therapy 

Small doses or further supplements are prescribed after the initial high-dose treatment to prevent recurrence.

2. Management of Ocular Complications 

• Artificial Tear Supplements: Symptomatic relief from ocular surface dryness can be obtained with preservative-free lubricants. 
• Topical Antibiotics: Antimicrobials in prophylactic or therapeutic preparation protect compromised corneal surfaces from secondary infection. 
• Corneal Protection: In cases of epithelial defect or ulcerations, submaximal or therapeutic contact lenses may be prescribed. 
• Surgical Intervention: In advanced cases, corneal perforation, corneal transplantation or other reconstructive procedures may be required.

3. Preventive Strategies 

• Periodic Supplementation: Vitamin A supplementation programs are offered in high-risk populations on a routine basis. 
• Breastfeeding Promotion: Exclusive breastfeeding of infants under 6 months is encouraged, as breast milk contains enough vitamin A. 
• Agricultural Interventions: Extension of home gardens, diversified crop cultivation for dietary diversity, and enhanced vitamin A intake.

FAQs about Xerophthalmia

1. Can xerophthalmia be cured? 

In the case of the eye disease xerophthalmia, a simple fix is vitamin A tablets. Early treatment is essential because it will afford the best outcome if a diagnosis is made early.

2. What is the test for xerophthalmia? 

Schirmer’s test, staining of corneal and conjunctival epithelial tissue by rose bengal dye and demonstration of epithelial strands by slit lamp examination show xerophthalmia.

3. Can xerophthalmia cause blindness? 

Xerophthalmia is a leading cause of preventable child blindness. Proper nutrition and health education can reduce the incidence of blindness from xerophthalmia.

4. What are the first symptoms of xerophthalmia? 

The conjunctiva—the thin lining of the eyelid and eyeball—dries out, thickens, and wrinkles. The drying out and wrinkling cause various symptoms. An early symptom is night blindness, which is the inability to see in dim light.

Conclusion 

Xerophthalmia is a serious, however entirely preventable, eye condition. Understanding the progression of disease from dry eyes to potential blindness illustrates the importance of vitamin A in ocular health. Medical students must master these essential clinical concepts to the best of their abilities for the NEET PG examination. 
To learn more about such medical concepts and prepare for the NEET PG exam, visit DocTutorials today. You can access the latest comprehensive, exam-focused digital notes to reinforce your grip on xerophthalmia or any other topic of similar relevance.