Alternative Treatments For Xerophthalmia

Dry Eye Handbook The Ultimate Dry Eye Treatment

The Dry Eye Handbook is based on extensive independent research over a 10 year period. The publication is ideally suited for everything from mild to severe cases of dry eye. The Dry Eye Handbook has helped hundreds of dry eye sufferers to date, and its appreciated by individuals, larger organisations as well as ophthalmologists. You will learn: #1. How to diagnose your specific case of dry eye most doctors actually have a hard time getting this correct. #2. How to start a proper dry eye treatment dont waste time doing the wrong things, get off to a correct start quickly. #3. The best diet for dry eyes learn what to eat and drink to create the biggest impact on your eye health. #4. The best eye drops for dry eyes find out what eye drops you should use for your specific case of dry eyes. #5. The best supplements for dry eyes find out all there is about anti-inflammatory supplements, oil supplements and much more. #6. The newest treatments find out the best and most innovative treatments for dry eye (constantly updated) #7. How to treat Meibomian Gland Dysfunction find out all there is about the best supplements, eye drops, eyelid scrubs, eyelid massages, heat compresses, removing chalazia and styes and much, much more. #8. How to treat Blepharitis get the details on how to reduce inflammation by using the best supplements, diets, artificial tears, eyelid scrubs and much more. #9. How to treat Aqueous Tear Deficiency if youre suffering from a lack of tears or a incorrect composition of your tears I will show you how to increase tear production, stabilise the tear film and several additional areas that will improve your eye comfort considerably.

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Xerophthalmia and Keratomalacia

Who And Xerophthalmia

The WHO classification of xerophthalmia is shown in Table 3. This classification was first adopted in 1976 (126), with minor modification in 1982 (247). The ocular signs are Around the beginning of the nineteenth century, the terms xerosis, xerophthalmia, and xerophthalmos were often used to describe dryness and associated changes of the eye that were considered to be related to conditions such as exposure, scrofula, syphilis, trachoma, and dryness of the eyes in older adults (252-256). The term xerophthalmia was applied in relationship to night blindness, corneal ulceration, and keratomalacia after further clinical observations and the development of ideas in the 1860s (20,27). Corneal ulceration may follow corneal xerosis, and the typical corneal ulcer associated with vitamin A deficiency is round or oval with a relatively clean, punched-out appearance, as if the cornea had been altered with a small trephine (Fig. 10). With full-thickness ulceration, the iris may prolapse through...

Ophthalmic Surgery And Dry Eyes

Chondroitin sulfate is used as a viscoelastic substance to protect and lubricate cells and tissues during ophthalmic surgery, as well as to preserve corneas before transplantation (Larson et al 1989, Liesegang 1990). In a double-blind crossover study of 20 subjects, 1 chondroitin sulfate was found to be equally as effective as polyvinyl alcohol artificial tear formulation and 0.1 hyaluronic acid in reducing itching, burning and foreign body sensation in people with keratoconjunctivitis sicca (Limberg etal 1987).

Vitamin A Deficiency and Increased Mortality in Children Lessons From Denmark

From 1909 to 1920, the Danish ophthalmologist Olaf Blegvad (1888-1961) documented cases of xerophthalmia, or clinical vitamin A deficiency, among children in Denmark (48). From 1911 to 1917, there was a strong, gradual increase in the number of cases of keratomalacia, the most severe eye lesion of vitamin A deficiency, followed by a decline in 1918 and 1919 and then an increase in 1920. During the same period in neighboring Sweden, there was no epidemic of xerophthalmia. Blegvad showed that the export of butter and cheese from Denmark and increased consumption of margarine within the country were linked with the increase in vitamin A deficiency. The manufacture of margarine ceased in 1917 after a German submarine blockade halted importation of raw materials, and butter, which was produced in Denmark at an expensive price, was then rationed at a more affordable cost for the poor after December 21, 1917. On May 1, 1919, butter rationing ceased (Fig. 1) (48). The mortality rate observed...

Bioavailability In Ocular Compartments

Intraocular Compartments Images

In normal humans, the basal rate of tear flow is approximately 1 mL min, and the physiologic turnover rate is approximately 10 to 15 per minute, which decreases with age. Basal tear flow is usually lower in patients with keratoconjunctivitis sicca and slightly higher in contact lens wearers.13 The half-life of the exponential decline of fluorescence in the precorneal tear film in normal humans, as measured by fluo-rophotometry, varies between 2 and 20 minutes. This variability also applies to other substances. The loss rate constant for fluorescein varies depending on the amount of tearing. Reflex tearing caused by stinging from instillation of an irritating drug produces a higher loss rate. Lid closure and local or general anesthesia can decrease the tear flow rate. Physical, psychological, and emotional factors can increase tearing.

Of Vitamin A Supplementation in the Early 1970s

The Xerophthalmia Club and Xerophthalmia Club Bulletin were founded in Jerusalem in 1971 at the Conference on the Prevention of Blindness, and H.A.P.C. Oomen was elected its first president. The bulletin was produced three times a year and was meant to provide an interdisciplinary tool to inform and coordinate efforts to eradicate vitamin A deficiency. In 1974, an expert group met in Jakarta, Indonesia under the auspices of WHO and the US Agency for International Development. A standardized classification of xerophthalmia, criteria for defining vitamin A deficiency as a public health problem, and dosage schedules for vitamin A were adapted (126).

Control of Infectious Diseases

Given the close relationship between some infectious diseases and vitamin A deficiency, the control of diseases such as measles (598) and diarrheal diseases would likely reduce the risk of xerophthalmia among infants and preschool children. Thus, programs aimed at more effective measles vaccines, prevention of diarrheal diseases, and malaria control would likely have an effect on reducing xerophthalmia. Treatment of intestinal parasites such as Ascaris lumbricoides may help to improve the vitamin A status of children who consume a diet high in provitamin A carotenoids (1036,1037).

Ellisons Landmark Trial and Other Therapeutic Trials of Vitamin A the Anti Infective Vitamin 19201940

Frequency distribution of 72 children admitted to the Rigshospital, Copenhagen for xerophthalmia from 1912 to 1919. (Reprinted from ref. 48.) Fig. 2. Frequency distribution of 72 children admitted to the Rigshospital, Copenhagen for xerophthalmia from 1912 to 1919. (Reprinted from ref. 48.) and the United States (56). It should be emphasized that these trials were not conducted in populations with clinical vitamin A deficiency, i.e., xerophthalmia, was widespread it was thought that vitamin A would reduce morbidity and mortality from infections in children and adults with subclinical vitamin A deficiency. Among the important discoveries during these trials was that vitamin A supplementation reduced mortality from measles in children (57,58) and reduced the morbidity of puerperal sepsis in women (59,60).

Further Investigations of the Relationship Between Vitamin A Deficiency and Child Mortality

WHO currently recommends high-dose vitamin A supplementation for children with xerophthalmia, acute measles, and diarrheal disease in developing countries where vitamin A deficiency is a public health problem (133). Some developing countries have adopted programs of intermittent, high-dose vitamin A capsule distribution for infants and children, a measure that may reduce diarrheal morbidity and mortality and is largely considered a temporary solution until other remedies can be found (132). The contemporary distribution of vitamin A capsules to children in the community in developing countries resembles the widespread home use of cod-liver oil by the teaspoon or capsule for children in the early half of the 20th century in Europe and the United States. Currently, a return to cod-liver oil is no longer a viable option the cod fisheries have nearly been depleted in the North Atlantic, and synthetic vitamin A is a relatively inexpensive source for supplements or fortification. Milestones...

Vitamin A Deficiency Infection and Mortality in Developing Countries A Recurring Theme

In 1948, Vulimiri Ramalingaswami (1921-2001) drew attention to the important association between diarrheal disease and vitamin A deficiency among young children seen at the Nutrition Clinic of the Nutrition Research Laboratories in Coonor, India (86). He noted that diarrheal disease and altered gastrointestinal pathology were consistent features of vitamin A deficiency, both in humans and in experimental animal models, and that the diarrheal disease resolved with administration of vitamin A (48,50,87-91). In a small therapeutic trial involving children with xerophthalmia and diarrheal disease, Ramalingswami divided children into three groups (1) children with keratomalacia and Bitot spots who received daily high doses of vitamin A, (2) children with Bitot spots who were treated with standard bowel-binding substances such as kaolin and bismuth carbonate, and (3) children with Bitot spots and diarrhea who were treated with sulfa antibiotics. In the first group, keratomalacia and Bitot...

Clinical Assessment

Cataracts (subcapsular polychromatophilic opacities posterior cortical spokes posterior subcapsular plaques mature cataracts) short depigmented ciliary processes hypotony iris neovascular tufts (resulting in spontaneous hyphema) keratitis sicca macular and peripheral retinal pigmentary degeneration miotic, sluggishly reacting pupils

Risk Factors for Vitamin A Deficiency

And boys are affected more often than girls. Breast-feeding practices such as no breastfeeding, early weaning, or rapid weaning are associated with an increased risk of vitamin A deficiency. Pregnant women and nonpregnant women of childbearing age are at higher risk of vitamin A deficiency. Vitamin A deficiency tends to cluster in households and in villages, with higher risk of xerophthalmia among children within the same family, and within mothers and their children. The relationships of risk factors for vitamin A deficiency are shown in Fig. 17. In developing countries, low socioeconomic status is a strong risk factor for vitamin A deficiency, as many families living in poverty cannot afford vitamin A-rich sources of animal foods such as eggs and meat and may have lower consumption of plant sources of vitamin A. However, the effects of poverty extend beyond food availability and quality of the diet. Poverty is also associated with lower quality of housing, lack of running water,...

Global Distribution

Blindness 1.0 , (2) prevalence of Bitot spots 0.5 , (3) prevalence of corneal xerosis and or ulceration 0.01 , (4) prevalence of xerophthalmia-related corneal scars 0.05 (600). Supportive biochemical evidence of deficiency is a prevalence of serum retinol 5 (600). Cambodia. The first national survey to assess the prevalence of vitamin A deficiency in Cambodia was conducted in 2000 by Helen Keller International (602,603). The prevalence of xerophthalmia among children aged 18-60 mo was 0.7 (602), and the prevalence of xeropthalmia among nonpregnant women was 2 (603). The survey revealed that high-dose vitamin A supplementation was reaching 10-55 of children aged 6-59 mo and 1-13 of postpartum women. The government of Cambodia integrated high-dose vitamin A capsule distribution into national immunization days for polio in 1996 (694). Vietnam. The prevalence of xerophthalmia has declined in Vietnam since the mid-1980s. In a survey in 1985 of 14,238 preschool children in the Hanoi region...

Vitamins Golden Rice

Millions of people in the world suffer from vitamin A deficiency (VAD), which leads to vision impairment and increased susceptibility to diarrhoea, respiratory diseases, and measles. In Southeast Asia it is estimated that five million children develop xerophthalmia (alteration in the structure of the conjunctiva and cornea found predominantly in children) every year. This problem may be equally severe in certain areas of Africa, Latin America and the Caribbean. Overall, around 500,000 children annually become irreversibly blind as a result of VAD.


Systemic rheumatic disease may present with a variety of manifestations in the head and neck regions. Especially important among these are the dermatologic findings of SLE, DM, and scleroderma. Rashes characteristic of these disorders may also arise later in the course of the diseases. Some of the more frequently reported manifestations to be aware of are autoimmune hearing loss, especially in SLE esophageal dysmotility in scleroderma oropharyngeal and esophageal involvement in DM PM and keratoconjunctivitis sicca and cervical spine involvement in RA.


Vitamin A deficiency remains a leading cause of morbidity, mortality, and blindness among preschool children in developing countries worldwide. The consequences of vitamin A deficiency include impaired immune function, growth retardation, anemia, xerophthalmia, and blindness. Diverse long-term strategies, including nutrition education, food fortification, and homestead food production are needed to prevent vitamin A deficiency in developing countries. Ultimately, family-based approaches are required to address vitamin A deficiency, because pregnant women and women of childbearing age are at high risk of vitamin A deficiency in many countries and are not reached by vertical programs such as vitamin A capsule distribution. Xerophthalmia and blindness tend to occur among children who are not reached by programs aimed at improving vitamin A status through capsule distribution, fortification, and nutritional interventions. Further work is needed to characterize these households in order to...

Food Fortification

Among poor urban toddlers in Guatemala, fortified foods (mostly fortified sugar, margarine, and Incaparina) contribute about one half of the RDI (1032). Fortification of MSG was used in pilot programs in Indonesia and the Philippines in the 1970s and 1980s (503,1033), but the color instability of the vitamin A in MSG and cost were some barriers to implementation of fortified MSG on a wider scale. Vitamin A-fortified margarine improved serum retinol levels and protected against xerophthalmia in Filipino preschool children (1034). Ideally, vitamin A-fortified foods should reach the most remote and impoverished families, as these constitute a higher-risk group for vitamin A deficiency. In remote Indonesia, salt and monosodium glutamate were widely consumed in most households, whereas instant noodles were consumed less in poorer families (1035).


The ocular component of SS is termed keratoconjunctivitis sicca (KCS). The Schirmer I test is used to test tear production. Standardized Schirmer strips 35 mm long and 5 mm wide, composed of sterilized filter paper, are folded at the notched ends and placed over the lateral lid margin of both lower lids and allowed to remain for five minutes, or until the strips are saturated, if sooner. The Schirmer I is preferred because it tests the ability of the lacrimal gland to produce tears under normal conditions of relatively mild stimulation. Application of a topical anesthetic (Schirmer II) creates an artificial situation in which test values are abnormally low, even in some patients without KCS. In most circumstances, less than 5 mm of wetting in five minutes is considered abnormal. Low Schirmer values are also caused by other ocular conditions not associated with SS.

Cranial Irradiation

The eyes and their surrounding structures can receive radiation in the course of brain irradiation or total body irradiation. This commonly results in dry eyes (xerophthalmia) which can lead in turn to corneal abrasions. Artificial tears can palliate this symptom. Patients whose eyes have been radiated are also at increased risk of developing cataracts. Radiation involving the ear can damage the acoustic structures, and this occurs more commonly than damage to the auditory nerve. Consequently, bone conducting hearing aids can yield effective amplification.


Vitamin A is involved in ocular health and function in two distinct ways. First, in the form retinaldehyde, it is an essential component of rhodopsin and is necessary for maintaining vision (Wahlqvist et al 1997). Deficiency states initially cause a reversible night-blindness that can progress to complete blindness due to photoreceptor degeneration (McCaffery & Drager 1993). Second, as retinoic acid it maintains normal differentiation of cells in the conjunctiva, cornea and other ocular structures, with deficiency resulting in xerophthalmia (dry eye) and corneal ulceration. In xerophthalmia, the cells lining the cornea lose their ability to produce mucus, and therefore lubrication of the eye becomes compromised. Dirt particles that eventually enter the eye are more easily able to scratch the surface, increasing the risk of infection and, ultimately, blindness.

Vitamin A Capsules

High-dose vitamin A supplementation is recommended for immediate treatment of infants, children, and adults (except women of reproductive age) with xerophthalmia according to the treatment schedule shown in Table 5. Women of reproductive age who have night blindness or Bitot spots should be treated with

Growth Retardation

Growth retardation is common among children in developing countries and is considered the best global indicator of physical well-being in children (498). It has long been known that vitamin A-deficient animals exhibit growth failure. Retinoic acid is known to regulate growth hormone gene expression (499). In Indonesia, children with xerophthalmia had reduced linear and ponderal growth (500). Clinical trials show that vitamin A supplementation has an impact on growth, but these effects are strongest in children with more severe vitamin A deficiency (501). In a trial from Aceh, Indonesia, periodic high-dose vitamin A supplementation was associated with greater ponderal growth among boys but not girls (502). In West Java, Indonesia, children in program villages that received vitamin A-fortified MSG had greater linear growth than children from villages without the fortified product (503). Another trial from central Java showed that vitamin A supplementation improved linear growth among...