2. VITAMIN A DEFICIENCY
BY: SUMAYYA NASEEM
INTERNEE OPTOMETRIST

3. Vitamin A - Needed everywhere.
Vitamin A is one of a group of fat soluble vitamins that are essential
for life and health. Three active forms: retinol, retinal and retinoic.
Vitamin A plays a critical role in:
•Vision (A is part of rhodopsin, the visual pigment)
•Epithelial tissues need to protect integrity.
•Growth
•Reproduction
•Pattern formation during embryogenesis
•Bone development
•Brain development
•Immune system function
Deficiency Diseases: Keratinization, xerosis, Xerophthalmia,
Infections, Weak bones, poor teeth.

5. • Vitamin A deficiency is a preventable cause of blindness.
• It is a well-known cause of blindness and is associated with elevated mortality among
infants and children.
• People most at risk are children between six months to six years, pregnant women,
and lactating women.
• One of the main causes of Xerophthalmia is the poor intake of vitamin A, this disease
is also associated with:
 Faulty feeding habits
 Mal absorption syndromes (cystic fibrosis, Whipple's disease, Crohn's disease,
ulcerative colitis, short bowel syndrome, gastroenteritis, measles)
 Pancreatic disease
 Chronic liver disease
 Weight Loss Surgery
 Poverty
 Ignorance
and some other conditions among the entire population, but mainly in developing
countries and in young children all over the world in particular.

6. Xerophthalmia
• Xerophthalmia (Greek for dry eyes) is a medical condition in which the eye fails
to produce tears. It may be caused by a deficiency in vitamin A and is sometimes
used to describe that lack, although there may be other causes.
Other causes include:
• Hypothyroidism
• Rheumatoid arthritis
• Sarcoidosis
• Scleroderma
• Sjogren's syndrome
• Systemic lupus erythematosus
• Drugs
– Antihistamines
– Nasal decongestants
– Tricyclic antidepressants
• Conjunctivitis
• Keratoconjunctivitis
• Keratoconjunctivitis sicca

8. • Xerophthalmia caused by a severe vitamin A deficiency is
described by pathologic dryness of the conjunctiva and
cornea. The conjunctiva becomes dry, thick and
wrinkled. If untreated it can lead to corneal ulceration
and ultimately in blindness.
• Xerophthalmia is a term that usually implies a
destructive dryness of the conjunctival epithelium due to
dietary vitamin A deficiency — a rare condition in
developed countries, but still causing much damage in
developing countries. Other forms of dry eye are
associated with aging, poor lid closure, scarring from
previous injury, or autoimmune diseases.

10. Classification of Xerophthalmia
Primary signs
X1A Conjunctival Xerosis
X1B Bitot’s spots with conj. xerosis
X2 Corneal Xerosis
X3A Corneal ulceration & Xerosis
X3B Keratomalacia
Secondary signs
XN Night Blindness
XF Xerophthalmic Fundus
XS Xerophthalmic Scars

11. Dryness & Bitot's spot

12. Signs of Xerophthalmia
Top left: Bitot's spot
Top right: Cornea with typical dry appearance and ulcer stained green with fluorescein dye;
Bottom right: Corneal scarring;
Bottom left: Deep corneal ulceration progressing towards keratomalacia.

14. Keratomalacia

16. Symptoms
• Night Blindness (poor vision at night or in dim light)
• Extreme dryness of the eyes
• Dry, foamy & silver-gray deposits on bulbar conjunctiva
• Wrinkling, progressive cloudiness of corneas.

18. Other factors involved in Xerophthalmia
 Protein energy malnutrition (PEM)
 Generalized infections (measles, malaria, gastroenteritis)
 Exposure ulcers
 Herpes simplex
 Intestinal parasites
 Treatment from traditional healers

19. TREATMENT
1. Nutritional and general treatment
2. Topical treatment to the eye
3. Surgery

20. W.H.O.’s recommended doses
(for treatment of children over 1 year of age)
Immediately on diagnosis 200,000 IU vit.A orally
(Day 1)
The following day 200,000 IU vit.A orally
(Day 2)
Four weeks later 200,000 IU vit.A orally
(Week 4)

21. W.H.O.’s recommended doses
(for treatment of children under 1 year of age or <8 kg)
Immediately on diagnosis 100,000 IU vit.A orally
(Day 1)
The following day 100,000 IU vit.A orally
(Day 2)
Four weeks later 100,000 IU vit.A orally
(Week 4)

22. NOTE
• Preventive doses of vitamin A are also given
to pregnant women and those who are breast
feeding. But small daily doses than one
massive dose. The reason is to prevent any
possibility of a massive dose of vitamin A
being teratogenic to fetus.
• If massive dose is not available, then child
should eat food rich in vitamin A.

24. Topical treatment to the eye
• Antibiotics
• Antiviral agents
• Padding an eye
• Closing the eyes
• Mydriatics
• No steroids

27. Surgery
• Corneal Grafting
• Conjunctival flaps

29. Prevention
1. Distribution of massive dose capsules
(with polio vaccine)
2. Food Fortification (to improve nutrition by
enriching commonly-used food products with
important vitamins and minerals)
» Cooking Oil
» Wheat Flour
l
3. Horticulture and agriculture
 Green leafy vegetables
 Orange colored fruits &
vegetables

33. Man fortifying oil in Mali
Fortified milk

34. 4. Nutrition & health education
• Radio
• TV
• School etc.
Mothers will need advice about:
•Breast feeding
•Weaning in general
•How to prepare them, E.g. giving fried egg to
the child
•Liver, egg, cheese, butter, fish liver oil etc are
good sources of vitamin A.
5. Immunization
• Measles
5. Avoid traditional healers
• Herbs
• Tooth paste etc