About Xerotic Keratitis , Keratomalacia

Xerotic Keratitis begins with dry ness of the conjunctiva; and a general haziness of the cornea, which soon leads to ulceration, perforation, and loss of the eye. Both eyes are generally affected; the disease occurs in feeble infants that rarely survive.

Keratomalacia is a disorder affecting the eyes, which is caused by vitamin A deficiency. Vitamin A deficiency can affect a variety of organs in the body including the eyes.

The topic Xerotic Keratitis caused by Keratomalacia you are seeking is a synonym, or alternative name, or is closely related to the medical condition Keratomalacia.

What is Keratomalacia? (Definition/Background Information)

• Keratomalacia is a disorder affecting the eyes, which is caused by vitamin A deficiency.  Vitamin A deficiency can affect a variety of organs in the body including the eyes
• Vitamin A is important for the optimal growth of the skin, bone, mucus membranes of the stomach, intestine, and reproductive tract
• Vitamin A is required to maintain the normal epithelium of cornea and conjunctiva. There is dryness of the cornea and conjunctiva with secondary ulceration and bacterial infection in Keratomalacia
• The common signs and symptoms of Keratomalacia include night blindness, excessive dryness of the eyes, and corneal wrinkling. In case of complications, the condition may lead to blindness and corneal infection
• Keratomalacia is treated through vitamin A replacement and eye drops to prevent eye dryness. With appropriate treatment and aggressive replacement of vitamin A, the prognosis is generally improved

Diagnosis.

Keratitis is recognized by careful inspection of the cornea under the proper conditions of illumination. Slight opacity is rendered most evident by strong oblique illumination which should be so arranged that the light will be concentrated upon the cornea, while the iris behind it is left in comparative shadow, to furnish a dark background.

Localized points of opacity in front of the pupil may also be studied with the ophthalmoscope, using the strongest con vex lens behind the mirror, and looking from about the focal distance of the lens in front of the eye.

Ulceration is best discovered by placing the patient where the light from a large window will be reflected from the surface of the cornea, snch a reflex showing all the irregulari ties of the reflecting surface. To make sure that these irregularities arc not filled in with mueus, that may render them invisible, it is well to wipe the sur face with a pledget of cotton. Or to outline an ulcer more distinctly for treat ment, it may be stained with a solution of fluorescin, 1 part; sodium bicarbonate, 2 parts; distilled water, 200 parts; or with one of toluiclin-blue 1 to 1000.

How is Keratomalacia Diagnosed?

The diagnosis of Keratomalacia may involve:

• Complete evaluation of medical history along with a thorough physical examination
• Eye examination and vision test
• Colour blindness test
• Laboratory measurement of serum retinol levels

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

Conjunctivms

Keratitis must be distinguished from conjunctivitis. Le sions of the cornea are the most common and the most dreaded complications of conjunctival inflammation. But more especially on that account is it necessary to recognize promptly when the cornea bet nus imolled.

The treatment gum d ktratitis is, too, in many re t, totallr different from that appro priatt to conjunctivitis. Ctiless the cor nea list. f exhibits the characteristic opac ity or 1–ss obstance, we cannot assume that it is affected. The redness of the perieorneal zone. while quite different

from the typical redness of conjunctivi tis, may be completely hidden by swell ing of the conjunctiva.

Lizirts.

The diircrential diagnosis be tween keratitis and iritis is also very im portant. IIere, too, the detection of the actual lesions present in one or thc other of these structures is to be relied on. Corneal disease may cause apparent dis coloration of the iris and in the early stage of keratitis the pupil is apt to be very small. But the use of a mydriatic (which would generally be very appropri ate for either disease) will, in keratitis, produce regular dilatation of the pupil, even if it is. not as wide as in the normal eye.

An error, much more grave, is to mis take inflammatory glaucoma for keratitis. Both diseases may present perieorneal redness, pain, photophobia, and haziness of the cornea and glaucoma shows im pairment of the sense of touch in the cornea, as markedly as does neuropathic keratitis. In the latter disease the ten sion of the eyeball may be diminished in glaucoma simulating keratitis it is always increased.

The pupil in glaucoma is more or less dilated in keratitis, un less a mydriatie has been used, it is con tracted or normal. The haziness of the cornea is more uniform and diffuse in glaucoma, while in keratitis it is more likely to be localized. Corneal ulcer may occur in glaucoma, but usually only in chronic cases.

The chief pain of glaucoma is of an aching character, and is felt as much in the brow and cheek as in the eyeball. That of keratitis is more likely to be smarting or burning, or the sense of a foreign body. If a mydriatic has been used and the pupil has been dilated, the tension of the eyeball and the oplitlialinoscopic symptoms must be relied on.

Haziness of the cornea, suffi cient to prevent an ophthalmoscopical diagnosis, is not likely- to occur in glau coma, except when the increase of ten sion is so great as to be quite unmistak able

What are the Signs and Symptoms of Keratomalacia?

The signs and symptoms of Keratomalacia include:

• Night blindness, which is poor vision in dim or poor light (especially at nights)
• Xerophthalmia – extreme dryness of the eyes
• Wrinkled cornea; progressive softening of the cornea and corneal cloudiness
• Grey deposit on the delicate membrane covering the whites of the eyes

This disorder is bilateral and it affects both the eyes.

Who gets Keratomalacia? (Age and Sex Distribution)

• Keratomalacia can occur in individuals of any age group; however, the condition is predominantly observed in infants and young children
• The condition is observed in both males and females; there is no gender preference
• The condition is more prevalent in certain developing countries where vitamin A deficiency is more common

What are the Risk Factors for Keratomalacia? (Predisposing Factors)

Risk factors associated with Keratomalacia include:

• Infants and pre-schoolers living below poverty line
• Malnourished people
• Alcoholics
• Individuals who are pure vegans
• Consumption of a diet poor in vitamin A (such as skimmed milk rather than whole milk)
• Individuals who suffer from fat malabsorption, inflammatory bowel diseases
• Those who have undergone small bowel surgery

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Keratomalacia? (Etiology)

Keratomalacia is caused by vitamin A deficiency typically in patients with protein-calorie undernutrition. It is characterized by a hazy, dry cornea. Corneal ulceration with secondary infection is common. The lacrimal glands and conjunctiva are also affected. Lack of tears causes extreme dryness of the eyes, and foamy spots appear on the temporal and often nasal bulbar conjunctiva (Bitot spots). Night blindness may occur. For further details, including specific therapy, see Vitamin A Deficiency.

Keratomalacia is an ocular disorder that is caused by the dietary deficiency of vitamin A. This condition is caused by taking ‘vitamin A poor foods’ such as:

• Beto carotene rich foods such as green leafy vegetables, orange-colored fruits and vegetables
• Retinoid rich foods such as liver and eggs

This deficiency disorder can also occur when the body is unable to absorb beta carotene and retinoids, or when the body is unable to convert beta carotene and retinoids to vitamin A.

What are the possible Complications of Keratomalacia?

The possible complications associated with Keratomalacia include:

• Blindness
• Corneal infection
• Corneal rupture (perforation)

Treatment of Keratomalacia

• Antibiotic eye drops or ointments
• Treatment of vitamin A deficiency and improvement of diet

Antibiotic eye drops or ointments can help cure an infection, but correcting the vitamin A deficiency and undernutrition with an improved diet or supplements is also important.

How is Keratomalacia Treated?

The treatment for Keratomalacia typically involves:

• Aggressive vitamin A replacement therapy
• Antibiotics to prevent infections in the fragile cornea
• Usage of eye drops for dry eyes
• Augmenting the diet with vitamin A, beta carotene, and retinoid. This can gradually help arrest the corneal and lacrimal gland damage

How can Keratomalacia be Prevented?

Keratomalacia is a preventable disorder that can be prevented by including the following in one’s diet:

• Foods (fruits and vegetables) that are rich in beta carotene that includes green leafy vegetables (broccoli, spinach), cantaloupe, sweet potatoes, apricots, palm oil, and carrots
• Foods that are rich in retinoids such as liver, eggs, and fish

Children diagnosed with measles must have adequate vitamin A rich foods, since they are at an increased risk for Keratomalacia.

What is the Prognosis of Keratomalacia? (Outcomes/Resolutions)

• Usually in Keratomalacia, there is ulceration of the cornea that occurs rapidly and this generally affects both the eyes. The ulceration can cause the loss of corneal thickness, which can result in corneal perforation. If this is not treated aggressively, this can lead to blindness
• With appropriate early treatment and proper replacement of vitamin A, the prognosis is generally improved

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