[Keratomalacia in children with malnutrition]

Twenty-nine malnourished preschoolers in third grade, with a history of globally deficient feeding and very poor individual and environmental hygiene, who presented ocular lesions attributed to avitaminosis A, mainly keratomalacia, were studied. Fifteen patients had keratomalacia with superficial corneal ulceration and fourteen had severe complications such as corneal perforation, descemetocele, expulsion of ocular contents and leukomas adherent to the rest of the eye structures, with final amaurosis. The pathophysiological alterations caused by vitamin A deficiency in ocular structures are synergistic to those inherent to protein deficiency. Treatment should be local, general or surgical; but the main management should be prophylactic, improving the socioeconomic and nutritional conditions of the family. Once severe keratomalacia lesions are established, important visual alterations will persist, from giant leukomas to complete blindness.