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Insights
Vitamin A deficiency in children can lead to severe eye conditions like keratomalacia and corneal xerosis. Early treatment of corneal xerosis significantly improves vision outcomes, while keratomalacia carries a high mortality and blindness risk.
Area of Science:
- Ophthalmology
- Nutritional Science
- Pediatrics
Background:
- Vitamin A deficiency is a significant global health issue, particularly in children.
- Ocular manifestations of vitamin A deficiency range from corneal xerosis to severe keratomalacia.
- Untreated deficiency can lead to irreversible blindness and increased mortality.
Purpose of the Study:
- To evaluate the outcomes of hospitalized children with vitamin A deficiency.
- To assess the prognosis of keratomalacia and corneal xerosis.
- To inform treatment strategies for ocular vitamin A deficiency.
Main Methods:
- Retrospective analysis of 216 children hospitalized with vitamin A deficiency between 1970-1977.
- Follow-up of 56 children, categorizing them into keratomalacia and corneal xerosis groups.
- Assessment of mortality, visual acuity, and long-term outcomes.
Main Results:
- The keratomalacia group had a 30% mortality rate and significant rates of total and monocular blindness.
- In the corneal xerosis group, 21 out of 24 children retained normal vision after treatment.
- Blindness in the keratomalacia group remained unchanged at one-year follow-up.
Conclusions:
- High mortality in keratomalacia cases may explain low prevalence in community surveys.
- Prompt treatment of corneal xerosis offers a high chance of visual recovery.
- Prioritizing treatment for eye involvement before keratomalacia is crucial for better outcomes.
Abstract:
Two-hundred sixteen children with vitamin A deficiency were hospitalized in Hyderabad, India, between 1970 and 1977. Out of these, 22 died during hospitalization. Fifty-six children could be followed-up, of whom 32 had keratomalacia and 24 corneal xerosis. In the keratomalacia group, nine died of reasons attributable to severe protein-energy malnutrition within 3 to 4 months after discharge from the hospital, five became totally blind, nine monocularily blind, and nine had adequate vision, although four of these had leucomas. Of the blind children, no change in condition was noted in the 11 located 1 year after the initial 3 to 4 month follow-up period. Of the 24 children with corneal zerosis, two died within 3 months, 21 retained normal vision, and one had adequate vision with leucoma. The high death rate, i.e., 30% of the keratomalacia cases in this study helps to explain the low prevalence of keratomalacia observed in past and current community surveys. The high return to normalcy of vision in the corneal xerosis cases after proper treatment support the recommendation of treating all children with eye involvement before the keratomalacia state whenever possible, for greater assurance of subsequent eye improvement.
