Xerophthalmia.

Xerophthalmia is a medical condition characterized by dryness of the eyes due to insufficient tear
production or poor quality tears. It primarily occurs as a result of vitamin A deficiency, which is essential
for maintaining the health of the cornea and conjunctiva.

Symptoms of xerophthalmia may include:

1. Dryness and irritation in the eyes

2. Redness and inflammation of the conjunctiva (conjunctivitis)

3. Difficulty seeing in low light or night blindness (nyctalopia)

4. Corneal ulcers or scars

5. Bitot's spots - white or grayish patches on the conjunctiva

6. Blindness if left untreated, particularly in severe cases

Xerophthalmia is often prevalent in areas where malnutrition is common, particularly in developing

countries. It can also occur in individuals with conditions that impair the absorption of dietary fats or
those who have undergone certain types of gastrointestinal surgery.

Treatment typically involves addressing the underlying cause, such as correcting vitamin A deficiency
through dietary changes or supplements. Additionally, artificial tears or lubricating eye drops may be
used to alleviate symptoms of dryness and discomfort. In severe cases, particularly if there are corneal
ulcers or scars, medical intervention such as surgery may be necessary to restore vision. Preventive
measures include ensuring a balanced diet rich in vitamin A-containing foods, particularly in at-risk
populations such as young children and pregnant women in areas with limited access to nutritious food.
Regular eye exams are also important for early detection and management of xerophthalmia.

Several risk factors can contribute to the development of xerophthalmia, including:

1. Malnutrition: Vitamin A deficiency is the primary risk factor for xerophthalmia. Inadequate intake of
foods rich in vitamin A, such as liver, dairy products, eggs, and colorful fruits and vegetables, can lead to
deficiency.

2. Poor diet: Diets lacking in essential nutrients, particularly vitamin A, increase the risk of
xerophthalmia. This is especially common in areas where access to diverse and nutritious foods is
limited.
3. Infancy and early childhood: Young children are particularly vulnerable to xerophthalmia due to their
rapid growth and development, coupled with potential inadequate intake of vitamin A-rich foods.

4. Pregnancy and lactation: Pregnant and breastfeeding women have increased nutritional needs, and if
their diet is deficient in vitamin A, they may be at risk of developing xerophthalmia.

5. Underlying health conditions: Certain medical conditions, such as cystic fibrosis, inflammatory bowel
disease, or liver disorders, can impair the absorption of dietary fats and fat-soluble vitamins like vitamin
A, increasing the risk of deficiency.

6. Gastrointestinal surgery: Surgical procedures involving the removal or alteration of parts of the
digestive tract can affect the absorption of nutrients, including vitamin A, leading to deficiency and
xerophthalmia in some cases.

7. Geographical location: Xerophthalmia is more prevalent in regions where malnutrition is common and
access to nutritious foods is limited, particularly in developing countries with socioeconomic challenges.

8. Poor socioeconomic status: Individuals from low-income backgrounds may have limited access to
nutritious foods and healthcare resources, increasing their vulnerability to xerophthalmia and other
nutritional deficiencies.

9. Alcoholism: Excessive alcohol consumption can impair the absorption and utilization of nutrients,
including vitamin A, contributing to the development of xerophthalmia.

10. Substance abuse: Certain drugs and substances, such as certain medications and illicit drugs, can
interfere with nutrient absorption and metabolism, potentially increasing the risk of xerophthalmia.

Addressing these risk factors through improved nutrition, access to healthcare, public health
interventions, and education can help prevent xerophthalmia and reduce its prevalence in at-risk
populations.

Prevention and control of xerophthalmia primarily involve strategies aimed at ensuring adequate intake
of vitamin A and addressing underlying risk factors. Here are some key approaches:

1. Dietary interventions: Promote consumption of foods rich in vitamin A, such as liver, dairy products,
eggs, orange-colored fruits and vegetables (e.g., carrots, sweet potatoes, pumpkin), leafy greens, and
fortified foods. Encourage dietary diversity to ensure overall nutritional adequacy.

2. Supplementation programs: Implement vitamin A supplementation programs, particularly in high-risk

populations such as young children, pregnant and breastfeeding women, and communities with
documented vitamin A deficiency. Supplementation may be in the form of high-dose vitamin A capsules
or periodic distribution of vitamin A-rich foods.
3. Nutrition education: Provide education on the importance of balanced nutrition, including the role of
vitamin A in eye health. Teach communities about locally available vitamin A-rich foods and culturally
appropriate dietary practices to prevent deficiency.

4. Breastfeeding promotion: Encourage exclusive breastfeeding for the first six months of life, followed
by continued breastfeeding alongside appropriate complementary feeding. Breast milk is a good source
of vitamin A and helps protect infants from deficiency.

5. Food fortification: Support national food fortification programs to enrich staple foods with essential
nutrients, including vitamin A. Fortification of commonly consumed foods like cooking oil, sugar, flour,
and salt can help increase vitamin A intake across populations.

6. Healthcare access: Ensure access to healthcare services, including prenatal and postnatal care, to
monitor and address nutritional status, particularly in vulnerable groups. Regular health check-ups,
including eye examinations, can help detect and manage xerophthalmia early.

7. Public health interventions: Implement public health initiatives aimed at improving sanitation,
hygiene, and overall living conditions to reduce the prevalence of infectious diseases that can
exacerbate malnutrition and vitamin A deficiency.

8. Community involvement: Engage communities in identifying and addressing factors contributing to

malnutrition and xerophthalmia. Empower community health workers and local leaders to promote
nutrition education, distribute supplements, and advocate for improved access to nutritious foods and
healthcare services.

9. Research and monitoring: Conduct research to assess the prevalence and determinants of
xerophthalmia, as well as the effectiveness of preventive interventions. Establish surveillance systems to
monitor nutritional status and eye health indicators, enabling timely intervention and evaluation of
programmatic efforts.

By implementing comprehensive strategies addressing both dietary intake and systemic factors,
xerophthalmia can be effectively prevented and controlled, ultimately reducing the burden of this
preventable cause of blindness and visual impairment.

When considering vitamin A supplements for children and adults, it's important to consult with a
healthcare professional to determine the appropriate dosage and form based on individual needs and
health status. However, here are some commonly recommended vitamin A supplements for both age
groups:

For Children:
1. Vitamin A Drops or Syrup: Liquid formulations specifically designed for infants and young children are
available and can be administered orally. These typically come in dropper bottles or measured syringes
for accurate dosing.

2. Pediatric Multivitamins: Many pediatric multivitamin products contain vitamin A in child-friendly

doses and formulations. These are often available in chewable tablets, gummies, or liquid forms.

3. Vitamin A Capsules: In some cases, healthcare providers may prescribe vitamin A capsules formulated
for children, especially for those at high risk of deficiency or with specific health conditions.

For Adults:

1. Standard Vitamin A Capsules or Tablets: Adults can typically take standard vitamin A supplements
available in capsule or tablet form. These are commonly found in pharmacies and health food stores.
However, it's essential to follow dosage recommendations carefully to avoid excessive intake, as vitamin
A can be toxic in high doses.

2. Multivitamins for Adults: Many multivitamin supplements formulated for adults contain vitamin A
along with other essential nutrients. These are convenient for individuals who prefer a comprehensive
approach to supplementation.

3. Cod Liver Oil: Cod liver oil is a natural source of vitamin A, as well as vitamin D and omega-3 fatty
acids. It's available in liquid and capsule forms and is a popular supplement choice for adults seeking to
boost their vitamin A intake.

4. Plant-based Sources: Some individuals prefer plant-based sources of vitamin A, such as beta-carotene
supplements derived from algae or other sources. These supplements provide provitamin A carotenoids
that the body can convert into vitamin A as needed.

When selecting a vitamin A supplement, consider factors such as dosage, formulation, potential
interactions with medications or other supplements, and individual preferences. Additionally, ensure
that the supplement is from a reputable manufacturer and meets quality and safety standards. Always
follow the recommended dosage instructions provided by the healthcare provider or the supplement
packaging to avoid adverse effects.

Administering vitamin capsules according to international units (IU) at different ages involves
considering factors such as recommended daily allowances (RDAs), tolerable upper intake levels (ULs),
and specific needs based on age and health status. Here's a general guideline for administering vitamin
capsules in IU at different age groups:
Vitamin A supplementation: who, when and how

The majority of countries where vitamin A deficiency (VAD) is known to be a severe public health
problem have policies supporting the distribution of vitamin A. This article provides guidelines for
vitamin A supplementation in children and women and discusses when it is safe to phase out
supplementation.

Vitamin A supplements for young children aged 6–59 months

The World Health Organization (WHO) recommends that all children aged 6–59 months should receive
supplements if they live in a community where VAD is a public health problem. These are communities
where the prevalence of night blindness is ≥ 1% in children aged 24–59 months, or where the
prevalence of VAD is ≥ 20% in infants and children aged 6–59 months.

The suggested vitamin A supplementation scheme for prevention of deficiency in children aged 6–59
months in areas where VAD is a severe public health problem is shown in Table Table11.

Vitamin A supplements for newborns and children aged 1–5 months

Vitamin A supplementation of newborns and children aged 1–5 months is not yet recommended by
WHO. Exclusive breastfeeding of infants is encouraged for the first six months of life, to help achieve
optimal growth, development and health.

Vitamin A supplements for pregnant women are not routinely recommended

Although women are highly susceptible to VAD during pregnancy, vitamin A supplementation during
pregnancy is not recommended, as high-dose vitamin A from supplements may cause harm to the
developing baby. Instead, pregnant women are encouraged to meet their increased requirements by
eating enough vitamin A-rich foods ; this is unlikely to harm the developing foetus.

High-dose vitamin A in oral liquid form is given to a child

The only circumstance in which vitamin A supplementation during pregnancy may be considered is
when women live in an area where VAD is a severe public health problem of pregnant women in that
area have night blindness). It is very important to note that far lower doses are needed for pregnant
women than for children, and doses need to be given .
Vitamin A supplements for women who have recently given birth are not routinely recommended

Giving high-dose vitamin A to women immediately after delivery is also not recommended by the WHO
(2011 Guidelines).

When to phase out vitamin A supplements

WHO and the United Nations Children's Fund (UNICEF) recommend phasing out vitamin A
supplementation when VAD is no longer a public health problem. This means there must be clear
evidence that the prevalence of night blindness or reduced serum retinol levels are well below the
minimum public health thresholds for an extended period of time and, at the same time, that mortality
rates in under-5s are in long-term decline.

Table 1. High-dose vitamin A supplementation to prevent deficiency in children aged 6–59 months

Target age group Oral dose Frequency Route of administration

1.6–11 months 100,000 IU Once Oral liquid, oil-based preparation of retinyl palmitate or retinyl
acetate

2.12–59 months 200,000 IU Every 4–6 months Oral liquid, oil-based preparation of
retinyl palmitate or retinyl acetate

Table 2. Low-dose vitamin A supplementation to prevent deficiency in pregnant women (Note: ONLY in
areas where vitamin A deficiency is a severe public health problem)

Target group Oral dose Frequency Route of administration Duration

Pregnant women Up to 10,000 IU vitamin A OR Daily dose Oral liquid, oil-based

preparation of retinyl palmitate or retinyl acetate.