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Xerophthalmia (Vitamin A Deficiency) - Clinical Guidelines
Xerophthalmia (Vitamin A Deficiency) - Clinical Guidelines
Xerophthalmia (Vitamin A Deficiency) - Clinical Guidelines
Clinical features
Treatment
Prevention
The term xerophthalmia covers all the ocular manifestations of vitamin A deficiency. Xerophthalmia can
progress to irreversible blindness if left untreated.
In endemic areas, vitamin A deficiency and xerophthalmia affect mainly children (particularly those suffering
from malnutrition or measles) and pregnant women.
Disorders due to vitamin A deficiency can be prevented by the routine administration of retinol.
Clinical features
– The first sign is hemeralopia (crepuscular blindness): the child cannot see in dim light, may bump into
objects and/or show decreased mobility.
Treatment
It is essential to recognise and treat early symptoms to avoid the development of severe complications.
Vision can be saved provided that ulcerations affect less than a third of the cornea and the pupil is spared.
Even if deficiency has already led to keratomalacia and irreversible loss of sight, it is imperative to
administer treatment, in order to save the other eye and the life of the patient.
– Retinol (vitamin A) PO
Regardless of the clinical stage:
Children from 6 to 12 months (or under 8 kg): 100 000 IU once daily on D1, D2 and D8
Children over 1 year (or over 8 kg): 200 000 IU once daily on D1, D2 and D8
Adults (except pregnant women): 200 000 IU once daily on D1, D2 and D8
Vitamin A deficiency is rare in breast fed infants under 6 months, if needed: 50 000 IU once daily on D1, D2
and D8.
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1/20/2018 Xerophthalmia (vitamin A deficiency) - Clinical guidelines
– Corneal lesions are a medical emergency. In addition to the immediate administration of retinol, treat or
prevent secondary bacterial infections: apply 1% tetracycline eye ointment twice daily (do not apply eye
drops containing corticosteroids) and protect the eye with an eye-pad after each application.
Prevention
– Systematically administer retinol PO to children suffering from measles (one dose on D1 and D2).
Note: to avoid excessive dosage, record any doses administered on the health/ immunisation card and do
not exceed indicated doses. Vitamin A overdose may cause raised intracranial pressure (bulging fontanelle
in infants; headache, nausea, vomiting) and, in severe cases, impaired consciousness and convulsions.
These adverse effects are transient; they require medical surveillance and symptomatic treatment if needed.
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