Xerophthalmia (vitamin A deficiency) Vitamin A deficiency is rare in breast fed infants under 6

months, if needed: 50 000 IU once daily on D1, D2 and D8.

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.
In pregnant women, treatment varies according to the stage
of illness:
• Hemeralopia or Bitot's spots: 10 000 IU once daily or 25
000 IU once weekly for at least 4 weeks. Do not exceed
indicated doses (risk of foetal malformations).
• If the cornea is affected, risk of blindness outweighs
teratogenic risk. Administer 200 000 IU once daily on D1, D2
and D8.
– Corneal lesions are a medical emergency. In addition to
the immediate administration of retinol, treat or prevent
secondary bacterial infections with 1% tetracycline eye
ointment, one application 2 times daily (do not apply eye
drops containing corticosteroids) and protect the eye with an
eye-pad after each application.

– Then, other signs appear gradually:

• Conjunctival xerosis: bulbar conjunctiva appears dry, dull,
thick, wrinkled and insensitive
• Bitot’s spots: greyish foamy patches on the bulbar
conjunctiva, usually in both eyes (specific sign, however not
always present).
• Corneal xerosis: cornea appears dry and dull
• Corneal ulcerations
• Keratomalacia (the last and most severe sign of
xerophthalmia): softening of the cornea, followed by
perforation of the eyeball and blindness (extreme care must
be taken during ophthalmic examination due to risk of
rupturing cornea).
Prevention
– Systematically administer retinol PO to children suffering
from measles (one dose on D1 and D2).
– In areas where vitamin A deficiency is common, routine
supplementation of retinol PO:
Children under 6 months: 50 000 IU single dose
Children from 6 to 12 months: one dose of 100 000 IU every
4 to 6 months
Children from 1 to 5 years: one dose of 200 000 IU every 4
to 6 months
Mothers after giving birth: one dose of 200 000 IU
immediately after delivery or within 8 weeks of delivery

Treatment
Note: to avoid excessive dosage, record any doses
Treat early symptoms to avoid the development of severe
administered on the health/ immunisation card and do not
complications. Vision can be saved provided that ulcerations
exceed indicated doses. Vitamin A overdose may cause
affect less than a third of the cornea and the pupil is spared.
raised intracranial pressure (bulging fontanelle in infants;
Even if deficiency has already led to keratomalacia and
headache, nausea, vomiting) and, in severe cases, impaired
irreversible loss of sight, it is imperative to administer
consciousness and convulsions. These adverse effects are
treatment, in order to save the other eye and the life of the
transient; they require medical surveillance and symptomatic
patient.
treatment if needed.
– Retinol (vitamin A) PO
Regardless of the clinical stage: https://medicalguidelines.msf.org/viewport/CG/english/xerophtha
Children from 6 to 12 months (or under 8 kg): 100 000 IU lmia-vitamin-a-deficiency-16689721.html
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