Xérophtalmie the term means all the ocular manifestations of vitamin A deficiency in the absence of treatment, xerophthalmia can progress to permanent blindness.
In endemic areas, vitamin A deficiency and xerophthalmia affect
mainly children (especially those suffering from malnutrition and measles) and pregnant women.
Disorders related to vitamin A deficiency can be prevented by administration
systematic retinol.
Clinical signs:
– The first sign is night blindness (loss of night vision): the dark, the child faces the objects and stops moving.
– Then the other signs gradually appear:
• conjunctival xerosis: bulbar conjunctiva dry, dull, thick, wrinkled and insensitive
• Spot Bitot: foamy plaque, silver-gray on the bulbar conjunctiva, often bilateral (specific sign but not always present)
• cornéene Xerosis: dry and dull cornea
• Ulcers of the cornea
• Keratomalacia (end stage) softening the cornea and the eyeball perforation and blindness. At this stage, the eye examination should be very careful (risk of rupture of the cornea).
Treatment:
It is essential to treat the early stages to prevent the onset of serious complications. That ulcerations affect less than a third of the cornea and the pupil is spared vision can be retained. It must also deal with the irreversible stage keratomalacia to save the other eye and the patient’s life.
– Retinol (vitamin A) PO
In children and adults (except pregnant women), treatment is the same regardless of the stage of disease:
Children 6 to 12 months or up to 8 kg: 100 000 IU once daily on D1, D2 and D8
Children over one year or more than 8 kg: 200 000 IU once daily on D1, D2 and D8
Adult: 200 000 IU once daily on D1, D2 and D8
Vitamin A deficiency is rare in children under 6 months breastfed. If necessary: 50,000 IU once daily on D1, D2 and D8.
In pregnant women, treatment is different depending on the stage:
• Night blindness and Bitot spots: do not exceed the dose of 10 000 IU / day or 25,000 IU / week (risk of fetal malformation) for 4 weeks minimum.
• Violations of the cornea: the risk of blindness outweighs teratogenic risk: 200 000 IU once daily on D1, D2 and D8.
– The achievement of the cornea is a medical emergency. In addition to the immediate administration of retinol, treat or systematically prevent secondary bacterial infection: apply tetracycline eye ointment 1% 2 times a day (do not use eye drops containing corticosteroids) and cover with an eye patch after each application.
Prevention:
– Systematically administer retinol PO to children with measles (one dose on D1 and D2) and malnourished children (single dose).
– In areas where vitamin A deficiency is common, supplementation of retinol PO:
Children under 6 months: 50,000 IU single dose
Children 6 to 12 months: a single dose of 100,000 IU every 4 to 6 months
Children from 1 to 5 years: a single dose of 200 000 IU every 4 to 6 months
Woman (after childbirth): a single dose of 200 000 IU immediately or within 8 weeks after delivery.
Note: note the doses administered in the health record and respect the dosage to avoid overdose. An overdose of vitamin A can cause intracranial pressure (bulging fontanelle in infants, headache, nausea, vomiting) and in cases of severe intoxication, impaired consciousness, convulsions. These symptoms are transient; they require monitoring and symptomatic treatment if necessary.
