Nightblindness and xerophthalmia
-
Upload
raju-kaiti -
Category
Healthcare
-
view
253 -
download
1
Transcript of Nightblindness and xerophthalmia
![Page 1: Nightblindness and xerophthalmia](https://reader031.fdocuments.net/reader031/viewer/2022021815/586e125d1a28ab8a588b5a95/html5/thumbnails/1.jpg)
NIGHTBLINDNESS AND
XEROPHTHALMIA
Raju Kaiti
Consultant Optometrist
Dhulikhel Hospital, KU
![Page 2: Nightblindness and xerophthalmia](https://reader031.fdocuments.net/reader031/viewer/2022021815/586e125d1a28ab8a588b5a95/html5/thumbnails/2.jpg)
Definition• Also termed as ‘nyctalopia’
• It is defined as diminution of vision in dim light
• It occurs due to defect in transition from photopic to scotopic vision
• Apart from adaptation of mainly photoreceptor rods and then cones, the neural adaptation mechanism also plays role in dark adaptation
![Page 3: Nightblindness and xerophthalmia](https://reader031.fdocuments.net/reader031/viewer/2022021815/586e125d1a28ab8a588b5a95/html5/thumbnails/3.jpg)
Causes
• Retinitis pigmentosa (RP)• Vitamin A deficiency• Gyrate atrophy of choroid and retina• Congenital stationary night blindness (CSNB)• Choroidermia• Myopia
![Page 4: Nightblindness and xerophthalmia](https://reader031.fdocuments.net/reader031/viewer/2022021815/586e125d1a28ab8a588b5a95/html5/thumbnails/4.jpg)
Other causes of Nyctalopia
• Glaucoma• Optic nerve atrophy • Cortical cataract• Panretinal photocoagulation• Zinc deficiency• Drugs – phenothiazine, chloroquine,
hydroxycholoquine
![Page 5: Nightblindness and xerophthalmia](https://reader031.fdocuments.net/reader031/viewer/2022021815/586e125d1a28ab8a588b5a95/html5/thumbnails/5.jpg)
Myopia• Myopic patients also complain of night blindness
which may be the most common cause of poor night vision
• However it is should not confused with blurring of vision in dim light as seen in all refractive disorders
• In very high myopes degenerative changes in choroid and retina lead to subnormal ERG and delayed dark adaptation
![Page 6: Nightblindness and xerophthalmia](https://reader031.fdocuments.net/reader031/viewer/2022021815/586e125d1a28ab8a588b5a95/html5/thumbnails/6.jpg)
RETINITIS PIGMENTOSA• Most frequently seen retinal dystrophy• The term "retinitis" pigmentosa -Donders(1855)• The term "pigmentary degeneration"-von
Graefe(1858)• "Pigmentary retinal dystrophy" -appropriate termPathology• Degeneration of retinal neuroepithelium• particularly of rods• Degeneration of entire retina, RPE, and also
choriocapillaris
![Page 7: Nightblindness and xerophthalmia](https://reader031.fdocuments.net/reader031/viewer/2022021815/586e125d1a28ab8a588b5a95/html5/thumbnails/7.jpg)
CLINICAL PRESENTATION:• Symptomatic onset between
age of 5-30 yrs may occur in 4th or 5th
decades• Symptoms: Difficulty in seeing at
night Daily-life handicap • SignClinical triad- Retinal arteriolar
narrowing Bony spicules Optic disc pallor
![Page 8: Nightblindness and xerophthalmia](https://reader031.fdocuments.net/reader031/viewer/2022021815/586e125d1a28ab8a588b5a95/html5/thumbnails/8.jpg)
Clinical features of RP• Incidence in 1:4000
• Night blindness is one of the hallmark symptoms in RP which usually begin in first or second decade of life
• Visual field loss is second hallmark of RP which is insidious and progressive
• Central vision loss• Light flashes• Loss of color vision• Hearing loss – associated in 30 % RP patients
![Page 9: Nightblindness and xerophthalmia](https://reader031.fdocuments.net/reader031/viewer/2022021815/586e125d1a28ab8a588b5a95/html5/thumbnails/9.jpg)
Clinical FindingsOther Findings: • Lens- Opacity , PSCC type • Vitreous-Condensations, opacities,
cells, PVD • Macula- Early broadening or
loss of the F. R. Epiretinal membrane
changes Pigment epithelial alterations-
mottling, bull's eye, atrophy, pigmentation
• Macular oedema• Full thickness holes
![Page 10: Nightblindness and xerophthalmia](https://reader031.fdocuments.net/reader031/viewer/2022021815/586e125d1a28ab8a588b5a95/html5/thumbnails/10.jpg)
Vitamin A deficiency• Primary cause of childhood blindness in Nepal
• Night blindness is a very sensitive although not very specific indicator of vitamin A deficiency
• Vitamin A forms rhodopsin also known as visual purple present in photoreceptor rods
• The sensitivity of rods is approximately proportional to antilogarithm of rhodopsin concentration
• Deficiency hence impairs functioning of photoreceptor rods leading to night blindness
![Page 11: Nightblindness and xerophthalmia](https://reader031.fdocuments.net/reader031/viewer/2022021815/586e125d1a28ab8a588b5a95/html5/thumbnails/11.jpg)
CHOROIDEREMIA
• X-linked recessive disease
• Granularity and depigmentation of the RPE can be seen around the peripheral fundus.
• Full-field ERGs are reduced in amplitude and delayed in b-wave implicit time with minimally increased dark-adaptation thresholds, and full visual fields
![Page 12: Nightblindness and xerophthalmia](https://reader031.fdocuments.net/reader031/viewer/2022021815/586e125d1a28ab8a588b5a95/html5/thumbnails/12.jpg)
CHOROIDEREMIA
![Page 13: Nightblindness and xerophthalmia](https://reader031.fdocuments.net/reader031/viewer/2022021815/586e125d1a28ab8a588b5a95/html5/thumbnails/13.jpg)
CHOROIDEREMIAIn more advanced stages dark-adaptation thresholds are further increased and the visual fields become constricted;
Female carriers of this disease may demonstrate fundus changes that include patchy depigmentation of the RPE.
However, carriers typically retain normal visual acuities and normal final dark-adapted rod thresholds
![Page 14: Nightblindness and xerophthalmia](https://reader031.fdocuments.net/reader031/viewer/2022021815/586e125d1a28ab8a588b5a95/html5/thumbnails/14.jpg)
GYRATE ATROPHY OF CHOROID AND RETINA
![Page 15: Nightblindness and xerophthalmia](https://reader031.fdocuments.net/reader031/viewer/2022021815/586e125d1a28ab8a588b5a95/html5/thumbnails/15.jpg)
GYRATE ATROPHY OF CHOROID AND RETINA
inherited by an autosomal recessive mode of transmission
Patients usually present in early adolescence with night deficiency and loss of peripheral vision.
Ocular findings include myopia, constricted visual fields, elevated dark-adaptation thresholds, reduced ERG responses and chorioretinal atrophy distributed circumferentially around the peripheral fundus
![Page 16: Nightblindness and xerophthalmia](https://reader031.fdocuments.net/reader031/viewer/2022021815/586e125d1a28ab8a588b5a95/html5/thumbnails/16.jpg)
![Page 17: Nightblindness and xerophthalmia](https://reader031.fdocuments.net/reader031/viewer/2022021815/586e125d1a28ab8a588b5a95/html5/thumbnails/17.jpg)
Stationary forms of night blindness
• Life long stable abnormality of scotpic vision having early onset
Subtypes:• CSNB with normal fundus• CSNB with abnormal fundus
CSNB with normal fundus• X-linked• AD • AR
![Page 18: Nightblindness and xerophthalmia](https://reader031.fdocuments.net/reader031/viewer/2022021815/586e125d1a28ab8a588b5a95/html5/thumbnails/18.jpg)
Stationary forms of night blindness
• CSNB with normal fundusX-linked –commonest• genetic defect- locus Xp11, mutation in rhodopsin
gene• Defect is lies in the failure of communication
between proximal ends of photorecetors and bipolar cells
• some pts. Do not c/o nyctalopia( way of life)• Nystagmus decrease VA or myopia• Range of VA- Normal to 6/60
![Page 19: Nightblindness and xerophthalmia](https://reader031.fdocuments.net/reader031/viewer/2022021815/586e125d1a28ab8a588b5a95/html5/thumbnails/19.jpg)
CSNB• CSNB with abnormal
fundus Fundus Albipunctatus
(AR) Oguchi’s Disease (AR)
Mizuo’s phenomenon
![Page 20: Nightblindness and xerophthalmia](https://reader031.fdocuments.net/reader031/viewer/2022021815/586e125d1a28ab8a588b5a95/html5/thumbnails/20.jpg)
Approach to NBTaking History ( complaints)
1. Night blindness (How do they present to us?) Progressive (RP) Stationary (CSNB) Sudden( paraneoplastic process) Age of onset – imp. Younger (x-linked RP, CSNB)
![Page 21: Nightblindness and xerophthalmia](https://reader031.fdocuments.net/reader031/viewer/2022021815/586e125d1a28ab8a588b5a95/html5/thumbnails/21.jpg)
Contd…..
2. Visual loss : Gradual , progressive Age of onset3. Visual field constriction: peripheral or central How can they present to us?
![Page 22: Nightblindness and xerophthalmia](https://reader031.fdocuments.net/reader031/viewer/2022021815/586e125d1a28ab8a588b5a95/html5/thumbnails/22.jpg)
Medical History• Operations ( Intestinal surgeries, removal of
polydactyl)• Liver diseases• Use of medicine- Hydroxycholoquine or
phenothiazine• Hearing status( RP, Usher’s Syndrome,choroideremia,
Refsum’s)• Mental retardation( BBS,LMS)• Renal disease (BBS)• Heart disease (KSS, Refsum’s)
![Page 23: Nightblindness and xerophthalmia](https://reader031.fdocuments.net/reader031/viewer/2022021815/586e125d1a28ab8a588b5a95/html5/thumbnails/23.jpg)
Family History
• Any NB in past 3 consecutive generation (Dominant RP)
• Anyone in the family affected by retinal degeneration
• Consanguinity
![Page 24: Nightblindness and xerophthalmia](https://reader031.fdocuments.net/reader031/viewer/2022021815/586e125d1a28ab8a588b5a95/html5/thumbnails/24.jpg)
General Examinationwt. loss- vit A deficiency truncal obesity –(Bardet-Biedl Syndrome)
![Page 25: Nightblindness and xerophthalmia](https://reader031.fdocuments.net/reader031/viewer/2022021815/586e125d1a28ab8a588b5a95/html5/thumbnails/25.jpg)
Systemic evaluation:
CVS- Kearn-Sayre Syndrome( ECG- Heart block)
P/A- Colostomy, surgical scars
ENT- Hearing loss ( Usher’s, RP, Choroideremia)
NS – Mental retardation( Bardet-Biedl Syndrome, Gyrate Atrophy Choroidermia, LMS) ,Spastic paraplegia (LMS)
Urogenital- hypogenitalism( Bardet- Biedl syndrome)
Musculo-Skeletal –Polydactyl (Bardet- Biedl syndrome, LMS), muscle weakness(Gyrate Atrophy), deformity (Choroidermia)
Skin – Melanoma ( paraneoplastic cause)
![Page 26: Nightblindness and xerophthalmia](https://reader031.fdocuments.net/reader031/viewer/2022021815/586e125d1a28ab8a588b5a95/html5/thumbnails/26.jpg)
Ocular EvaluationVisual AcuityEOM ( external ophthalmoplegia- KSS, Bassen-Kornzweig, Refsum’s)Lid ( ptosis- KSS)Lens – PSCC- ( RP, Choroideremia, Gyrate Atrophy)Vitreous – fibrillar changes ( Choroideremia), PVD( Gyrate Atrophy)Fundus-Normal or Abnormal Normal fundus ( CSNB)Refractive Status Myopia- ( RP,choroideremia, Gyrate Atrophy) High Myopia ( CSNB) Astigmatism-( RP)
![Page 27: Nightblindness and xerophthalmia](https://reader031.fdocuments.net/reader031/viewer/2022021815/586e125d1a28ab8a588b5a95/html5/thumbnails/27.jpg)
Fundus Changes in cases of NB
•RP
Choroideremia
Gyrate atrophy
![Page 28: Nightblindness and xerophthalmia](https://reader031.fdocuments.net/reader031/viewer/2022021815/586e125d1a28ab8a588b5a95/html5/thumbnails/28.jpg)
Fundus Changes
Oguchi
![Page 29: Nightblindness and xerophthalmia](https://reader031.fdocuments.net/reader031/viewer/2022021815/586e125d1a28ab8a588b5a95/html5/thumbnails/29.jpg)
Investigations • Visual fields( All)
• Dark Adaptometry
• ERG( all)
• Color vision( later stages of RP)
• Biochemical: Ser. Vit A level Ser. Lipoprotein( Bassen – Kornzweig syndrome) Ser. Phytanic acid level ( Refsum’s) Ser. Ornithine level( Gyrate Atrophy)
![Page 30: Nightblindness and xerophthalmia](https://reader031.fdocuments.net/reader031/viewer/2022021815/586e125d1a28ab8a588b5a95/html5/thumbnails/30.jpg)
ManagementStaging ( current VA, VF, dark adaptation, color vision, rod-cone ERG)
Give devices for maximizing remaining vision
Monitoring Disease progression- 2yrs.-VF,ERG,Va
Counseling – Genetic + Vocational
Medical T/T: Vit. A, Acetazolimide, Docosahexanoic acid(DHA)-trial( RP) Vit A, K, E( Bassen- Kornzweig) Vit B6 ( Gyrate Atrophy)
![Page 31: Nightblindness and xerophthalmia](https://reader031.fdocuments.net/reader031/viewer/2022021815/586e125d1a28ab8a588b5a95/html5/thumbnails/31.jpg)
XEROPHTHALMIA
![Page 32: Nightblindness and xerophthalmia](https://reader031.fdocuments.net/reader031/viewer/2022021815/586e125d1a28ab8a588b5a95/html5/thumbnails/32.jpg)
Definition:
• Xerophthalmia is the general term applied to all the ocular manifestations of impaired Vitamin A metabolism, from night blindness through complete corneal destruction
![Page 33: Nightblindness and xerophthalmia](https://reader031.fdocuments.net/reader031/viewer/2022021815/586e125d1a28ab8a588b5a95/html5/thumbnails/33.jpg)
XEROPHTHALMIA• Xerophthalmia
• Xeros --- Dry
• Ophthalmia --- Eye
• literally means “dry eye,”
• Many causes of dry eye but conventionally Xerophthalmia has become synonymous with vitamin A deficiency.
![Page 34: Nightblindness and xerophthalmia](https://reader031.fdocuments.net/reader031/viewer/2022021815/586e125d1a28ab8a588b5a95/html5/thumbnails/34.jpg)
RDA: 5000 IU for men 4000 IU for women
Sources: liver, egg yolks and dairy products, tomatoes, yellow and green leafy vegetables, and fish liver oils.
Vitamin A helps the eyes , the skin and the development of healthy teeth and bones.
we can also battle stress with enough of this vitamin.
Deficiency will also make susceptible to infection
![Page 35: Nightblindness and xerophthalmia](https://reader031.fdocuments.net/reader031/viewer/2022021815/586e125d1a28ab8a588b5a95/html5/thumbnails/35.jpg)
Risk Factors
• Protein Energy Malnutrition
• Measles, Chickenpox, High Fevers
• Bronchopneumonia, Tuberculosis, Diphtheria
• Gastroenteritis, Dysentery, Worm Infestations
![Page 36: Nightblindness and xerophthalmia](https://reader031.fdocuments.net/reader031/viewer/2022021815/586e125d1a28ab8a588b5a95/html5/thumbnails/36.jpg)
Xerophthalmia in Nepal:• Two sources of information
– Tribhuvan University Survey (1980-1981 AD)– Nepal Blindness Survey (1980-1981 AD)
• Major public health problem
• 0.9% bilateral blindness due to nutritional corneal ulceration
• Every day one child dies and one child goes blind of xerophthalmia
![Page 37: Nightblindness and xerophthalmia](https://reader031.fdocuments.net/reader031/viewer/2022021815/586e125d1a28ab8a588b5a95/html5/thumbnails/37.jpg)
Normal Vitamin A MetabolismDietary Vitamin A(Carotenes in plant food)(Retinol in animal food)
Digestion and absorption of Vitamin A from the food Transport in intestinal lymphatics
1. Storage of Vitamin A in liver cells as retinol2. Production of retinol binding protein (the carrier protein)
Transport of retinol bound to retinol binding protein
1. Formation of rhodopsin - used in night vision2. Maintenance of healthy corneal and conjunctival cells
FOOD
INTESTINE
LIVER
BLOOD
EYE
![Page 38: Nightblindness and xerophthalmia](https://reader031.fdocuments.net/reader031/viewer/2022021815/586e125d1a28ab8a588b5a95/html5/thumbnails/38.jpg)
Vitamin A Deficieny
Dietary deficiency of Vitamin A
Diarrhoea; Gastroenteritis; Parasites
Not enough Vitamin A stored in the liver
Low Vitamin A levels in the blood
Night Blindness
FOOD
INTESTINE
LIVER
BLOOD
EYE
Anorexia from other diseases
Protein Energy Malnutrition
Poor intestinal absorption
Not enough Retinol Binding Protein synthesis
Xerophthalmia
![Page 39: Nightblindness and xerophthalmia](https://reader031.fdocuments.net/reader031/viewer/2022021815/586e125d1a28ab8a588b5a95/html5/thumbnails/39.jpg)
Slide XE01Conjunctival xerosis (X1A) and corneal xerosis (X2)The term conjunctival xerosis (X1A) applies to any stage of xerotic change in the conjunctiva, with thickening and wrinkling in advanced cases as in this slide. In this case there is also infiltration and haziness of the cornea (X2).
![Page 40: Nightblindness and xerophthalmia](https://reader031.fdocuments.net/reader031/viewer/2022021815/586e125d1a28ab8a588b5a95/html5/thumbnails/40.jpg)
Bitot’s spot is a single or multiple heaping up of desquamated keratinised bulbar conjunctival epithelial cells, most commonly in the inter-palpebral fissure on the temporal aspect of the eye. Most spots are foamy, some are more solid and cheese-like. In children under the age of about 6 years they usually respond to vitamin A dosing. However, sometimes they are unresponsive and then probably indicative of VAD in the past. In older children and adults they are usually unrelated to VAD.
![Page 41: Nightblindness and xerophthalmia](https://reader031.fdocuments.net/reader031/viewer/2022021815/586e125d1a28ab8a588b5a95/html5/thumbnails/41.jpg)
![Page 42: Nightblindness and xerophthalmia](https://reader031.fdocuments.net/reader031/viewer/2022021815/586e125d1a28ab8a588b5a95/html5/thumbnails/42.jpg)
• Most of the bulbar conjunctiva is covered with foamy, keratinised epithelial cells. The cornea is hazy and the limbus is infiltrated by fine blood vessels (neovascularisation).
![Page 43: Nightblindness and xerophthalmia](https://reader031.fdocuments.net/reader031/viewer/2022021815/586e125d1a28ab8a588b5a95/html5/thumbnails/43.jpg)
Most of the bulbar conjunctiva is covered with foamy, keratinised epithelial cells. The cornea is hazy and the limbus is infiltrated by fine blood vessels(neovascularisation).
![Page 44: Nightblindness and xerophthalmia](https://reader031.fdocuments.net/reader031/viewer/2022021815/586e125d1a28ab8a588b5a95/html5/thumbnails/44.jpg)
Cloudy cornea, corneal ulcer
![Page 45: Nightblindness and xerophthalmia](https://reader031.fdocuments.net/reader031/viewer/2022021815/586e125d1a28ab8a588b5a95/html5/thumbnails/45.jpg)
Keratomalacia is due to severe VAD in which the cornea liquefies in the acute stage. On resolution various types of corneal destruction/scarring are inevitable, as is visual impairment
![Page 46: Nightblindness and xerophthalmia](https://reader031.fdocuments.net/reader031/viewer/2022021815/586e125d1a28ab8a588b5a95/html5/thumbnails/46.jpg)
![Page 47: Nightblindness and xerophthalmia](https://reader031.fdocuments.net/reader031/viewer/2022021815/586e125d1a28ab8a588b5a95/html5/thumbnails/47.jpg)
• A case that could be treated. • An advanced state of deficiency
with keratomalacia.
![Page 48: Nightblindness and xerophthalmia](https://reader031.fdocuments.net/reader031/viewer/2022021815/586e125d1a28ab8a588b5a95/html5/thumbnails/48.jpg)
The same eye one month after treatment. The child was treated immediately with large doses of vitamin A. The cornea has healed and there is only a scare left in the lower part, not impairing vision. This child was lucky.
![Page 49: Nightblindness and xerophthalmia](https://reader031.fdocuments.net/reader031/viewer/2022021815/586e125d1a28ab8a588b5a95/html5/thumbnails/49.jpg)
Scars attributable to VAD are usually bilateral and located in the central and inferior portion of the cornea. In the field these inactive lesions are often one of the commonest clinical pieces of evidence of a public health problem of VAD in the past. However, a careful history must be taken to exclude those not related to VAD in the past; they might result from injury or infectious eye disease.
![Page 50: Nightblindness and xerophthalmia](https://reader031.fdocuments.net/reader031/viewer/2022021815/586e125d1a28ab8a588b5a95/html5/thumbnails/50.jpg)
Plate 1: Xerophthalmic fundus in a 24-year-old otherwise well nourished Indonesian woman who presented with night blindness, constricted visual fields and severe conjunctival and corneal xerosis.Plate 2: Two months after vitamin A therapy the small yellowish-white retinal lesions in the patient in Plate 1 have largely disappeared
![Page 51: Nightblindness and xerophthalmia](https://reader031.fdocuments.net/reader031/viewer/2022021815/586e125d1a28ab8a588b5a95/html5/thumbnails/51.jpg)
![Page 52: Nightblindness and xerophthalmia](https://reader031.fdocuments.net/reader031/viewer/2022021815/586e125d1a28ab8a588b5a95/html5/thumbnails/52.jpg)
Eye Changes
1. ConjunctivaX1AX1B
+ XN2. Cornea
X2X3AX3BXS
3. RetinaXNXF
Warning Sign
Medical + Ophthalmological Emergency
First Sign of Xerophthalmia
![Page 53: Nightblindness and xerophthalmia](https://reader031.fdocuments.net/reader031/viewer/2022021815/586e125d1a28ab8a588b5a95/html5/thumbnails/53.jpg)
The Recommended Doses of Vitamin A
• Prophylactic Schedule:Dose By Mouthmg I.U.
– All Children 110 200,000Every 4 -6 months
– Mothers 110 200,000Just after giving birth
For children less than 1 year of age, reduce dose by one half
![Page 54: Nightblindness and xerophthalmia](https://reader031.fdocuments.net/reader031/viewer/2022021815/586e125d1a28ab8a588b5a95/html5/thumbnails/54.jpg)
The Recommended Doses of Vitamin A
• Treatment Schedule:
If the children is severely ill with gastroenteritis or unable to swallow, the first dose should be intramuscular injection water soluble Vitamin A
Emergency Treatment of Children with Xerophthalmia or Corneal Ulcers
Day / Week Dose By Mouthmg I.U.
Day 1 110 200,000Day 2 110 200,000Day 14(2-4 Weeks)
110 200,000
![Page 55: Nightblindness and xerophthalmia](https://reader031.fdocuments.net/reader031/viewer/2022021815/586e125d1a28ab8a588b5a95/html5/thumbnails/55.jpg)
National Vitamin A Programme
• Children : 6 months - 5 years (3.5 Million)• Twice a year : April 18 & 19
October 18 & 19• Coverage :75 districts - 85%• FCHV : 48,000• Reduction of Child Mortality : 20-25 thousand
![Page 56: Nightblindness and xerophthalmia](https://reader031.fdocuments.net/reader031/viewer/2022021815/586e125d1a28ab8a588b5a95/html5/thumbnails/56.jpg)
Prevention of Xerophthalmia
• Distribution of Massive Dose Capsules• Fortification of Foods• Horticulture and Agriculture• Nutrition and Health Education
i. Late Weaningii. Early Supplementationiii. Mass Media Radio, TViv. Changing Eating Habits
• Immunization
![Page 57: Nightblindness and xerophthalmia](https://reader031.fdocuments.net/reader031/viewer/2022021815/586e125d1a28ab8a588b5a95/html5/thumbnails/57.jpg)
Treatment of XerophthalmiaA. MEDICAL
1. Vitamin A Massive Dosing• Oral: Day 1, 2, 14 - 200,000 I.U.• Injection: 1st Day Only - 100,000 I.U.
Water MiscibleNo oily preparation
If not available: Give food rich in Vitamin A
2. Supportive Therapy• Fluids• Proteins• Control of Infection• Deworming
![Page 58: Nightblindness and xerophthalmia](https://reader031.fdocuments.net/reader031/viewer/2022021815/586e125d1a28ab8a588b5a95/html5/thumbnails/58.jpg)
Treatment of XerophthalmiaA. MEDICAL
3. Eye• Antibiotcs, Mydiatrics• Pad specially in X3A, X3B• Avoid Exposure: Antibiotic Ointment• Methyl Cellulose Drops
B. SURGERY1. Conjunctivoplasty2. Keratoplasty
a. Prophylacticb. Optical
C. REHABILITATION
![Page 59: Nightblindness and xerophthalmia](https://reader031.fdocuments.net/reader031/viewer/2022021815/586e125d1a28ab8a588b5a95/html5/thumbnails/59.jpg)
Prevention of Vitamin A deficiency
– Breastfeeding – Vitamin A
supplementation – Food fortification – Promotion of
vitamin A-rich diets
![Page 60: Nightblindness and xerophthalmia](https://reader031.fdocuments.net/reader031/viewer/2022021815/586e125d1a28ab8a588b5a95/html5/thumbnails/60.jpg)
THANK
YOU…………………