Xerophthalmia - PowerPoint PPT Presentation

View by Category
About This Presentation
Title:

Xerophthalmia

Description:

Title: 1 Author: Acer Last modified by: host1 Created Date: 1/6/2006 6:07:33 AM Document presentation format ... – PowerPoint PPT presentation

Number of Views:1971
Avg rating:3.0/5.0
Slides: 49
Provided by: acer191
Learn more at: http://www.med.cmu.ac.th
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Xerophthalmia


1
(No Transcript)
2
Xerophthalmia
  • Literaly means dry eye
  • Ocular abnormalities from vitamin A deficiency
    (nutritional deficiency)
  • Include night blindness, conjunctival and corneal
    xerosis, corneal ulceration and melting
  • If in severe stage will have liquefactive corneal
    necrosis (Keratomalacia)

3
Causes
  • Vitamin A deficiency
  • Protein malnutrition
  • systemic diseases
  • Eg. Sjogren' s syndrome, SLE, rheumatoid
    arthritis, scleroderma, sarcoidosis, amyloidosis,
    hypothyroidism
  • medications
  • antihistamines, nasal decongestants,
    tranquilizers, and anti-depressant drugs

4
Epidemiology
  • Remains a worldwide problem especially in the
    developing countries
  • peak incidence is 3-5 years of age
  • associated with vitamin A deficiency and
    malnutrition in general

5
(No Transcript)
6
(No Transcript)
7
METABOLISM
FOOD
TARGET TISSUE
Photoreceptor, Epithelial tissue
GUT
Absorp 50-90 retinol
BLOOD
LIVER
retinal binding protein
Retinyl palmitate
8
FUNCTIONS
  • Gene expression
  • Epithelial cell differentiation
  • Normal growth
  • Photopic vision
  • Immune function
  • Antioxidant

9
(No Transcript)
10
Clinical Features
Vitamin A Deficiency
11
Clinical Features
  • Night Blindness
  • Difficulty seeing in the dark. Abnormal dark
    adaptation
  • Xerosis (Dry Eyes)
  • The white of the eye loses its shine and begins
    to wrinkle.
  • Bitot's Spots
  • Patches of little gray bubbles on the whites of
    the eye.
  • Corneal Ulceration
  • Dullness or damage to the cornea.
  • Keratomalcia
  • Soft or bulging cornea.

12
Night blindness
13
require some time for their eyes to adjust from
brightly lit areas to dim ones. Contrast vision
may also be greatly reduced.
14
(No Transcript)
15
Xerosis (Dry Eyes)
16
Marked conjunctival and corneal xerosis
17
Bitot's Spots
18
(No Transcript)
19
(No Transcript)
20
(No Transcript)
21
(No Transcript)
22
Corneal changes
Corneal punch-out lesion
23
Corneal Ulceration
24
Corneal scar
25
Keratomalacia
  • Liquefaction of part or all of the cornea,
    leading to rupture, with extrusion of the eye
    contents and subsequent shrinking of the globe
    (phthisis bulbi), or to anterior bulging (corneal
    ectasia and anterior staphyloma) and blindness.

26
(No Transcript)
27
(No Transcript)
28
(No Transcript)
29
(No Transcript)
30
Diagnosis
  • Most -clinical diagnosis

31
Laboratory tests (Unusual)
  • A serum retinol study
  • - costly but direct measure
  • - high-performance liquid chromatography
  • - gt20 mg/dl adequate
  • - lt10 mg/dl grossly deficient
  • - plasma vitamin A level or lt0.35 mmol/L
  • - lt0.7 mg/L in children younger than 12 years is
    considered low
  • - respect to light and temperature

32
  • Total retinol binding protein
  • - easier to perform and less expensive
  • - detected by an immunologic assay.
  • - more stable compound than retinol
  • - less accurate because they are affected by
    serum protein concentrations
  • - zinc deficiency interferes with RBP production

33
Conjunctival impression cytology
  • histologic appearance of superficial epithelial
    layers
  • Conjunctival xerosis -The epithelium is
    characterized by keratinization
  • - Keratomalacia - Stromal necrosis is covered by
    keratinized epithelium

34
conjunctival xerosis The epithelium is
characterized by keratinization, a
prominent granular cell layer, and distended
squamous cells with large, open nuclei
and prominent
nucleoli.
35
Keratomalacia The sharply demarcated area of
stromal necrosis is covered by keratinized
epithelium
36
TREATMENT
37
Treatment
  • Vitamin A orally is given. May be given by
    intramuscular injection also and repeated.
  • Correct malnutrition
  • Diet Plenty of milk, butter, dark green leafy
    vegetables, carrots, orange, cod-liver oil
    required.
  • Topical lubrication and retinoic acid may be use
    as adjunctive
  • If infection is present in eyes - antibiotic
    ointment may be applied.

38
Emergency Patient Care
  • In order to treat or prevent a secondary
    bacterial infection, which would compound corneal
    damage.
  • Apply an antibiotic eye ointment, e.g.
    tetracycline or chloramphenicol.
  • Protect the eye with an eye shield in order to
    prevent trauma.
  • In the case of young children, it may be
    necessary to restrain arm movements while
    applying the shield.
  • Vitamin A must be administered orally immediately
    upon diagnosis.

39
  • For treatment of xerophthalmia according to the
    schedule shown below.

Timing lt1 year of age (IU) 1 year of age (IU)
Immediately on diagnosis 100,000 200,000
Next day 100,000 200,000
Within 2-4 weeks 100,000 200,000
Severe protein energy malnutrition Monthly until PEM resolved 100,000 200,000
40
Treatment Women with Xerophthalmia
  • Women of reproductive age require special
    attention because of the potential teratogenic
    effects of very high dose retinol early in
    pregnancy
  • Women of reproductive age with night blindness or
    Bitot's spots should be treated with
  • A daily oral dose of 5,000-10,000 IU of vitamin A
    for at least 4 weeks.
  • Such a daily dose should never exceed 10,000 IU,
    although a weekly dose not exceeding 25,000 IU
    may be substituted.

41
  • All women of reproductive age, whether or not
    pregnant, who exhibit severe signs of
    xerophthalmia (i.e. acute corneal lesions) should
    be treated with three dose treatment.

Immediately on diagnosis Next day 2 weeks later
200,000IU 200,000IU 200,000IU
42
Drug of choice
  • Retinol palmitate, 110 mg or
  • Retinol acetate , 66 mg
  • ? 200,000 IU Vit.A
  • oral, immediately and again the following day
  • Additional dose every 1-2 week to restore liver
    reserve.
  • Parenteral replacement essential Retinol acetate
    100,000 IU in 55 mg water can replace first oral
    dose.
  • Correct protein energy malnutrition

43
PREVENTION
44
Prevention
  • Short-term
  • High dose VIT A supplement
  • VIT A supplement can reduce child mortality by
    34
  • VIT A supplement is on the most cost-effective
    prevention
  • Distributed by health facilities or teams

45
Vitamin A prophylaxis schedule
Age Dose (IU) Timing
Infants (0-6 mo.) 25,000 1-3 times
Children (6-12 mo.) 100,000 Once every 4-6 months
Children (gt12 mo.) 200,000 Once every 4-6 months
Woman (postpartum) 200,000 Within 1 month of delivery
Pregnant and lactating woman 5-10,000 Daily
46
  • Medium-term
  • Introducing food fortified with VIT A such as
    milk, tea, cereal
  • Long-term
  • - Improve socioeconomic level
  • Improve health and nutrition
  • education

47
(No Transcript)
48
THANK YOU
  • FOR YOUR ATTENTION
About PowerShow.com