Xerophthalmia

Xerophthalmia

In xerophthalmia, the cornea and conjunctiva of the eye dry out. Vitamin A deficiency is usually the cause of the disease, which is particularly widespread in developing countries. Treatment is by vitamin A substitution or by creating an artificial tear film.

What is xerophthalmia?

The cornea is the foremost, highly curved, and transparent portion of the eyeball in front of the pupil. The transparency of the cornea is absolutely necessary for the eye function. The homogeneously structured surface is covered by a tear film. The conjunctiva, i.e. the conjunctiva, is also an important part of the eyes. For meaning of hepatocellular carcinoma in English, please visit sportingology.com.

The mucous membrane-like layer of tissue connects the eyeball to the eyelids. Both of these elements of the eye can be impaired in their function by diseases. A disease affecting both the cornea and the conjunctiva is xerophthalmia. This is a dehydration phenomenon that often leads to blindness. The disease is most common in developing countries.

The age group mainly affected is that of young children. For this reason, xerophthalmia is also known as childhood blindness. In western industrialized nations, dry eye syndrome occurs from time to time. This phenomenon is to be distinguished from xerophthalmia in the narrower definition, although in the literature any type of dry eye is sometimes referred to as xerophthalmia.

Causes

In the broader definition, xerophthalmia can have different causes. In the narrower definition, hypovitaminosis is the causative factor. Without vitamin A, the conjunctiva and cornea can dry out. In most cases, such deficiency symptoms are caused by improper nutrition or malnutrition.

Severe vitamin A deficiency dissolves the collagen matrix, softens the cornea and irreversibly destroys the eye. Due to malnutrition in developing countries, xerophthalmia is still the most common cause of blindness. South and East Asia and African countries, Latin America and the Middle East are particularly affected.

In the broader definition, xerophthalmia can also be caused by incomplete eyelid closure in the sense of lagophthalmos, although not all of the changes described occur. In addition, tear secretion disorders can cause similar symptoms, for example in the context of Sjögren’s syndrome.

Symptoms, Ailments & Signs

The symptoms of xerophthalmia depend on the primary cause in the individual case. If there is a vitamin A deficiency, less light-sensitive pigment is produced in the rods. The onset of xerophthalmia can therefore manifest itself in the form of night blindness in the context of vitamin A deficiency. The epithelial cells in the conjunctiva also keratinize.

In addition to this keratinization, dull white spots appear on the conjunctiva. The callus becomes dry and rough at the same time. Vessels form on the cornea. The view is affected by the change in transparency. In xerophthalmia from causes other than vitamin deficiency, there is no photosensitive pigment deficiency. However, the conjunctiva and cornea dry out in any case. In addition, many patients complain of severe itching in the eye.

In addition, the phenomenon is associated with a subjectively felt foreign body sensation. With progressive dehydration of the eyes, the protection of the antibacterial tear film is missing, so that inflammations such as conjunctivitis or keratitis occur over time. If left untreated, there are subsequent complications such as keratomalacia, which can cause irreversible impairment of vision.

Diagnosis & course of disease

The diagnosis of xerophthalmia is primarily based on anamnestic and visual diagnostics. The symptoms are traced back to a cause as part of the diagnostics. In Western countries, tear secretion disorders are the most common cause. Secretion disorders are detected using the Schirmer test.

Blotting paper strips in the conjunctival sac absorb the tear fluid. In the event of a deficiency, the paper that is hung in remains dry. Vitamin A deficiency can meanwhile be clarified by [blood test|blood analysis]]. The prognosis for patients with xerophthalmia depends on the primary cause and its treatability. The stage of xerophthalmia also plays an important role in the prognosis.

Complications

In many cases, the symptoms of xerophthalmia are not particularly clear, so that early diagnosis and treatment of this disease cannot be initiated. Those affected primarily suffer from night blindness, which can have a very negative effect on everyday life and quality of life.

The cornea of ​​the affected person dries out and there is a strong sensitivity to light and permanent itching in the eye. It is not uncommon for the eyes to swell due to the severe itching. A foreign body sensation also occurs in the eye due to xerophthalmia and can negatively affect the eyesight of those affected.

Inflammation and infections can also occur in the eye if the disease is not treated. An irreversible restriction or reduction in vision can also be a disease-related consequence. Xerophthalmia is usually treated without complications and can limit the symptoms relatively well.

Those affected are dependent on the intake of supplements and the use of eye drops. In most cases, this will limit all complaints. The life expectancy of the affected person is not negatively affected by xerophthalmia.

When should you go to the doctor?

People who prefer an unbalanced diet are well advised to initiate a check-up visit with a doctor at regular intervals. The general state of health should be checked so that any abnormalities can be dealt with accordingly. An unbalanced diet often results in a lack of vitamins or other important and vital nutrients, which must be recognized and changed in good time. If there is a loss of vision, it is always necessary to consult a doctor.

Blurred vision, hypersensitivity to light influences or night blindness are worrying. In the case of these complaints, a doctor’s visit is necessary so that the cause can be clarified. A severe itching of the eye is also to be understood as a warning signal from the organism. If there is redness or open wounds in the area of ​​the eyes or eyelids, there is a need for action. If the disease progresses unfavorably or without medical treatment, irreversible damage to vision can occur.

Failure to work with a doctor can result in blindness. It is therefore advisable to consult a doctor as soon as the first changes or abnormalities in vision occur. An unusually dry eye or cornification should be evaluated and treated as soon as possible. In addition, if you feel generally unwell or have other diffuse symptoms in your body, it is advisable to consult a doctor.

Treatment & Therapy

The therapy of xerophthalmia depends on the primary cause. A causal treatment must be sought, for example, in the case of a causal vitamin A deficiency, through intravascular vitamin substitution. Tear fluid treatments are available as symptomatic treatment options.

The missing tear film is compensated by replacement liquid. If dysfunction of the meibomian glands is the cause of xerophthalmia, eye drops containing anakinra are given. The human interleukin antagonist is known as an active ingredient in the treatment of rheumatoid arthritis and also appears to be able to alleviate xerophthalmia. In Germany, however, the approval of the eye drops is still pending.

In addition, antibiotic eye drops are used off-label. These drops usually work with the active ingredient azithromycin and prevent complications from bacterial infestation. Antibiotics act directly on the epithelia within the meibomian glands. This not only prevents bacterial contamination. This also stimulates the formation of a greasy secretion that can keep the eyes permanently moist.

Inflammations caused by complications are reduced with high doses of antibiotics in order to prevent late complications caused by inflammation and thus irreversible damage to the eyes. In principle, xerophthalmia, regardless of the cause, is a disease that can be controlled relatively easily in industrialized nations and usually does not cause any irreversible damage. In developing countries, however, it often leads to blindness to this day, since the medical and food supply is inadequate.

Prevention

The form of xerophthalmia caused by vitamin A deficiency can be prevented by a balanced diet and thus a balanced intake of vitamin A. Eyelid closure and other forms cannot be fully prevented. Anyone who notices a foreign body sensation in the eye should therefore always consult an ophthalmologist. Early diagnosis of xerophthalmia prevents irreversible damage.

Aftercare

In most cases, the person affected with xerophthalmia has only very limited direct follow-up measures available. First and foremost, sufferers of this disease should consult a doctor at an early stage to prevent the occurrence of other symptoms and complications. In the worst case, the affected person can also become completely blind if no timely treatment is given, so that a doctor should be contacted at the first signs and symptoms of this disease.

Self-healing cannot occur. In the case of xerophthalmia, those affected are usually dependent on the use of eye drops. This can limit and alleviate most complaints. As a rule, the person concerned should ensure that the dosage is correct and that the eye drops are used regularly. If you have any questions or if you have any side effects, it is advisable to consult a doctor first. Even after successful treatment, regular check-ups by an ophthalmologist are very important. In most cases, xerophthalmia does not reduce the patient’s life expectancy.

You can do that yourself

Xerophthalmia is often based on a lack of vitamin A in the diet. If the affected person is outside of a developing country, they should review and optimize their diet. The intake of the individual foods per meal must be controlled and adapted to the needs of the organism.

Vitamin A is found in foods such as carrots, spinach, red peppers, apricots, broccoli or tomatoes. In order to alleviate the existing symptoms, care should be taken to ensure that the foods mentioned are consumed in such a way that the daily vitamin A requirement is sufficiently covered. In addition, the eyes should be adequately protected against unfavorable influences. Strain or strain on the eyes should be avoided. Everyday work should be carried out under optimal lighting conditions so that no complications are triggered. If signs of fatigue appear, periods of rest should be taken. The organism needs time to regenerate so that no long-term damage to vision occurs.

If dry eyes are present, prescribed drops must be used. An artificial supply of water or similar liquids is not recommended. In some cases, increasing the frequency of blinking can help relieve symptoms. Therefore, the mechanism of blinking should be increased independently, especially in dry ambient conditions or in polluted air.

Xerophthalmia