Summary about Disease
Keratomalacia is a serious eye disorder characterized by corneal degeneration due to severe vitamin A deficiency. It leads to softening, ulceration, and ultimately, perforation of the cornea, potentially causing blindness. It is most prevalent in developing countries among malnourished children.
Symptoms
Dryness of the eyes (xerophthalmia)
Night blindness (nyctalopia)
Corneal clouding or haziness
Corneal softening
Corneal ulceration
Corneal perforation (in advanced stages)
Photophobia (sensitivity to light)
Bitot's spots (foamy, triangular patches on the conjunctiva)
Causes
The primary cause of keratomalacia is severe vitamin A deficiency. Contributing factors include:
Malnutrition (especially in children)
Dietary insufficiency of vitamin A
Conditions that impair vitamin A absorption (e.g., cystic fibrosis, celiac disease)
Poverty and food insecurity
Medicine Used
Vitamin A supplementation: Oral vitamin A is the primary treatment. Dosage varies depending on age and severity.
Topical antibiotics: To treat or prevent secondary bacterial infections of the cornea.
Artificial tears: To alleviate dryness and provide lubrication.
Cycloplegic eye drops: To relieve pain and prevent synechiae (adhesions) in cases of corneal ulceration.
Nutritional Support: Balanced diet with vitamin-rich foods.
Is Communicable
No, keratomalacia is not communicable or contagious. It is a nutritional deficiency disease and not caused by an infectious agent.
Precautions
Dietary intake: Ensure adequate vitamin A intake through a balanced diet rich in vitamin A-containing foods (e.g., liver, dairy products, orange and yellow fruits and vegetables).
Supplementation: In areas where vitamin A deficiency is prevalent, prophylactic vitamin A supplementation programs are essential, especially for children.
Early Detection: Regular eye exams, especially in at-risk populations, can help detect early signs of vitamin A deficiency and xerophthalmia.
Proper Hygiene: Good hygiene practices can help prevent secondary infections in individuals with corneal damage.
Addressing underlying conditions: Treat any underlying medical conditions that impair vitamin A absorption.
How long does an outbreak last?
Keratomalacia isn't an "outbreak" in the traditional sense of an infectious disease. The progression and duration of the condition depend entirely on the severity of the vitamin A deficiency and how quickly treatment is initiated. If the underlying vitamin A deficiency is corrected promptly, the progression of the disease can be halted, and some improvement may be possible. However, severe damage, such as corneal scarring or perforation, may be permanent. Without treatment, the condition can worsen rapidly, leading to blindness.
How is it diagnosed?
Clinical examination: A thorough eye examination by an ophthalmologist, including slit-lamp examination, is crucial.
Medical history: Assessment of dietary history and risk factors for vitamin A deficiency.
Serum Vitamin A Levels: Blood tests to measure serum retinol (vitamin A) levels.
Impression cytology: This test involves collecting cells from the conjunctiva to assess for changes associated with vitamin A deficiency.
Timeline of Symptoms
The progression of symptoms can vary, but generally follows this pattern: 1. Early Stages:
Night blindness (nyctalopia) - Often the first noticeable symptom.
Dryness of the eyes (xerophthalmia). 2. Intermediate Stages:
Bitot's spots (foamy patches on the conjunctiva).
Conjunctival xerosis (dryness).
Corneal xerosis (dryness). 3. Advanced Stages:
Corneal clouding.
Corneal softening.
Corneal ulceration.
Keratomalacia (corneal melting).
Corneal perforation. 4. End-Stage:
Blindness.
Important Considerations
Prevention is key: Vitamin A deficiency is preventable through adequate dietary intake and supplementation programs.
Early intervention is crucial: Prompt diagnosis and treatment can prevent irreversible corneal damage and blindness.
Public health initiatives: Addressing malnutrition and food insecurity in vulnerable populations is essential to prevent keratomalacia.
Nutritional education: Educating communities about the importance of vitamin A in the diet is vital.
Long-term monitoring: Individuals who have had keratomalacia require long-term follow-up to monitor for complications and ensure continued adequate vitamin A intake.