Xerophthalmia is a term for a group of eye diseases that are caused by vitamin A deficiency.

While it is a rare condition in the developed world, it is the leading cause of preventable blindness in children and adult women in developing countries. About 254 million children around the world have vitamin A deficiency, leading to xerophthalmia, as well as other serious health problems.

Fortunately, this eye disease is preventable and treatable with vitamin A therapy. When caught early enough, it can be reversed.(Learn more)

Night blindness, drying of the cornea, white lesions called Bitot’s spots on the conjunctiva, bacterial infections, retinopathy, liquification of the cornea, and eventual blindness are all associated with xerophthalmia.

It is important to get enough vitamin A in your diet. If you don’t get enough from healthy food, you can get vitamin A from a dietary supplement.(Learn more)

Xeropthalmia can also be caused by an underlying condition that prevents absorption of certain vitamins and minerals, like cystic fibrosis, cancer, or hypothyroidism.(Learn more)

A questionnaire about symptoms is used to diagnose xeropthalmia, along with an eye exam. You may also work with your physician if you have a vitamin A deficiency.(Learn more)

Xeropthalmia: A Preventable Form of Blindness

Xerophthalmia is a progressive eye disease caused by vitamin A deficiency. Women and children, particularly in developing countries, tend to be the most at risk for this condition, which is the leading cause of preventable blindness.

There are several conditions that are associated with xerophthalmia, with night blindness being the most noticeable symptom of vitamin A deficiency. Ulcers on the cornea or white spots on the eyes may also indicate this vitamin deficiency. If you have these, you need help from an optometrist or ophthalmologist along with a doctor to manage your nutritional intake.

Symptoms of xerophthalmia begin as mild vision issues, like trouble seeing while driving or walking at night. Without treatment, these issues will become progressively worse until they are irreversible.

Fortunately, vitamin therapy reverses damage if the condition is caught early enough. The World Health Organization (WHO) notes that as many as 254 million children around the globe have vitamin A deficiency, which can lead to xerophthalmia. Again, it is the leading worldwide cause of childhood blindness, although it is a preventable disease.

What Is Xerophthalmia?

The term xerophthalmia covers a group of eye disorders that become progressively worse as the body becomes more vitamin deficient. These conditions are:

  • Nyctalopia, or night blindness, which is the inability to see in low or dim light.
  • Bitot’s spots, or lesions on the conjunctiva that are whitish and opaque.
  • Keratomalacia, or drying and clouding of the cornea, which leads to liquefaction.
  • Corneal xerosis, or a dry, hazy appearance to the cornea.
  • Corneal ulcers.
  • Bacterial infections in the eye.
  • Retinopathy, or damage to the retina so light is not transmitted as images through the optic nerve.
  • Blindness.

Vitamin A is a vital component in maintaining several organ systems, so people who suffer deficiency in this important nutrient are likely to develop other problems first, including trouble with their heart, lungs, kidneys, and blood circulation. The immune system will not work very well, so the person is at risk of infections.

Diarrhea and measles are the most common signs of vitamin A deficiency that impact the immune response of those in developing nations. Low iron levels in the blood can also indicate a vitamin A deficiency.

Appropriate levels of vitamin A consumption vary based on age:

  • Infants up to 3 years old: 600 mcg
  • 4 to 8 years old: 900 mcg
  • 9 to 13 years old: 1700 mcg
  • 14 to 18 years old: 2800 mcg
  • Adults: 3000 mcg

These foods are good sources of vitamin A:

  • Beef liver
  • Carrots
  • Pumpkins
  • Sweet potatoes
  • Peppers
  • Cantaloupe
  • Mangoes
  • Fortified breakfast cereals
  • Broccoli
  • Salmon
  • Spinach
  • Pistachios

Xerophthalmia May Be a Symptom of Another Underlying Condition

People who develop xerophthalmia in the United States or developed countries may have an underlying condition that leads to trouble absorbing vitamin A from their normal diet or vitamin supplements. Some conditions associated with vitamin A deficiency, leading to xerophthalmia, include:

  • Cystic fibrosis. This chronic illness often leads to trouble with the pancreas, called pancreatic insufficiency. This can cause trouble absorbing nutrients from food because of problems absorbing fat from the diet.

    Medical studies show that 15 to 40 percent of people with cystic fibrosis develop vitamin A deficiency, which can cause xerophthalmia if it is not addressed. Further research has shown that taking oral supplements reduces the risk of this issue and can prevent blindness.

  • Cancer. Observational studies have associated vitamin A deficiency and some types of cancer, especially lung cancer in current or former smokers. One study suggested that beta carotene and vitamin A supplements, or eating a diet rich in these nutrients, reduced the risk of developing lung cancer, but subsequent studies have been inconclusive.
  • Hypothyroidism. Problems with the thyroid can show up as low metabolism and symptoms like depression, but it can also appear as a vitamin A deficiency. This may lead to xerophthalmia if the condition is not diagnosed quickly enough.

Xerophthalmia May Be a Symptom of Another Underlying Condition

The term xerophthalmia was created by the medical community in 1974 as a way to classify several eye diseases that all seemed to come from the underlying cause of vitamin A deficiency. The condition has become a way for optometrists, ophthalmologists, and other medical professionals to diagnose and treat this vitamin deficiency through eye symptoms and visual changes, especially night blindness.

Night blindness and other vision problems are most effectively diagnosed with a questionnaire during an eye exam. This can be difficult when attempting to diagnose young children, as they may not know they should see more clearly in dim light or darkness.

If your child complains about vision changes, or you as an adult experience sudden changes in your sight, work with your optometrist to understand the root causes. You may also need help from your general practitioner or physician if you have a chronic condition that may cause vitamin A deficiency.

When caught early enough, vitamin A therapy can stop and sometimes reverse damage to your eyes. Some symptoms, like corneal lesions and damage, may not be reversible. Your treatment team will help you to treat existing issues and manage the condition to avoid further damage.

References

Xerophthalmia. (June 2020). StatPearls.

What Is Night Blindness and What Can I Do About It? VSP.

Keratomalacia. (May 2020). Merck Manual: Consumer Version.

Retinopathy. (August 2017). Harvard Health Publishing, Harvard Medical School.

Vitamin A: Fact Sheet for Health Professionals. (February 2020). National Institutes of Health (NIH), Office of Dietary Supplements (ODS).

Xerophthalmia and Night Blindness for the Assessment of Clinical Vitamin A Deficiency in Individuals and Populations. (2014). Vitamin and Mineral Nutritional Information System (VMNIS), World Health Organization (WHO).

The Eye Signs of Vitamin A Deficiency. (2013). Community Eye Health Journal.

How to Manage Children With the Eye Signs of Vitamin A Deficiency. (2013). Community Eye Health Journal.

Management of Bitot’s Spots. (December 2016). American Academy of Ophthalmology.