Xerophthalmia

What is xerophthalmia?

Xerophthalmia is pronounced "zeer-of-thal-mee-uh” or “zeer-op-thal-mee-uh.” The Greek root words literally mean “dry eye.”

While the group of conditions that is xerophthalmia includes dry eyes, it covers other signs and symptoms that affect your eyes. Xerophthalmia is caused by a lack of vitamin A and can cause blindness.

The vitamin A deficiency can happen in two ways:

• You don’t get enough vitamin A in your diet.
• Your body can’t use the vitamin A you do get effectively.

How common is xerophthalmia?

According to the World Health Organization, there are some 254 million children worldwide with vitamin A deficiency. There are about 2.8 million children with xerophthalmia. In addition, it causes about 350,000 cases per year of childhood blindness, making it the leading cause of blindness in children.

What are the signs and symptoms of xerophthalmia?

The signs and symptoms of xerophthalmia include the following items presented in the order, or stage, in which they generally happen:

• Night blindness (nyctalopia): You can’t see well at night or in poor light such as in a restaurant or movie theater. You may also have trouble adjusting to changes in lighting.
• Conjunctival xerosis: Your conjunctiva is dry. (Xerosis is a medical term for dry skin or membranes.) Your conjunctiva is a thin tissue that covers the white parts of your eyes (sclera) and the inside of your eyelids.
• Bitot spots: You have foamy silver-gray triangular spots that appear on the whites of your eyes.
• Corneal xerosis: Your cornea is dry and it shouldn’t be. Your cornea is a clear layer that protects your eye.
• Corneal ulcers: You have holes or sores in your cornea.
• Keratomalacia: Your cornea softens and becomes cloudy, which can also produce scars.
• Xerophthalmic fundus: Your retina develops lesions (sores) and can change in structure.

What causes xerophthalmia?

Vitamin A deficiency causes xerophthalmia. Vitamin A is important to your vision in two major ways: for moisture and for pigments.

Your eyes need vitamin A to produce moisture to keep your corneas properly lubricated. If your corneas get too dry, they can become damaged, which can lead to blindness.

Also, your eyes need vitamin A to make specific pigments for your retinas to work correctly. A lack of vitamin A hinders your eyes’ ability to make these pigments, which can lead to night blindness. Rods are the parts of your eye that allow you to see in darkness or dim light.

You may lack vitamin A because you don’t get enough vitamin A in your diet or because you can’t use vitamin A effectively.

Dietary causes of vitamin A deficiency and xerophthalmia

Vitamin A deficiency doesn’t happen often in the U.S. and other developed countries. Many of the people who are affected are children in developing nations who aren’t able to get the nutrients they need.

How is xerophthalmia diagnosed?

Your provider may use these methods to diagnose xerophthalmia:

• Complete medical history: Your provider will take a medical history that includes information on food intake.
• Complete eye examination: Your provider will do a thorough examination of your eyes.
• Clinical signs: This means your provider will assess the signs and symptoms that are affecting your eyes (clinical signs).
• Blood tests: These tests will measure vitamin A levels.
• Night vision tests and dark adaptation testing: These tests measure how well you can see in dim and darker light and how long it takes your eyes to get used to the dark.
• Impression cytology: This technology tests specimens from the conjunctiva for diseases of the eyes’ surface.
• Electroretinogram: This test measures the way your eyes respond to light.

How is xerophthalmia treated?

Your healthcare provider will recommend vitamin A supplements. Your provider may also suggest using artificial tears and topical antibiotics if you have an infection.

How can I reduce my risk of developing xerophthalmia?

The best way to avoid xerophthalmia is to include adequate amounts of vitamin A in your diet. These foods provide vitamin A:

• Dark green leafy vegetables like spinach and kale.
• Yellow and orange fruits like papayas and oranges.
• Yellow vegetables like squash and pumpkin.
• Carrots.
• Liver.
• Egg yolks.
• Fish liver oils.
• Foods and drinks that are fortified with vitamin A.

Treatment for people with vitamin A deficiency includes supplements. Providers need to monitor these people because too much vitamin A can be fatal.

What can I expect if I have xerophthalmia?

If xerophthalmia is treated, you can expect to recover. Without treatment, there’s a possibility of blindness.

When should I see my healthcare provider about xerophthalmia?

If you’re having any vision issues, see your healthcare provider as soon as possible, even if you just feel like your eyes are dry.

Your provider, or your child’s provider, will check the eyes and skin during a health examination and will notice dryness of the skin and eyes. Providers will be able to see some of the changes to the eyes, which can happen because of vitamin A deficiency.

Your provider may also ask about your food intake or your child’s dietary habits and make suggestions.

What is the difference between xerophthalmia and keratomalacia?

Xerophthalmia is a term for a group of eye problems that happen as a result of not getting enough vitamin A. Keratomalacia, or a softening of your cornea, is one of the conditions that are grouped under xerophthalmia. Keratomalacia is like a subset of xerophthalmia.

What is the difference between xerophthalmia and xerostomia?

The difference is that they refer to dryness of different parts of your body. Xerophthalmia refers to having dry eyes. Xerostomia refers to having a dry mouth.

A note from Cleveland Clinic

Experiencing symptoms of eye disease can be scary. If you do have symptoms, see your provider as soon as you can. In the case of xerophthalmia, vitamin A tablets are a simple fix. It’s important to get a diagnosis early because early treatment leads to the best outcome. Global health organizations are working to eliminate vitamin A deficiency in developing countries to reduce cases of preventable blindness and illness among children.