Understanding Xerophthalmia: A Consequence of Vitamin A Deficiency

Xerophthalmia is an ocular diseases caused due to vitamin A deficiency. It typically represents a late manifestation of this deficiency, and its symptoms are indicative of the critical role vitamin A plays in maintaining eye health. It is a

Also see: Eye health nutrients

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. It is quite common in developing countries

How is Xeropthalmia diagnosed?

. Complete Medical History

  • Your healthcare provider will begin by taking a detailed medical history, which includes information about your dietary habits and vitamin A intake. This step helps in identifying potential risk factors associated with vitamin A deficiency.

2. Comprehensive Eye Examination

  • A vital aspect of the diagnostic process involves a comprehensive eye examination. During this examination, your healthcare provider will thoroughly assess your eyes, looking for specific clinical signs and symptoms indicative of xerophthalmia.

3. Clinical Signs Assessment

  • Clinical signs refer to observable signs and symptoms affecting your eyes. Your healthcare provider will carefully evaluate these clinical signs, such as dryness, redness, night blindness, and changes in the conjunctiva and cornea.

4. Blood Tests

  • Blood tests are a critical component of diagnosing xerophthalmia. They are used to measure the levels of vitamin A in your bloodstream. A deficiency in vitamin A can be indicative of xerophthalmia.

5. Night Vision Tests and Dark Adaptation Testing

  • Night Vision Tests and Dark Adaptation Testing could be done.These specialized tests assess your ability to see in low-light conditions and how quickly your eyes adapt to darkness. Impaired night vision and prolonged adaptation time can be indicative of xerophthalmia.

6. Impression Cytology

  • Impression cytology may be done. It is a technology-based test that involves collecting specimens from the conjunctiva, the eye’s surface. These specimens are then analyzed to detect any diseases or abnormalities affecting the eye’s surface.

7. Electroretinogram (ERG)

  • An Electroretinogram may be done. It is a diagnostic test that measures how your eyes respond to light stimuli. It provides valuable information about the functioning of your retinal photoreceptor cells. Changes in the ERG can indicate the presence of xerophthalmia-related retinopathy.

What are the signs and symptoms of xerophthalmia?

Symptoms of Xerophthalmia

  • Night Blindness (Nyctalopia): One of the earliest signs of vitamin A deficiency, night blindness results in decreased vision in low-light conditions.
  • Discomfort and Loss of Vision: As xerophthalmia progresses, individuals may experience persistent discomfort and a gradual loss of vision.

Ocular Manifestations of Xerophthalmia

The ocular manifestations of xerophthalmia primarily affect the conjunctiva and cornea, leading to various eye conditions:


 xerophthalmia bitots spot

bitot spot in Xeropthalmia

  • Xerosis: Xerosis refers to the dryness of the conjunctiva, particularly in the interpalpebral zone. It is characterized by the loss of goblet cells, squamous metaplasia, and keratinization.
  • Bitot Spots: These are triangular patches of foamy keratinized epithelium in the interpalpebral zone, often caused by Corynebacterium xerosis.
 xerophthalmia keratomalacia

Keratomalacia in Xeropthalmia


  • Lustreless Appearance: The cornea may appear lustreless due to secondary xerosis.
  • Punctate Corneal Epithelial Erosions: Bilateral punctate erosions in the corneal epithelium within the interpalpebral zone can progress to epithelial defects but can be reversible with proper treatment.
  • Keratinization: Severe cases may lead to corneal keratinization.
  • Keratomalacia: This represents a severe and potentially life-threatening condition characterized by sterile corneal melting through liquefactive necrosis. In advanced cases, keratomalacia can lead to corneal perforation or corneal ulcer.
  • Retinopathy: In advanced xerophthalmia, yellowish peripheral dots on the retina may develop, accompanied by a decreased electroretinogram amplitude.

Difference between xerophthalmia and xerostomia

The difference between xerophthalmia and xerostomia lies in the areas of the body they affect.

Xerophthalmia refers to the condition of having dry eyes. In xerophthalmia, the eyes experience dryness, which can lead to symptoms such as discomfort, redness, and vision problems. It is often associated with a deficiency in vitamin A and can have various causes, including environmental factors.

Xerostomia, on the other hand, refers to the condition of having a dry mouth. In xerostomia, the mouth lacks sufficient saliva, which can result in dryness, a sticky feeling in the mouth, and difficulties with chewing and swallowing. Xerostomia can be caused by various factors, including medication side effects, medical conditions, or radiation therapy to the head and neck area.

In summary, the key distinction is that xerophthalmia pertains to dry eyes, while xerostomia pertains to a dry mouth. Both conditions can have different underlying causes and may require different approaches to treatment.


Treatment of xeropthalmia

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.

Keratomalacia, the severe corneal condition resulting from vitamin A deficiency, requires immediate medical attention, especially in infants due to the risk of mortality.

  • Systemic Treatment: This involves the administration of oral (oil-based 200,000 IU) or intramuscular (aqueous-based 100,000 IU) vitamin A for cases of keratomalacia. Multivitamin supplements and dietary sources rich in vitamin A are also provided.
  • Local Treatment: Intense lubrication, topical retinoic acid, and the management of corneal perforation are crucial components of local treatment for xerophthalmia.

Preventing Xerophthalmia

there are steps you can take to prevent this condition, primarily by ensuring an adequate intake of vitamin A. Here’s how you can incorporate vitamin A-rich foods into your diet to safeguard your eye health and overall well-being:

1. Fish Liver or Fish Oil

  • Rich in vitamin A, fish liver and fish oil are excellent dietary sources of this essential nutrient. Consider adding fish such as cod or salmon to your meals or incorporating fish oil supplements into your daily routine.

2. Chicken

  • Chicken is a good source of vitamin A and can be a part of various delicious and healthy recipes.

3. Beef and Other Meats

  • Beef, as well as other meats like pork and turkey, provides vitamin A. Including lean cuts of meat in your diet can contribute to your vitamin A intake.

4. Eggs

  • Eggs are not only versatile but also packed with nutrients, including vitamin A. Enjoy them as part of your breakfast or in various dishes.

5. Carrots

  • Carrots are renowned for their vitamin A content and beta carotine and are easy to incorporate into your diet as snacks, in salads, or as a side dish.

6. Citrus Fruits like Lemons

  • While citrus fruits like lemons are not typically high in vitamin A, they provide other essential nutrients that support overall eye health and immune function.

7. Mangos

  • Mangos are a delicious tropical fruit that not only satisfies your taste buds but also contributes to your vitamin A intake.

8. Yams

  • Yams, a starchy root vegetable, are rich in vitamin A and can be prepared in various ways, such as roasted, mashed, or in soups.

9. Dairy or Milk Products

  • Dairy products like milk, yogurt, and cheese are sources of vitamin A. They are not only nutritious but also versatile for use in a wide range of recipes.

10. Green Vegetables – Include a variety of green vegetables like spinach, kale, and broccoli in your diet. These vegetables are not only rich in vitamin A but also provide numerous other health benefits.

vitamin a supplements can also help treat xeropthalmia.

Incorporating these vitamin A-rich foods into your daily meals can help prevent xerophthalmia and support your overall health.


Xerophthalmia serves as a stark reminder of the critical importance of vitamin A in maintaining eye health. Its ocular manifestations, ranging from night blindness to corneal complications, highlight the severe consequences of vitamin A deficiency. Early detection, proper treatment, and a diet rich in vitamin A sources are essential in preventing and managing this potentially debilitating condition. Consult an Optometrist

Reference: Kanski Clinical Ophthalmology

Follow us in Facebook

Leave a Reply

Your email address will not be published. Required fields are marked *