|Year : 1983 | Volume
| Issue : 4 | Page : 429-433
Survey of ocular diseases in arid zone (Jaisalmer) with special reference to vitamin A
RG Sharma, YC Mishra, GL Vermae, LN Maheshwari, Raman Sarda
Department of Ophthalmology, S.M.S. Medical College & Hospital, Jaipur, India
R G Sharma
Department of Ophthalmology, S.M.S. Medical College & Hospital Jaipur, (Rajasthan)
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Sharma R G, Mishra Y C, Vermae G L, Maheshwari L N, Sarda R. Survey of ocular diseases in arid zone (Jaisalmer) with special reference to vitamin A. Indian J Ophthalmol 1983;31:429-33
|How to cite this URL:|
Sharma R G, Mishra Y C, Vermae G L, Maheshwari L N, Sarda R. Survey of ocular diseases in arid zone (Jaisalmer) with special reference to vitamin A. Indian J Ophthalmol [serial online] 1983 [cited 2020 Apr 7];31:429-33. Available from: http://www.ijo.in/text.asp?1983/31/4/429/27572
A true perspective of the ophthalmic maladies in areas with special geophysiological conditions can only be attained if the eye diseases are studied in relation with the epidemiological features in a statistically representative sample of a population of that particular area. Its application could not be more practical than in the persent scientific survey which was conducted in an area of dist. Jaisalmer of Rajasthan representing a classical picture of the arid climate.
| Materials and methods|| |
Out of seven villages of Jaisalmer dist. comprising of 3322 families, 270 families were surveyed by stratified random sampling technique with the help of random sampling numbers. Co-operation of the district administrative and medical authorities was secured for information regarding family, religon, socioeconomic status, occupation and educational status. Special stress was laid on general examination ; on nutritional status and eye examination was carried out in detail specially for the anterior segment/ with special reference to Vit. A deficiency. Routinely Hb. estimation and R.B.C. count was done in all the cases.
Estimation of Serum Vit. A.: Carr Price method as described by Varley (1963) was carried out in selected number of Vit. A deficiency cases
| Observations and discussion|| |
Jaisalmer district is situated in the north west part of Rajasthan India at a distance of 300 Km. from Jodhpur city at a /attitude of 26°54' and longitude 70°55' W. The area is full of deserts. Subsoil water level is approx. 300 to 400 ft. deep. It has a dry climate subjected to extremes of cold and heat with prevalence of hot dust storms in summer month. Temp. in the summer ranges between 26° to 46° C, in winters 2° to 30° C. Average rainfall of the area is 10 to 20 cm, maximum in the month of July and average relative humidity is 40 to 45%. The density of the population works out to be 4 persons/sq.Km. Agriculture and animal breeding and other small cottage industries are the main occupations. Principle crops of the area are bajra, maize, wheat, grams & pulses. The literacy rate was 17.73% more in males (28.72%) less in females (5.83%.) 53% of the 1500 persons surveyed had a monthly income of over 800 while 3.80% persons were having income from 401 to 800 and 48.33% had in income of 51 to 400 rupees while the rest had a monthly income of 50 to 150 rupees per month. 38.47 persons were Hindus; 27.07% persons were Muslims; 6.42% Jains and 26% belong to S.C./S.T.
55.55% families were non-vegetarian but consumed meat occasionally because of poverty. The staple diet was bajra and other cereals. The diet was deficient in quantity as well as in quality.
The present work in this arid zone of Rajasthan was picked up because of the dire need of a survey truely representing the whole population. The common ocular lesions ascribed due to poor hygienic conditions in the arid zone in the present survey [Table - 1] were mucopurulent conjunctivitis, trachoma, blepharitis, stye, chalazion, dacryocystitis, corneal ulcers and opacities. Degenerative lesions observed were pterygium, pingecula and lens opacification, conjunctival xerosis with or without bitot's spots, corneal xerosis, keratomalacia night blindness. Squint and defective vision were also observed.
It appears therefore that the ocular lesions are due to multifactorial processes in arid zone and manifestations of a vicious cycle of personal hygeine, physical environment, nutritional status, lack of medical education and poverty. Mucopurulent conjunctivitis was present in 6.42% in children below 10 years of age. James Kuruvillal has reported a lower prevalence 0.94% in a survey of school going children and it appears it is because of improved hygienic conditions in the Coastal area of Karnataka.
The present survey revealed clinical signs of trachoma of all stages in 59.60% of the cases. Active trachoma was present in 10 20% cases. The I.C.M.R. (1960 to 1962) in a state wise survey found that trachoma prevalence in Jaisalmer was 59.2%. Gupta et a1 observed a prevalence rate of 59.74% in the sandy areas of Rajasthan. Active trachoma was seen under the age of 15 years while persons above the age of 15 usually had healed trachoma. Entropion was observed in 3.13% and trichiasis in 1.07%. The females suffered more than the males. 1.13°o, had corneal opacities of various grades due to trachoma, bacterial or viral infections and trauma.
Pterygium was observed in 1.66% of the population and more frequently in the males probably due to demands of the daily He. 13.73% of the population had lenticular opacities, a higher prevalence rate probably due to bright sunlight and dietary deficiency of essential nutrients.
Prevalence rate of Vit. A deficiency in the area was 9.6% [Table - 2]. Ghosh et al recorded an incidence of 8.6°% in Pondichery while Agarwal observed a rate of 6.89% of Vit. A deficiency in villages near Delhi. It appears that poverty, illiteracy, climatic conditions coupled with ignorance are the important factors dominating the Jaisalmer district. It was more in the males 12.64% as compared to females 8.6%. Higher susceptibility of the male sex to Vit. A deficiency has also been observed by Me. Laren C (1963). Vit. A deficiency was observed in children less than 1 year of age, probably due to poor nutritive value of mothers milk who are malnourished. Vit. A deficiency in school going children (males 29.58%, Females 17.58%), as compared to the preschool children was more. Gill et a1 observed 57.56% of the children suffering from Vit. A deficiency while Malviya et al observed it to be 46.3%.
In elderly people the prevalence of Vit. A deficiency was more in females 5% as compared to males 2.99% respectively. Most of the cases in this study belong to the families where total income was less than rupees 150/- p.m. It appears that economic status has a direct relation with prevalence of this diseasce. All the cases of Vit. A deficiency were underweight as well. A higher incidene of recurrent diarrhoea, malabsorption and recurrent infection is met with in our part of the country.
The night blindness prevalent rate in the present survey was 1.47%. Agarwal recorded 1.2% during their survey of Delhi villages. The prevalence rate of Bitot's spot in our survey was 4.4% while Agarwal observed it to be 4.8%. Xerosis of the conjunctiva and corneal xerosis were observed in 5.66%. Desais observed the prevalence of Xerosis in school going children in 2.66% in Jodhpur city. The avilability of various foods in urban areas accounts for lesser prevalence of xerotic conditions.
[Table - 3] shows that the total 110 cases of Vit. A deficiency below the age of 15 years were associated with some nutritional deficiency disease, more commonly nutritional marasmus and Riboflavin deficiency. All the 110 children were below weight [Table - 4] and the Vitamin A deficiency was almost equal in 2nd and 3rd degree.
The mean serum Vit. A conc. in the controls was found to be 35.5 microgram/100 ml. Bhandari has reported a mean concentration of 33.8% microgroms which is in confirmity with our observation. In the present study [Table - 5] cases judged clinically as suffering from Vit. A deficiency had low levels of Serum Vit. A concentration (10-30 microgram) while in keratomalacia (10-20 microgram%) Xerosis cornea (12-26 micrograms%) and Bitot's spots (12-30 micrograms%).
The Vitamin A levels were directly proportional to the severity of the disease. Bhandari in a study of xerophthalmia and keratomalacia recorded the serum vit. A level to be varying from 12-36 microgram%. The present findings of serum Vit. A level is akin to the observation,.
| Summary|| |
It can be safely concluded that Vita A deficiency manifesting clinically in form of conjunctival and corneal involvements and proved biochemically, in the arid zones of Rajasthan (Dist. Jaisalmer indicates that the cause of deficiency is due to poor nutritional status because of low socio-economic conditions. In the present study, the prevelance of vitamin A deficiency and other ocular diseases in relation to arid zone have been highlighted.
| References|| |
James Kuruvilla and P.N. Srinivasa Rao 1978 Ind J. Ophthalmol 11: 9.
Gupta, U.C. and Preobragenski, V.V., 1964 J. All Ind. Ophth, Soc., 12: 39-49.
Ghosh, B.N., Dutta. S,P, R. Gopal Krishna; Lamba, K., Sood, H.N. and Lamba, F.A. 1969, Orient. Arch. Ophthalmol 7: 16-24.
Agarwal, L.P., Dhir, S.P. and Gupta, S.B. 1960, Orient. Arch. Ophthamol, 7, 85: 92,
Gill, P.S. et al: 1969, J. Indian M.A. 53: 156-8.
Desai, N.C., Chauhan, B.S., Qureshi, M.S. and Sharma, S.R. 1977, Ind. of Ophthalmol Vol. 25 No. I AP.
Bhandari, S.C., Thesis submitted to University of Rajasthan for M.S. (Oph.), 1968.
Rodger, F.C.: Exp. Eye Res. 3/4, 367-372, 1964.
[Table - 1], [Table - 2], [Table - 3], [Table - 4], [Table - 5]