|Year : 1967 | Volume
| Issue : 5 | Page : 172-174
Malnutrional blindness in Udaipur
SP Mathur, JM Makhija, DR Shah, BL Bhandari
Department of Ophthalmology, General Hospital, Udaipur, Rajasthan, India
|Date of Web Publication||21-Jan-2008|
S P Mathur
Department of Ophthalmology, General Hospital, Udaipur, Rajasthan
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Mathur S P, Makhija J M, Shah D R, Bhandari B L. Malnutrional blindness in Udaipur. Indian J Ophthalmol 1967;15:172-4
In a vast country like India, where a large majority of rural socio-economically poor population get their one square meal with great difficulty, there are many sufferers from chronic general malnutrition, which may manifest in clinical or subclinical forms. The eye has to take its share which mostly results in blindness.
Keratomalacia is probably the commonest cause of nutritional blindness in Udaipur, particularly in infants and children from the rural population, where it is a State-problem. We wish to illustrate this fact in this paper, by presenting a collection of those cases which were referred to us from their eye examination, from the medical and pediatric wards of the General Hospital, Udaipur, during a period of one year, where they were being treated for their general condition.
| Habits and Habitat|| |
All the patients examined in this series came from rural areas with poor economic conditions. They belonged to large families, with children having born in quick succession, most of whom died shortly afterwards due to merasmus.
The staple diet in this area is maize taken in one or two meals a day with salt or dal. Vegetables are scarce. Cattle is of a poor quality. Those who are non-vegetarians cannot afford meat frequently.
All these factors combined establish ideal conditions for an unbalanced diet deficient in vitamins and proteins.
| Observations|| |
1. Total number of cases examined during February 1965 to February
Males ... ... 62
Females ... .., 40
2. Age :
3 years and under ... 76
Over 3 years ... 26
3. General clinical diagnoses
a) Gastro-intestinal diseases (Dysentry, Diarrhoea, Gastro-enteritis, Hepatitis, etc.).. 78
b) Kwashiorkor ... 11
c) Severe anaemia ... 6
d) Avitaminosis A ... 3
e) Rickets ... ... 3
f) Koch's abdomen ... 1
4. Presenting signs (general):
i) Over the face and feet.. 44
ii) Over whole of the body.. 5
b) Merasmus ... ... 53
c) Severe dehydration ... 22
d) Respiratory tract infection.. 26
e) Enlarged liver ... 25
f) Signs of shock due to peripheral circulatory failure ..7
5. Ophthalmic signs:
a) Keratosis of canjunctiva 102 (100%)
b) Keratosis of conjunctiva with Keratomalacia.. 51
c) Perforation of cornea with staphyloma or phthisis bulbi ... ... 21
6. Laboratory investigations :
8 Gms to 12 Gms ... 30
5.1 Gms to 7.9 Gms ... 25
3.1 Gms to 5 Gms ... 19
Below 3 Gms ... 19
b) Stool examination
Bacillary exudates and R.B.C. ... 64
Ankylostoma Duodenale ova ... ... 6
Bulky stool ... ... 12
c) Liver Biopsy (done only in those cases where there was enlargement):
Fatty infiltration ... 20
Cirrhosis ... ... 3
| Treatment|| |
Acute cases were treated on individual merits. Furazolidone (Furoxone) and neomycin were used in cases of gastro-enteritis, along with maintenance of fluid balance. Tetracyclin was used for respiratory infections. As soon as acute condition subsided a nutritious diet was given and supplemented with proteins, vitamins and anti-anaemic factors in heavy doses. Most of the cases responded to this, except those whose general condition was extremely poor and expired in the hospital shortly after their admission.
The eye was treated with tetracyclin ophthalmic suspension 3 or 4 times a day. Those who showed Keratomalacia were given pad and bandage.
| Results on Discharge|| |
Relieved with good general condition and useful vision ... 12
Relieved with good general condition but with total blindness.... 51
Left against medical advice ... 23
Died in the Hospital ... 16
| Discussion|| |
All the cases in this series had poor nutritional background. They had come from the rural population, were illiterate, and the socio-economic condition was extremely poor. Many of them could not afford a prolonged stay in the hospital which is usually required while treating nutritional disorders, and had lost children with similar symptoms in the past.
A large majority was admitted primarily with gastro-intestinal disorders. This could have been either the cause or resultant of malnutrition, establishing a vicious circle. Feeding habits were faulty, mother's milk had either dried early or was scanty. Gastrointestinal disorders, when added to such a condition, precipitated the crisis.
In these cases malnutrition had manifested as rickets, Koch's abdomen, anemia etc., but the inevitable results was anasarka or merasmus, dehydration, respiratory tract infection, liver damage, peripheral circulatory failure, keratomalacia and death. Even if they were treated for all these complications by hospitalisation, they had to go back to the same rural conditions of poverty, illiteracy and poor sanitation which would repeat the process once again,
In this connection preventive aspect cannot be overstressed. This includes education, eradication of gastrointestinal diseases, improvement of personal hygiene and sanitation. All these factors are closely connected with general prosperity of the society. The problem is in the hands of the general practitioner- working in the villages. It is suggested that while treating merasmic children particularly with gastroenteritis, stress should be given to treat the syndrome of malnutrition as a whole with massive doses of proteins and vitamins particularly Vit. A, in order to prevent the dreaded complication of keratomalacia and blindness.
| Summary|| |
The serious loss to life and vision due to delays in treatment of malnutritive condition and their causes is emphasised in a study of 102 cases referred to the ophthalmic department from the pediatric wards.