|Year : 1981 | Volume
| Issue : 3 | Page : 191-193
Correlation of stages of xerophthalmia with grades of malnutrition
M Mathew, PS Sandhu
Department of Ophthalmology, Lady Hardinge Medical College, New Delhi, India
Department of Ophthalmology, Lady Hardinge Medical College, New Delhi
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Mathew M, Sandhu P S. Correlation of stages of xerophthalmia with grades of malnutrition. Indian J Ophthalmol 1981;29:191-3
The present study is undertaken to see the incidence of nutritional xerophthalmia in malnourished children and to find out the stages of xerophthalmia in different grades of malnutrition with an attempt to correlate them. Xerophthalmia has been classified by Duke elder, Venktaswamy, & W.H.O. We have taken Duke Elder's classification for this study which is similar to that of primary signs of W.H.O. gradation 1976.
| Materials and methods|| |
A total number of 100 children upto the age of 8 years suffering from malnutrition were studied. The diagnosis of xerophthalmia was made on clinical basis by diffuse light and by slit lamp examination wherever possible. Although ocular changes were present due to deficiency of other vitamins and minerals, we have confined ourselves to the study of the stages of xerophthalmia in relation to grades of malnutrition. [Table - 1] shows expected weight of babies in different ages. In 1972 Indian Academy of Paediatricians suggested classification of malnutrition according to the body weight which is given in [Table - 2].
The classification used is that of Duke elder & is as follows.
Stage I : Stage of pre-xerosis i.e. lack of lustre detected by seeing conjunctival reflex.
Stage II : Stage of epithelial xerosis i.e. wrinkling of conjunctiva, xerotic patches in cornea, Bitot's spots.
Stage III : Keratomalacia.
Stage IV : Keratomalacia with sequelae.
| Observations|| |
In this series of 100 cases of malnutrition, 17 were of Grade I, 24 of Grade II, 19 of Grade III and 40 of Grade IV. It is of great significance that 62 patients with malnutrition had xerophthalmia.
[Table - 3] shows that 29.4% of Grade I, 62.5% of Grade II, 63.3% of Grade III, 75% of Grade IV malnutrition had Xerophthalmia. 7 cases showed keratomalacia in these 100 cases. 5 cases out of 7 were bilateral.
The graphic representation of xerophthalmia in different grades of malnutrition indicates that the severity of xerophthalmia is directly proportional to the severity of malnutrition [Figure - 1]
| Discussion|| |
62% of the malnourished children showed xerophthalmia and it is highly significant that 7% had keratomalacia, this being bilateral in 5 cases i.e 5%.
The following facts therefore emerge from the study 1 ) The bilaterality of 5 cases i.e. 5% of this series if projected to large population of malnourished children in India, the number would be frightening and alarming. 2) The affected children of xerophthalmia being from the first decade, they have a larger life span. Hence the number of years of blindness are much more for these, than the years in other types of blindness due to cataract or glaucoma. Apart from the physical and mental trauma the economic burden on the family and the nation therefore is collosal. It is very essential to highlight the importance of malnutrition and its hazards on the body in general and the eye in particular.
| Summary|| |
A series of 100 cases of malnutrition was studied. It was found that nutritional xerophthalmia is present in 62% of cases, in all grades. Further split up of xerophthalmia shows xerophthalmia 29.4% in grade 1, 62.5% in grade II, 63.3%in grade III and 75% in grade IV of malnutrition. Keratomalacia is found in 7% of cases and was seen only in grade III and IV of malnutrition. Of these 5% was bilateral which resulted in total blindness.
| Acknowledgement|| |
Authors acknowledge the help rendered by Dr. V.V. Guiral, Professor of Paediatrics for this study.
| References|| |
Duke Elder, S., 1965, System of ophthalmology Vol. III part 2 Henry Kimpton, London 118.
Venkataswamy, G., 1975, Personal Communication.
Venkataswamy, G, 1966, Proc All India Ophthalmol. Soc, 12 : 77.
W.H.O organisation Technical Report series 590, 1976, Vitamin A deficiency and Xerophthalmia World Health Organisation, Geneva.
[Figure - 1], [Figure - 2]
[Table - 1], [Table - 2], [Table - 3]