Indian Journal of Ophthalmology

: 1981  |  Volume : 29  |  Issue : 4  |  Page : 485--488

Hypovitaminosis A associated with Helminth infestations

IS Roy, E Ahmed 
 Institute of Ophthalmology, Medical College, Calcutta, India

Correspondence Address:
I S Roy
Institute of Ophthalmology, Medical College, Calcutta

How to cite this article:
Roy I S, Ahmed E. Hypovitaminosis A associated with Helminth infestations.Indian J Ophthalmol 1981;29:485-488

How to cite this URL:
Roy I S, Ahmed E. Hypovitaminosis A associated with Helminth infestations. Indian J Ophthalmol [serial online] 1981 [cited 2021 Apr 22 ];29:485-488
Available from:

Full Text

Vitamin A or Retinol plays possibly a vital role in the metabolism of all human cells. In man, the conversion of precursor-carotene into retinol occurs chiefly in the walls of the small intestine. The relationship between retinol and protein is rather complex ; retinol is transported to the liver by retinolbinding protein and wrapped by serum pre-albumen.

GOPALAN et al[1] have recently suggested the following daily requirements of Vit. A for the Indians, which are a little different from those suggested earlier by joint F.A.O./W.H.O. group of nutritional experts (1967)

Infants : 300-400 micrograms.

Children : 250-600 micrograms.

Adolescents-men : 750 micrograms and women

Women during se- : 1150 micrograms.

cond half of preg­nancy and during first year of lactation.

So it appears that the normal need of vita­min A is variable according to the age, state of health, and demand of the body. The clinical features of hypovitaminosis A appear when the average daily allowance is less than half the daily suggested requirements.

The W.H.O. survey of the incidence of xerophthalmia in the world revealed that mal­nutrition is one of the major causes of blind­ness in Africa, Asia and South America. In India the whole of South India, Orissa, Bihar, Bengal, Madhya Pradesh and Utter Pradesh have been shown as endemic areas. Surveys of malnutritional blindness in India have been undertaken in course of various records­W.H.O./I.C.M.R.. T.C.P.P., Ophthalmic Out Patients records, School health surveys[3],[4],[5] It appears that the incidence varied between 1.5 to 10 percent in population.

In India there are about one million eco­nomically blind people due to malnutrition[6] which is clinically evident in 35.6 percent or more cases[7]. The commonest cause of Paedia­tric blindness is keratomatacia[8].

Literature is replete with various aspects of hypovitaminosis A,[9],[10],[11],[12].


The signs and symptoms can be grouped under two broad headings according to W.H.O,

reports (1975-76)[13],[14].

A. Primary signs

(X1 A ) Conjunctival xerosis.(XI B ) Bitot's spot with conjunctival xerosis(X 2 ) Corneal xerosis.(X3 A ) Corneal ulceration with xerosis. 5. (X3B) Keratomalacia.

B. Secondary signs

(X N ) Night blindness.(X N ) Xerophthalmia fundus.(Xs) Corneal scars following kerato­malacia.

Poor vitamin A status of an individual is evidenced by xerophthalmia, night blindness associated with protein-calorie malnutrition (PCM) and infections. Conjunctival pigmen­tation appears to be an early sign of xeroph­thalmia.[12]

We fully agree with Chandra AND Venkatachalan[15] who emphasized that "the diagnosis is easy provided that the practitioner makes it a point to examine the conjunctiva and cornea in every child that attends the clinic irrespective of the complaint."


The causative factors of hypovitaminosis A are well khown. Of the in, defective absorp­tion appears to be more important and in our view, it needs a greater emphasis.

The role of intestinal parasites in different ocular disorders including keratomalacia; 95 percent of his 1500 cases of kemtomalacia showed presence of worms deserve empha­sis.[16],[17] Severe diarrhoea in cases of kerato­malacia has beer reported[18],[19],[10].

In our previous communications (1969­197.5)[9],[10] we reported the association of hel­minths with hypovitaminosis A showing ocular signs. In a previous study of sixty cases selec­ted solely on the history of diarrhoea or dysentery, ova, cysts or parasites were found to be present in 50 percent cases.


One hundred cases of xerophthalmia from different age-groups were selected at random from the Eye Outpatients' of Medical College Hospital, Calcuttaduring last one year or so.

Ocular findings were documented. Evidence of under nutrition and/or malnutrition, if any, was noted.

A. single specimen of stool in each case was examined by clinical pathologist attached to the Eye Infirmary.


The Age-incidence (Shown in [Table 1])

80 percent of the cases were below the age of 10 years, of which maximum number of cases were infants.

General Health

Children often showed evidence of under nutrition and/or malnutrition, but there was practically no such evidence in adults.

Evidence of xerophthalmia [Table 2]

Most of them showed pigmentation at equatorial portion of bulbar conjunctiva on the outer side and Bitot's spots. Only a few pre­sented wish keratomalacia and they were all in infants. Rarely some cases presented with general opacity in one or both eyes but still with presence of Bitot's spot.

Ova, parasites or cysts

Infants and children below 10 years showed maximum number of positive cases. Ascaris ova and giardia cysts were particularly com­mon in 0-10 years age-group. E. histolytica was universally present in all age-groups, while a few patients above the age of 10 years show­ ed- hook worm ova. About 30 percent cases did not reveal any ova, parasites or cysts [Table 3].


In addition to vitamin A injections, anthel­minthics were prescribed in all cases showing helminth infestation.


Since there is no control study comparing xerophthalmia cases showing helminths and helminths in general population, it is difficult to pinpoint helminth infestation alone to be cause of hypovitaminosis A, but the associa­tion is certainly very common. Better thera­peutic response when vitamin A administration is coupled with proper anthelminthic is also very suggestive.

A single microscopic examination of faecal specimen reveals ova, parasites or cysts in about one-sixth to one-third cases and many of them are voided at varying intervals. So such examinations at intermittant intervals would detect more cases of helminths.


One hundred cases of xerophthalmia show­ing evidence of helminth infestation have been documented[20].


1Gopalan, C., Ramasastri. B.V. and Balasubra­manian, SC., 1976, Nutritive value of Indian Foods, National Inst. of Nutrit on, I.C.M.R. Hyderabad.
2McLaren, D.S., 1963, Global Map, Malnutrition and the Eye, Academic Press, New York.
3Ahmed, E. and Bose, J., 1964, Bull. Madras Ophthalmol Assoc. 1:107.
4Dey, A. Dristishakti (W.H.O.No.), V. 43 (Cited by 6)
5Rao, K.S., Swaminathan, V.N., 1950., Bull. W.H.O. 20; 603.
6Venkataswamy, G., 1966, In 'Proc. Nutritional Symposium on Nutritional Disorders of the Eye'. N.S.P.B., Hyderabad.
7Dhanda, R.P., 1966, In 'Proc. National Sym­posium on Nutritional disorders of the eye'. N.S.P.B., Hyderabad.
8Venkataswamy, G., 1966, J. Indian Med. Assoc. 47:67.
9Ahmed, E., 1969, Indian Med. Gazette, 9:55.
10Ahmed, E. Roy, S.N., 1970, Indian Pract., 23,225.
11Gopalan, C., Bagchi, K. and Agarwal, L.P. Eds., 1966, Proc. National Symposium on Nutritional disorders of the eye. N.S.P.B., Hyderabad.
12Stern, J.J., 1950, 'Nuti ition in Ophthalmology'. Nutrition monograph series No. 1, New York.
13W.H.O., 1975, W.H.O. Tech. Rep. Ser. No. 580.
14W.H.O., 1976, W.H.O. Techn. Rep. Ser. No. 590.
15Chandra, H. and Venkatachalam, P.S., 1978, In 'Manual of Paediatrics of South East Asia' Ed. Robinson, W.H.O. Publication, Orient Longman 1963.
16Tiwary, R., 1960, 19th Conc. Ophth., New Delhi, Acta 1:415.
17Tiwary, R., 1968, J. All India Ophthalmol. Soc., 14:87.
18Sinha, B.N., 1966, J. Indian Med. Assoc, 43, 55.
19Roy, I.S. and Ahmed, E., 1974., Xeroph­thalmia Club Bull., No. 6
20Roy, I.S. and Ahmed, E., 1975, In 'Documenta Ophthaimologica', Vol. 5: Public Health Ophthalmo­logy. Ed. Holmes.