xero ph thal mia

Xerophthalmia

Dr.Irma A. Pasaribu,Sp.MataDepartment of Ophthalmology

Definition

• Semua manifestasi karena kekurangan vit.A pada mata, termasuk:– Perubahan anatomi mata– Perubahan anatomi dan fungsi retina

Metabolism

• Retinol (vit A)Larut lemak, ditemukan dlm dagin, ikan, fowl, diary products

• Carotene (pro vitamin A)Ditemukan pd daun hijau, sayuran

merah dan kuning, minyak2 dari tanaman; hrs diubah mnjd vitamin A

Metabolism

• 50-90% retinol absorbed in intestines• Deposited in liver as retinol palmitate• Retinol palmitate enters bloodstream, combines

with retinol binding protein• Bound retinol palmitate leaves bloodstream and

enters epithelial tissues of whole body

Vitamin A Status & Clinical Condition• Vit.A stts: Sufficient

– Input: Sufficient– Serum vit.A: Sufficient– Liver vit.A: Sufficient deposition

• Normal demand: normal clinical condition• Increased demand (measles, fever, resp.

tract inf.): mild symptoms, supplements <

Vitamin A Status & Clinical Condition• Vit.A status: Poor

– Input: diet poor in carotenes and vit.A– Serum vit.A: very low– Liver vit.A: very low or non-existant

• Normal demand: very apparent symptoms of VAD, night blindness, xerophthalmia

• Increased demand (measles, fever, resp. tract inf.): very high mortality

Early Detection of Xerophthalmia• Recognize the individual at risk• Recognize the community at risk• Know the sosio-ecologic indicators

associated with risk of vit.A deficiency

Clinical Features Deserving Special Attention

• History of poor vision in poor lighting or in evening or in nighttime,

• Other ocular symptoms• Frequent episodes of diarrhea, fever, or

respiratory tract infection• Helminthic infestation, or suspicion of

Measles or varicella infection

Clinical Features Deserving Special Attention

• Poor or no immunization history• Low birth weight• Indicator of Protein Energy Malnutrition (weight,

height, upper arm circumference, general appearance)

Non Clinical Consideration in Early Detection of Xerophthalmia

• Breast feeding patterns: quantity and quality• Dietary patterns: frequency of feeding, type of

food, beliefs and attitudes concerning food• Employment and income

Therapy

• Day one: vit.A 200.000 IU (100.000 IU for <12 months of age)

• Day two: same dose• After 1 week: same dose• 2-4 weeks: same dose

Therapy

• Improve nutritional status• Overcome accompanying diseases• Promotion of good nutrition, good health,

and good living conditions• Overcome poverty and ignorance

Prevention

• Good nutritions, prevention of diseases, good living conditions, attitudes and behaviour supporting good health and living

• Vitamin A maintenance dose• Vitamin A distribution programs