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An Approach to Visual Loss in a Child
Published in Vivek Lal, A Clinical Approach to Neuro-Ophthalmic Disorders, 2023
Muhammad Hassaan Ali, Stacy L. Pineles
Common causes of corneal blindness like vitamin A deficiency, measles, trauma and trachoma are rare in infancy but are still occasionally reported from developing countries. Patients may present with corneal opacification and other associated features. If a bilateral disease is seen with keratomalacia, suspect vitamin A deficiency, which is treated with vitamin A supplementation after the age of 6 months.
Assessment – Nutrition-Focused Physical Exam to Detect Micronutrient Deficiencies
Published in Jennifer Doley, Mary J. Marian, Adult Malnutrition, 2023
Vitamin A deficiency may also cause several other eye disorders that are identifiable by conducting an NFPE, including conjunctival xerosis, corneal xerosis (Figure 7.3) and keratomalacia.2,4 Conjunctival xerosis is characterized by severe dryness to the eyes, specifically the conjunctiva, and occurs bilaterally. It can then progress to dryness of the cornea, known as corneal xerosis, which appears as a dull, opaque milky cornea. Keratomalacia, or “hazy cornea”, characterized by drying and clouding of the cornea, is progressive and results from untreated xerosis. A potential non-nutrient cause of keratomalacia is hyperthyroidism.4
Skin problems in infancy and old age
Published in Rashmi Sarkar, Anupam Das, Sumit Sethi, Concise Dermatology, 2021
The condition rarely starts before 4–6 weeks of age and usually begins between the ages of 2 and 3 months. It may first show itself on the face but spreads quite quickly to other areas, although the napkin area is conspicuously spared – presumably as a result of the area being kept moist. The ability to scratch develops after about 6 months of age and the appearance of the disorder alters accordingly, with excoriations and lichenification. At this time, the predominantly flexural distribution of the disorder begins, with thickened, red, scaly, and excoriated (and sometimes crusted and infected) areas in the popliteal and antecubital fossae. The eyes are often affected, eye rubbing being the probable cause of sparseness of eyebrows and eyelashes. It may also be the cause of corneal softening (keratomalacia) and its deformity (keratoconus). Emollients are important in management and mothers should be carefully instructed on their benefit and how to use them. Similarly, bathing should be in lukewarm water, with patting dry, rather than long-lasting hot scrubs with vigorous towelling afterwards. Weak topical corticosteroids only should be used – 1% hydrocortisone and 0.1% clobetasone butyrate are appropriate. For more severely affected infants, topical tacrolimus (Protopic) or pimecrolimus (Elidel) has proved a useful alternative to steroids.
Wound Healing and Mucin Gene Expression of Human Corneal Epithelial Cells Treated with Deproteinized Extract of Calf Blood
Published in Current Eye Research, 2019
The effect of DECB under ocular surface conditions has been reported, including with corneal wounds and dry eye syndrome. The migration and proliferation of epithelial cells is critical during the repair of the wounded cornea, and the epithelium plays a central role in this process.8 In developed countries, traumatic corneal wounding is the leading cause of ocular emergencies, causing permanent scarring and increasing the risk of recurrent corneal erosions.9 DECB promotes corneal wound healing10-13 and tends to increase tear secretion and tear breakup time (BUT) in dry eye patients.13 However, most reports are from clinical research, and there have been a very limited number of in vitro tests using corneal epithelial cells (CECs). In particular, some debates on the efficacy of DECB require more experimental evidence. In a rabbit central corneal wound model, DECB did not show a markedly better effect in comparison to physiological saline eye drops used as a control.3 Additionally, Solcoseryl may not be adequate as a single agent for the control keratomalacia due to its minimal inhibition of matrix metalloproteinase (MMP) 2 activity.14
Childhood blindness and visual impairment in the Narayani Zone of Nepal: a population-based survey
Published in Ophthalmic Epidemiology, 2019
R. N. Byanju, Ram Prasad Kandel, Prasanna Sharma, Hari Bahadur Thapa, Manisha Shrestha, Ken Bassett
Our blindness estimate of 10/100,000 is lower than that reported by Muhit in Bangladesh (30/100,000)10 and lower than estimates based on infant mortality rates in Nepal (50/100,000).1 This is likely due, in part, to the almost complete absence of corneal blindness found in our study (27% in Bangladesh). Low corneal blindness is in keeping with Nepal’s strong public health program distributing vitamin A and consistent with global trends,2,11 however, keratomalacia due to Vitamin A deficiency was found as a cause of blindness in blind school populations in Nepal from 2008–2011.12 The low prevalence of blindness and corneal blindness in our study is also likely due to high measles vaccine coverage in Nepal as demonstrated by Adhikari, where over 96% of children sampled in his population-based assessment of factors associated with low vision and blindness in Nepal had received measles vaccine.5
Clinical, histopathological, and genetic aspects in one case of ligneous conjunctivitis
Published in Ophthalmic Genetics, 2018
Rolf Raimann, Rene Moya, Rodrigo Anguita, Rudolf Kobus, Marcela Pérez, Patricio Gonzalez
Ligneous conjunctivitis starts with tearing and redness of the conjunctivae. After that, the development of pseudomembranes occurs commonly on the tarsal conjunctiva which changes to white, yellow-white, or red thick masses with a woody-like consistency. It usually recurs after local excision. It could also be accompanied by mucoid discharge from affected eyes (8–22). Ligneous conjunctivitis is more frequent in children and infants, even though the onset of this disease has been described at any age (10–12). In half of the cases, both eyes are involved and, typically, the upper eyelid is affected more often. With respect to bulbar conjunctiva involvement, this has been reported with less frequency (6–22). In a quarter of the cases, the cornea is involved and this is responsible for development of poor visual acuity due to scarring, vascularization, keratomalacia, and corneal perforation. The duration of this condition varies from few months to 44 years (8–22). Our patient had slowly progressive symptoms at the beginning, without corneal involvement and multiple recurrences.