Dry eye disease and unpredictable hazards

Doctor Nguyen Bui Dieu Linh

Dry eye disease caused by a lack of vitamin A, which is severely affected by blindness, is still a threat to children of many countries in the world including our country . According to estimates by the World Health Organization, every year more than half a million children in countries are blind; up to 6-7 million other children with vitamin A deficiency may be mild or moderate, making these children more susceptible to infections such as diarrhea, pneumonia .

Vitamin A deficiency and dry eye disease are a common malnutrition in children, especially in children with severe malnutrition, after suffering from diarrheal diseases, respiratory infections . Common diseases in children rural and mountainous areas due to underdeveloped economy and poor nutrition. One study showed an association between dry eye incidence and high malnutrition rates.

Clinical manifestations of dry eye disease

The earliest sign of dry eye disease is that children are " blinded ", unable to see at dusk, often children are afraid, have little activity, walk or stumble or touch objects. This sign is difficult to detect in young and undetectable children in children who do not know it. More severe manifestations include: Conjunctival dryness, unevenness of the conjunctiva, loss of luster, pale yellow color in the conjunctiva of the eyeball and in the conjunctiva. When the dry conjunctiva is waterproof, opaque, opaque as milk due to small bubbles of hyperkeratosis, the conjunctiva is not visible. The conjunctiva may be thick, wrinkled, pigmented, making the conjunctiva grayish-gray, or small scattered particles, at the corner of the eyelid with brown-colored deposits.

- Bitot streak is a typical symptom of vitamin A deficiency disease. Bitot streaks are a group of gray-white thickened cells emerging on the surface of the eyeball, the surface covered with a tiny layer of foam or lumpy on the surface. The face of the eyeball, usually the triangular triangle, turns to the edge of the cornea, or is oval-shaped, usually in both eyes.

- Dry cornea: make children dazzled with light, or close their eyes, squint. The cornea exhibits a loss of light, darkness, and dryness, with an increase in inflammatory cell spots, blurring as a mist, often in the lower half of the cornea.

- Corneal ulcer: This is a severe symptom, the child is very afraid of light, eyes are always closed, watery eyes. The level of ulcer may be as small as pea, can be up to 1/3 or whole of the cornea, opaque white due to superinfection. Sometimes there is a phenomenon of swelling, necrosis, puncturing the cornea, iris.

- Corneal scars: due to dryness of the cornea, corneal ulcers, scars may be just like small spots, or like smoke, maybe the entire cornea leads to blindness.

- Ocular lesions: Using ophthalmic lamps, we can detect ocular lesions due to lack of vitamin A with the appearance of the bottom of the macula with small spots usually at the edge of the retinal blood vessels.

How to prevent vitamin A deficiency?

Improving diet: The daily diet should provide enough vitamin A and carotene. Vitamin A is only found in animal foods, but carotene is available in dark green vegetables, orange-colored fruits. It is recommended to grind vegetables, carrots or soup for children to eat. Carotene-rich foods like spinach, spinach, lettuce, onion, and gac . often come with many other precious nutrients such as riboflavin, vitamin C, calcium, iron and trace elements. Food for children with extra fat to support absorption of carotene.

Supplementing vitamin A in foods: Enhance vitamin A into lean milk because this type is often used in nutrition programs in countries where eye dryness is circulating.

- Give vitamin A: When the community has detected a problem of vitamin A deficiency, giving vitamin A capsules high doses is an immediate and effective measure, and has a long-term program to prevent vitamin deficiency A. Usually give the child a capsule of 200,000 UI twice a year. If the disease is progressing, taking vitamin A according to the World Health Organization treatment regimen is as follows: Immediately after diagnosis: 200,000 UI orally or 100,000 UI intramuscularly; The next day: 200,000 UI by mouth; 2-4 weeks later, or more severe illness before discharge of 200,000 UI by mouth. For children under 1 year of age use half of the above dose. Can be administered intramuscularly with water-soluble vitamin A preparations when patients have severe vomiting or diarrhea. Need to actively prevent infections such as sore throat, pneumonia, diarrhea, especially measles also affect the eyes, especially dangerous for children who lack vitamin A. Therefore, the prevention of malnutrition and infection must be implemented in primary health care operations.