International Ophthalmology

, Volume 14, Issue 3, pp 195–199

Xerophthalmia, keratomalacia and nutritional blindness

  • Alfred Sommer


Vitamin A deficiency remains a major cause of pediatric ocular morbidity. Over five million children develop xerophthalmia annually, a quarter million or more becoming blind. It is also a major pathway for measles-associated blindness, particularly in Africa. Treatment is practical and inexpensive, based upon the oral administration of 200,000 IU vitamin A on two successive days, at a cost of 10 cents U.S. Given the potential rapidity of corneal necrosis (keratomalacia) and the relative inaccessibility of health services to those at greatest risk, prevention is probably more important than treatment. Oral administration of high dose supplements (2000,000 IU every 3 to 6 months), vitamin A fortification of commonly consumed items, or best of all, increased dietary intake of natural sources of vitamin A will reduce the number of needlessly blind young children. Given recent evidence that vitamin A deficiency greatly increases overall mortality, even among children without evidence of xerophthalmia, the same prophylactic regimen may improve child survival by 35% or more.

Key words

xerophthalmia keratomalacia vitamin A deficiency nutritional blindness child survival 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Sommer, A. Nutritional Blindness: Xerophthalmia and Keratomalacia. New York: Oxford University Press, 1982.Google Scholar
  2. 2.
    Sommer, A. Vitamin A deficiency and xerophthalmia. Arch Ophthalmol, in press.Google Scholar
  3. 3.
    Sommer, A. Vitamin A deficiency today: conjunctival xerosis in cystic fibrosis (editorial). J Roy Soc Med 1989; 82: 745–6.Google Scholar
  4. 4.
    Bloch CE. Clinical investigation of xerophthalmia and dystrophy in infants and young children (Xerophthalmia et dystrophia alipogenetica). J Hygiene 1921; 19: 283–301.Google Scholar
  5. 5.
    Blackfan KD, Wolbach SB. Vitamin A deficiency in infants. A clinical and pathological study. J Pediatr 1933; 3: 679–706.Google Scholar
  6. 6.
    Sommer A, Tarwotjo I, Hussaini G. Incidence, prevalence and scale of blinding malnutrition. Lancet 1981; 1: 1407–8.Google Scholar
  7. 7.
    Sommer A. New imperatives for an old vitamin (A): The VII E.V. McCollum International Lecture in Nutrition. J Nutr 1989; 119: 96–100.Google Scholar
  8. 8.
    Sommer A, Tarwotjo I, Hussaini G, Susanto D. Increased mortality in mild vitamin A deficiency. Lancet 1983; 2: 585–8.Google Scholar
  9. 9.
    Sommer A, Tarwotjo I, Djunaedi E, West KP, Loedin AA, Tilden R, Mele L. Impact of vitamin A supplementation on childhood mortality: a randomized controlled community trial. Lancet 1986; 1: 1169–73.Google Scholar
  10. 10.
    Muhilal, Permeisih D, Idjradinata YR, Muherdiyantiningsih, Karyadi D. Vitamin A-fortified monosodium glutamate and health, growth, and survival of children: a controlled field trial. Am J Clin Nutr 1988; 48: 1271–6.Google Scholar
  11. 11.
    Sommer A. Field Guide to the Detection and Control of Xerophthalmia. Second Edition, Geneva, World Health Organization, 1982.Google Scholar
  12. 12.
    Natadisastra G, Wittpenn JR, Muhilal, West KP Jr, Mele L, Sommer A. Impression cytology: a practical index of vitamin A status. Am J Clin Nutr 1988; 48: 695–701.Google Scholar
  13. 13.
    Sommer A, Emran N, Tjakrasudjatma S. Clinical characteristics of vitamin A responsive and nonresponsive Bitot's spots. Am J Ophthalmol 1980; 190: 160–71.Google Scholar
  14. 14.
    Tielsch JM, Sommer A. The epidemiology of vitamin A deficiency and xerophthalmia. Ann Rev Nutr 1984; 183-205.Google Scholar
  15. 15.
    Sommer A, Sugana T, Djunaedi E, Green WR. Vitamin A responsive pan-ocular xerophthalmia in a healthy adult. Arch Ophthalmol 1978; 96: 1630–4.Google Scholar
  16. 16.
    Sommer A, Muhilal, Tarwotjo I, Djunaedi E, Glover J. Oral versus intramuscular vitamin A in the treatment of xerophthalmia. Lancet 1980; 1: 557–9.Google Scholar
  17. 17.
    Foster A, Sommer A. Corneal ulceration, measles and childhood blindness in Tanzania. Br J Ophthalmol 1987; 71: 331–43.Google Scholar
  18. 18.
    Barclay AJG, Foster A, Sommer A. Vitamin A supplementation and mortality related to measles: a randomized clinical trial. Br Med J 1987; 294: 294–6.Google Scholar
  19. 19.
    WHO/UNICEF/IVACG Task Force. Vitamin A Supplements: a guide to their use in the treatment and prevention of vitamin A deficiency and xerophthalmia. Geneva, World Health Organization, 1988.Google Scholar

Copyright information

© Kluwer Academic Publishers 1990

Authors and Affiliations

  • Alfred Sommer
    • 1
  1. 1.The Dana Center for Preventive Ophthalmology of the Wilmer Eye Institute and School of Public Health, Johns Hopkins Medical InstitutionsBaltimoreUSA
  2. 2.Dana Center, Wilmer 120, Johns Hopkins HospitalBaltimoreUSA

Personalised recommendations