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Bitot's spots
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Xerophthalmia is a major cause of blindness in children in Africa and Latin America.

  • peak incidence is 3-5 years of age
  • associated with vitamin A deficiency and malnutrition in general

Clinical features:

  • night blindness is an early manifestation. Later, there is drying - xerosis - of the conjunctiva with the development of characteristic oval or triangular spots - Bitot's spots
  • xerosis of the cornea is seen initially as a mild haziness inferiorly. This is followed by corneal ulceration with full thickness dissolution known as keratomalacia - there may be extrusion of the intraocular contents

Treatment:

  • vitamin A therapy and a protein-rich diet are essential.
  • topical antibiotics are given to prevent secondary bacterial infection. Keratomalacia is irreversible and causes permanent corneal scarring

Diet supplements rich in vitamin A or beta-carotene should be provided in high risk areas to prevent the condition (NB vitamin A should be avoided during pregnancy because of the risk of vitamin A embryopathy).

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