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Blindness in Children

Dr. Radhika Batra has made blindness prevention the mission of her lifetime. Together with a group of young dedicated docs and nurses, she is distributing free vitamin A to children 1-5 years of age.  For this. She has collaborated with Vitamin Angels, a US based organisation that is active in 66 countries

About 1.4 million children worldwide suffer from blindness, 75% of which are in Asia and Africa [1]. The most common cause of this is Vitamin A deficiency. Vitamin A deficiency results in an estimated 350,000 new cases per year. It is also associated with higher infant and childhood mortality rates.  60 to 80% of children that become blind because of Vitamin A deficiency die within a few years because of increased susceptibility to infections and lack of care. Vitamin A deficiency can also cause poor night vision.

Vitamin A deficiency can occur due to a variety of reasons such as poor intake of foods rich in Vitamin A, the vitamins not being absorbed by the body usually due to diarrhoea and the increased need for Vitamin A during infections such as measles [2].

In order to prevent childhood blindness due to Vitamin A deficiency, approximately 500 million doses are given annually at the cost of  1$ per dose. Hence, the prevalence of Vitamin A deficiency and hence corneal scarring has decreased in many areas of the world. For example, in Uganda between 1951 and 1965 53% of all children born were blind due to cornel scarring as compared to only 14% between 1980 and 1995. However, in many areas still such as urban slums and poor communities in rural areas, some communities are still affected by Vitamin A blindness today [3].

Measles epidemics also cause corneal blindness since due to the infection there is increased need for Vitamin A in the body which it is sometimes not able to get. Measles immunizations have increased to target levels in most areas since the launch of EPI in 1974. Hence, the number of cases of measles and deaths resulting due to measles have declines significantly [3]. Again, this is not true of the communities mentioned above.

In India, there are about 320,000 blind children. This is more than any other country in the world. Preventing blindness in children is considered a priority since it can affect their development, mobility, education and employment opportunities. This has many implications on their families and their quality of life [4].

The term commonly used to describe an eye showing features of Vitamin A deficiency is xeropthalmia. The term literally means ‘dry eye’. A sign of xeropthalmia is the dry appearance of both the conjunctiva and the cornea. Vitamin A deficiency can occur at any age. However, the age group most at risk is 6 months to 6 years. A typical child at risk for xeropthalmia is of 1 to 3 years of age who is no longer breast fed, is malnourished, and has developed measles or another infection or has diarrhoea. The signs and symptoms of xeropthalmia are as follows. There is night blindness. Then there is conjunctival xerosis which is the dry appearance on the surface of the eye. This happens because of damage to the cells which produce secretions that moisten the eyes surface. In Bitot’s spots, a spot has a foamy white appearance and may be found in both eyes. They might appear in children under 3 years. However, they are more common in older children.  In corneal xerosis, the surface of the cornea can have a typical dry appearance. In corneal ulceration with xerosis there is an ulcer in the cornea along with xerosis. In keratomalacia, the cornea may melt very quickly, even within a few hours. Corneal scarring is the significant end stage of malnutrition causing eye damage. In this, the anterior part of the eye may bulge forward or the opposite may occur and the eye shrinks.  xeropthalmia is treated by administering Vitamin A orally to the children [5].

 

 

References –

[1] http://www.who.int

[2] http://www.cehjournal.org

[3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2580065/

[4] http://www.ijo.in/article.asp?issn=0301-4738;year=2008;volume=56;issue=6;spage=495;epage=499;aulast=Bhattacharjee

[5] https://www.cehjournal.org/resources/prevention-of-childhood-blindness-teaching-set-full-text/