Xerophthalmia disease: Symptoms, causes and treatment

What is xerophthalmia disease?

Xerophthalmia is a group of eye problems caused by severe vitamin A deficiency (VAD). Often resulting from malnutrition, xerophthalmia is the top cause of preventable blindness among children around the world, found most frequently in poverty-stricken regions. 

It can affect various parts of the eye, including the:

• Conjunctiva – A clear membrane on the front of the eye and inside of the eyelids

• Cornea – The clear front part of the eye that allows light to enter and helps the eye to focus

• Retina – A membrane on the back of the eyeball that contains two types of photoreceptors: rods for black-and-white vision and cones for color vision

Xerophthalmia can also affect people with conditions that affect the body's ability to process vitamin A and other nutrients, even in more developed countries where it’s rare. 

Conditions that may put you at higher risk for developing xerophthalmia include:

• Alcoholism or liver disease

• Cystic fibrosis

• Gastrointestinal disorders that affect nutrient absorption (for example, Crohn's disease, celiac disease or short bowel syndrome) and bariatric surgery 

• Premature birth (for babies in the first year of life)

• Strict vegan or vegetarian diets

While most Americans get enough vitamin A in their regular diets, it's important to eat plenty of colorful fruits and vegetables each day — especially if you're at risk for developing problems with vitamin A absorption, storage or transport in your body.

Without treatment, xerophthalmia can cause night blindness, dry eyes and other eye problems, and may eventually lead to vision loss.

What causes xerophthalmia?

Xerophthalmia is caused by a lack of vitamin A in the diet due to malnutrition or issues processing vitamin A in the body (such as poor absorption, storage or transportation). 

There are two main ways to get vitamin A through food:

• Retinol  – This preformed vitamin A in animal foods, such as liver and dairy products, can be used directly by the body for many key functions.

• Carotenoids – This "provitamin A" in yellow and orange fruits and vegetables, such as carrots, cantaloupe and squash, can be turned into retinol and then used by the body.

Vitamin A plays a key role in immune system function, reproductive health and helping organs, such as the heart and lungs, work properly.

It's also key for good vision. There are many eye benefits of vitamin A. For example, vitamin A combined with other antioxidants may slow the progress of macular degeneration. 

On the other hand, a lack of vitamin A can cause eye problems ranging from eye infections to severe dry eye to poor night vision to blindness.

Prevention of xerophthalmia

The best way to prevent xerophthalmia is to eat a balanced diet that includes plenty of foods with vitamin A. Foods that are rich in vitamin A include:

• Beef liver and chicken liver

• Dairy products (for example, whole milk and cheese)

• Salmon and some other fish

• Green leafy vegetables (for example, kale and spinach)

• Green, yellow and orange vegetables (for example, broccoli, carrots and squash)

• Orange and yellow fruits (for example, apricots, cantaloupe and mangos)

• Fortified foods (for example, breakfast cereals)

A nutritious diet for good vision includes foods with vitamin A, along with foods that contain vitamin C and vitamin E, which are also important for good eye and overall health.

How much vitamin A do I need for healthy eyes?

The recommended daily dose of vitamin A varies by age and life stage and is different for men and women, teen girls and teen boys, and people who are pregnant or breastfeeding. 

Here are vitamin A daily requirements in mcg (micrograms) of retinol activity equivalents (RAE) from the National Institutes of Health:

Will having more than normal amounts of vitamin A improve eyesight?

Once you have normal vitamin A levels, consuming more won’t make your vision any better. That’s an urban legend.

Talk to your doctor if you're concerned about getting enough vitamin A in your diet. It's important to tell your doctor about any medications you're taking since some drugs can increase or decrease vitamin A levels in the body.

What are the symptoms of xerophthalmia?

Vitamin A deficiency (VAD) can lead to a group of progressive eye problems known as xerophthalmia.

Xerophthalmia signs and symptoms generally progress if not treated, often starting with poor night vision. A patient may notice some symptoms while other signs of xerophthalmia may only be visible to an eye doctor during a comprehensive eye exam.

Signs and symptoms of xerophthalmia may include:

• Inability to see well in low light (night blindness)

• Severe dry eye (eye dryness, watering, redness and discomfort)

• Bitot's spots (dry, foamy spots on the conjunctiva)

• Corneal ulceration, scarring and softening (keratomalacia)

If left untreated, xerophthalmia can lead to blindness. That's why it's crucial to seek proper assessment, diagnosis and treatment if you experience any symptoms.

How do you treat xerophthalmia?

The treatment for xerophthalmia is vitamin A therapy, usually through oral vitamin A supplements. 

Xerophthalmia treatment for children in developing countries typically involves taking a very high dose of vitamin A for two days in a row with another dose two weeks later. 

For other patients, a doctor will decide on a treatment plan based on the patient and the severity of and reason for their vitamin A deficiency. For example, bariatric surgery patients may take a vitamin A supplement every day, with a plan to change dosing as needed based on regular blood testing results.

Your doctor may also talk to you about adjusting your nutritional habits to address xerophthalmia. They may tell you to add more foods with vitamin A to your diet, such as organ meats, dairy products, colorful fruits and vegetables, and enriched foods.

It is important to follow your doctor's advice on how much vitamin A you should take or ingest because taking too much can cause vitamin A toxicity. Over time, vitamin A toxicity can lead to birth defects, liver issues, central nervous system problems and low bone mineral density.

Eye exams for prevention of xerophthalmia

It's important to eat a nutritious diet rich in colorful fruits and vegetables, see your doctor regularly and get routine eye exams. Even if you're not at risk for developing xerophthalmia, getting the right amount of vitamin A is key to keeping your eyes healthy. 

If you experience any eye symptoms, such as dry eye or issues with night vision, see your eye doctor right away.

Page published on Tuesday, February 15, 2022

Medically reviewed on Tuesday, January 11, 2022