Bitot’s Spot , Xerophthalmia

Bitot’s spot, xerophthalmia

It is characterized by abnormally and persistently dryness, which prevents tears from lubricating the eyes. It is a lack of vitamin A.

Symptoms

• Blurred vision.
• Redness of the eye
• Feeling of burning and itching in the eye
• Light sensitivity
• Night blindness
• Bitot’s spots
• Corneal xerosis

Causes

• Aging
• A lack of vitamin A
• Inadequate eyelid closure
• Toxic burns
• Prescription drugs, such as antihistamines
• Radiotherapy

WHO Classification of Xerophthalmia (1982) and clinical features

• XN: Night blindness: Earliest symptoms of xerophthalmia in children in which child is unstable too see in the dark.
• XIA: Conjunctival xerosis: Non-wettable: One or more wrinkled, dry areas of conjunctiva. Patches affect the inter-palpebral region and appear like sand bags.
• XIB: Bitot's spots: On the inner and outer surfaces of the cornea, parents observe triangular, foamy, white patches. Other characteristics include blindness, corneal scarring, wrinkled conjunctiva, and dry eyes.
• X2: Corneal xerosis: The cornea appears lifeless, dry, and dull. Punctuated keratopathy, which starts in the lower nasal quadrant and progresses to haziness and granular pebby dryness, is the first change in the cornea.
• X3a: Keratomalacia, corneal, melting or ulcer over less than or equal to 1/3 rd the corneal surface.
• X3B: Keratomalacia, corneal melting or ulcer over more than 1/3rd of the corneal surface.
• XS: Corneal scar due to a healing of keratomalacia, usually resulting in blindness.
• XF: Xerosis of fundus: Typically, the area of the fundus at the level of the optic disc will have elevated, whitish lesions that are seed-like and dispersed.

Treatment/Management

Replace vitamin 'A'

• Give intramuscular vitamin "A" in doses of 25,000 IU for children under 6 months, 50,000 IU for children 6 to 12 months, and 1 ,500,000 IU for children over 1 year old if the kid has diarrhea or is ill and is unable to accept oral vitamin "A." The dose is administered right away, then again the next day and four weeks later.
• Give a double dose of the oral vitamin A capsule if the youngster is not constipated and can handle oral ingestion.
• Women of reproductive age, whether or not they are expecting, should take 10,000 Iu of vitamin A daily for two weeks. Corneal Xeropthalmia: complete dosage schedule administration (patient older than 1 year)

Treat the general health condition of children

• Foods high in protein and vitamin A need to be added to the diet.
• Precautions should be taken to prevent diarrhea.
• Immunization against pediatric diseases that are common

Treatment of local condition

• In stages XIA, XIB, and X2, artificial tear solution should be infused 4-6 times per day with antibiotic drops, followed by an antibiotic ointment at bedtime.
• To prevent eyeball perforation in stages X3A and X3B, a pad and bandage must be placed over the closed eye each day after applying an antibiotic and atropine eye ointment.
• A corneal transplant is necessary at stage XS.

Nursing consideration

• During a hospital stay, care
• Taught parents about Xerophthalmia prevention strategies and the significance of giving vitamin 'an' to young children.
• Encourage children to get enough vitamin A and to get vaccinated against common childhood infectious diseases.
• Encouragement of breastfeeding
• Health services for mothers and young children should be improved.