Sequelae of severe xerophthalmia--a follow-up study.

Two-hundred sixteen children with vitamin A deficiency were hospitalized in Hyderabad, India, between 1970 and 1977. Out of these, 22 died during hospitalization. Fifty-six children could be followed-up, of whom 32 had keratomalacia and 24 corneal xerosis. In the keratomalacia group, nine died of reasons attributable to severe protein-energy malnutrition within 3 to 4 months after discharge from the hospital, five became totally blind, nine monocularily blind, and nine had adequate vision, although four of these had leucomas. Of the blind children, no change in condition was noted in the 11 located 1 year after the initial 3 to 4 month follow-up period. Of the 24 children with corneal zerosis, two died within 3 months, 21 retained normal vision, and one had adequate vision with leucoma. The high death rate, i.e., 30% of the keratomalacia cases in this study helps to explain the low prevalence of keratomalacia observed in past and current community surveys. The high return to normalcy of vision in the corneal xerosis cases after proper treatment support the recommendation of treating all children with eye involvement before the keratomalacia state whenever possible, for greater assurance of subsequent eye improvement.