Early Detection of Xerophthalmia by Impression Cytology-Reply FREE

Alfred Sommer, MD; John Wittpenn, MD

Arch Ophthalmol. 1986;104(7):971-972. doi:10.1001/archopht.1986.01050190028007

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ABSTRACT

ABSTRACT | REFERENCES

In Reply. —Xerophthalmia ("dry inflamed eye") refers to clinically detectable disease.^1-4 As defined by the World Health Organization^1-3 and the International Vitamin A Consultative Group⁴ nightblindness (XN), conjunctival xerosis (X1A), and Bitot's spots (X1B) represent early, mild xerophthalmia, in contrast to corneal xerosis (X2) and, particularly, destructive corneal melting (X3).Early "vitamin A deficiency" is another matter, and one that is difficult to define. The work of Wolbach et al,⁵ Mori,⁶ and Blackfan et al⁷ suggest squamous metaplasia of the respiratory and genitourinary tracts may well precede xerophthalmia. More sophisticated probes of cellular metabolism and immunologic status would likely identify earlier, milder consequences of vitamin A deficiency. Except when severely depressed, serum vitamin A levels are not a reliable index of either vitamin A stores or their consequences.We viewed impression cytology as one potential approach to the objective determination of physiologically significant vitamin

REFERENCES

ABSTRACT | REFERENCES

Vitamin A Deficiency and Xerophthalmia: Report of a Joint WHO/USAID Meeting. World Health Organization Technical Report Series No. 590. Geneva, World Health Organization, 1976.

Control of Vitamin A Deficiency and Xerophthalmia: Report of a Joint WHO/USAID/ UNICEF/HKI/IVACG Meeting. World Health Organization Technical Report Series, No. 672 Geneva, World Health Organization, 1982.

Sommer A: Field Guide to the Detection and Control of Xerophthalmia , ed 2. Geneva, World Health Organization, 1982;.

McLaren DS, Ballentine EJ, ten Doesschate J, et al: The Symptoms and Signs of Vitamin A Deficiency and Their Relationship to Applied Nutrition: A Report of the International Vitamin A Consultative Group . Washington, DC, Nutrition Foundation, 1981;.

Wolbach S, Howe P: Tissue changes following deprivation of fat-soluble A vitamin . J Exp Med 1925;;42:753-777.

Mori S: Primary changes in eyes of rats which result from deficiency of fat-soluble A in diet . JAMA 1922;;79:197-200.

Blackfan KD, Wolbach SB: Vitamin A deficiency in infants: A clinical and pathological study . J Pediatr 1933;;3:679-706.

Hatchell D, Sommer A: Detection of ocular surface abnormalities in experimental vitamin A deficiency . Arch Ophthalmol 1984;;102:1389-1393.

Wittpenn JR, Tseng SCG, Sommer A: Detection of early xerophthalmia by impression cytology . Arch Ophthalmol 1986;;104:237-239.

Sommer A, Tarwotjo I, Hussaini G, et al: Increased mortality in children with mild vitamin A deficiency . Lancet 1983;;2:585-588.

Sommer A, Katz J, Tarwotjo I: Increased risk of respiratory disease and diarrhea in children with pre-existing mild vitamin A deficiency . Am J Clin Nutr 1984;;40:1090-1095.

Sommer A, Tarwotjo I, Djunaedi E, et al: Impact of vitamin A supplementation on childhood mortality: A randomized controlled community trial. Lancet, in press.

Sommer A, Hussaini G, Muhilal, et al: History of nightblindness: A simple tool for xerophthalmia screening . Am J Clin Nutr 1980;;33:887-891.

Sommer A, Green WR, Kenyon KR: Clinical-histopathologic correlations of vitamin A responsive and nonresponsive Bitot's spots . Arch Ophthalmol 1981;;99:2014-2027.

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