Keratomalacia associated with adrenal hypoplasia in a defective.

So far as the eye is concerned, the clinical picture varies from a mild conjunctival epithelial xerosis, sometimes with hemeralopia, to an advanced state of keratomalacia and necrosis of the cornea, with its attendant tendency to hypopyon ulcers and panophthalmitis. So far as the general condition is concerned, the clinical picture varies from one of very little disturbance to extreme debility, marasmus, and death from pneumonia. While xerotic changes of this type have been observed from the earliest times, especially in time of war, when malnutrition, famine, fatigue, and debilitating diseases were rife, the first detailed clinical picture was given by Bitot (1863) of Bordeaux. Since then, xerosis of the conjunctiva in its mildest form has been well recognized as occurring more particularly in children, especially boys, in association with night blindness. The condition is seen in the summer months, and the children need not be conspicuously ill-nourished. Improper diet after the cessation of breast-feeding is a common cause of its appearance, but the lesion also occurs in adults, although more rarely. During the first years of life, children who are ill-nourished and marasmic and have typical intestinal disorders, may show a much more severe condition characterized by extreme xerosis of the conjunctiva and keratomalacia and necrosis of the cornea.