Xerophthalmia in the presence of kwashiorkor.

The patient with xerophthalmia is usually found in the polyclinic or during a more-orless superficial school or village inspection. He is a child, and as he comes from an environment unaccustomed to serious medical care, it it often difficult to make the parents understand the gravity of the condition and obtain their consent for his admission to hospital. The patients with xerophthalmia described here presented also many signs of what is supposed to be protein malnutrition. Most were clear cases of kwashiorkor. As the aetiology of kwashiorkor is often believed to be confused by vitamin deficiencies, it would seem important to analyse the clinical picture as a whole. I regret that the regular estimation of serum protein and vitamin A levels in the blood was impossible, but believe that clinical observation alone yielded some interesting facts, related with the aetiology of both xerophthalmia and kwashiorkor. Because of the localization of signs and symptoms in the eyes and the easy success of specific therapy, treatment often tends to be restricted to relief of the eye signs, but if the patient can be nursed where he properly belongs, that is in hospital, it is not difficult to demonstrate that the eye lesions are part of a state of malnutrition. Hemeralopia in older children may be compatible with fair general nutrition, but xerosis conjunctivae, more commonly seen in infants and young children, is usually indicative of serious metabolic and nutritional disturbances.