Childhood blindness disease of the eye .pptx

Childhood blindness disease of the eye

1. Childhood blindness Tsedeke Asaminew M.D Asst Prof. JU Dept Ophtha .

2. Epidemiology 1.4 million children blind globally , 22.9% in sub-Saharan Africa, 320,000 blind

3. Causes Causes of blindness in children are also a cause of child mortality measles , Vitamin A deficiency, congenital rubella syndrome, cerebral malaria ,head injuries, tumors prevalence of blindness underestimates the magnitude because it is a measure of those blind children who survive.

4. Vitamin A deficiency Dietary sources of retinol Animal foods contain the active vitamin retinol liver is the best source which stores retinol milk Plant foods staple diet for poor people carotene pigment which is converted into retinol best source is red palm oil, others carrots, mangoes, papaya poor sources rice , cassava, yams, and white maize

5. Functions of vitamin A Vision Immune function Cellular health and maintenance; growth, reproduction, gene expression, skin health Fetal development Antioxidant activity

6. Causes Inadequate vitamin A intake Mal-absorption or problems in liver metabolism

7. Manifestations Poor growth Permanent blindness leading cause of preventable blindness in children Increased susceptibility to infection and subsequently death

8. Progress of ocular complication( xerophthalmia ) XN: Night blindness X1A: Conjunctival Xerosis , X1B: Bitot’s Spot X2: Corneal Xerosis X3A: Corneal ulceration <1/3 X3B: Corneal ulceration >1/3 XS: Corneal Scar, XF: Xerophthalmia Fundus 8

9. Vitamin A deficiency 9

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14. Treatment Indications All children with any active corneal ulceration. All children with signs of Xerophthalmia All children with measles All severely ill or malnourished children from areas where Xerophthalmia occurs

15. Treatment guideline Recommended dose of vitamin A for age > one year or weight > 8 Kg Day 1,2, 14 th day 200,000 IU for age < one year or weight < 8 Kg Day 1,2, 14 th day 100,000 IU

16. Vitamin A deficiency How much of a Public health problem do you think is Vitamin A deficiency in Ethiopia? 16

17. Blindness-Ethiopia

18. Low vision-Ethiopia

19. Vitamin A deficiency In Ethiopia VAD is a major public health problem. A national study (2005): prevalence rates Bitot’s spots: 1.7 % Night-blindness: 0.8% (children), 1.8 % (mothers) Deficient serum retinol levels: 37.7 % of children. 19

20. Vitamin A deficiency How do you think vitamin A deficiency can prevented at a community level? 20

21. Strategies for the control and elimination of VAD Supplementation of Vitamin A Capsules Promote and support optimal breastfeeding Food Diversification for Vitamin A Food fortification with vitamin A, and Infection Control 21

22. Supplementation of Vitamin A Capsules reduces childhood blindness by up to 70% Reduces strain on OPD services and hospital admissions Increases children’s chance of survival Deaths from measles can be reduced by 50% Deaths from diarrhea can be reduced by 40% Overall mortality can be reduced by 24%. 22

23. Preventive supplementation Children < one year old 55 mg or 100,000 IU, repeat every 4-6 months Children > one year old 110mg or 200,000 IU, repeat every 4-6 months Children at birth 27.5mg or 50,000 IU ??Mothers just after giving birth 165mg or 300,000 IU Pregnant and lactating mother 5.5mg or 10,000 IU daily for two weeks.

24. Vitamin A supplementation in postpartum women is not recommended 24

25. Administration of vitamin A supplements Age Ask if vitamin A capsule given in the last month 25

26. Identification of Vitamin A Deficiency in Population Vitamin A deficiency symptom/sign WHO cut-off levels Children Clinical Night blindness >1% Bitot’s Spots >0.5% Conjunctival xerosis >0.01% Corneal scar >0.05% 26

27. Identification of Vitamin A Deficiency in Population 27 Vitamin A deficiency symptoms/sign WHO cut-off levels Pregnant women Night blindness during recent pregnancy >5% Biochemical levels Serum retinol levels <0. 35 μ mol /L or 10 μ g/dl >5% Serum retinol levels of 0.7μ mol /L or <20 μ g/dl >15%

28. Other important causes of childhood blindness Congenital cataract Refractive error Congenital glaucoma Symptoms: Triad of Epiphora , Photophobia, Blepharospasm Signs: Triad of Megalocornea ( buphthalmos ), Haab’s striae ( descement membrane break), IOP > 20mm Hg Tumors: e.g. Retinoblastoma Retinopathy of prematurity

29. MESSAGE In developing countries, 60% of children die within a year of going blind!

30. THANK YOU!