Vitamin_A_Deficiency_Eye_Recognition_Field_Final.pptx

Vitamin a deficiency and it's role in eye

1. Vitamin A Deficiency and the Eye: Recognition in the Field For Ophthalmologists Prepared by: [Your Name] Date: [Insert Date]

2. Objectives Understand vitamin A deficiency and its ocular manifestations Learn field recognition and WHO classification Review Indian prevalence and national programmes Understand treatment, supplementation, and role of community workers

3. Global Burden of Vitamin A Deficiency Major cause of preventable childhood blindness Affects over 190 million preschool-age children worldwide High prevalence in Southeast Asia and Africa Associated with increased morbidity and mortality

4. Indian Prevalence CNNS 2016–18: Vitamin A deficiency in children 5–9 yrs ~19.3% Adolescents 10–19 yrs ~14.4% State-wise variation: Bihar, MP, UP high-risk areas Risk factors: low dietary intake, malnutrition, maternal literacy, high birth order

5. Vitamin A Metabolism & Forms Retinol, retinal, retinoic acid forms Stored in liver as retinyl esters Transported by retinol-binding protein Essential for visual cycle and epithelial integrity

6. Role of Vitamin A in Eye Development & Maintenance Vitamin A Phototransduction (Visual Cycle) Epithelial Integrity Tear Film Stability Ocular Development Immune Protection Antioxidant Function

7. Daily Requirement of Vitamin A (ICMR-NIN 2020) Infants 0–12 mo: 350 µg RE/day (~1200 IU) Children 1–3 yr: 400 µg (~1330 IU) Children 4–6 yr: 400 µg (~1330 IU) Children 7–9 yr: 600 µg (~2000 IU) Adolescents 10–18 yr: 500–600 µg Adults: 700–900 µg, Pregnant 770 µg, Lactating 1300 µg

8. Dietary Sources of Vitamin A Preformed vitamin A: liver, egg yolk, butter, fish liver oil, fortified milk Provitamin A carotenoids: green leafy vegetables, carrots, pumpkin, mango, papaya Fat-soluble: requires dietary fat for absorption

9. WHO Classification of Xerophthalmia XN: Night blindness X1A: Conjunctival xerosis X1B: Bitot’s spots X2: Corneal xerosis X3A/B: Keratomalacia XS: Corneal scar XF: Xerophthalmic fundus

10. Night Blindness (XN) Difficulty seeing in dim light Often first symptom noticed by caregivers

11. Conjunctival Xerosis (X1A) Dry, lustreless conjunctiva May precede corneal involvement

12. Bitot’s Spots (X1B) Foamy, triangular patches on bulbar conjunctiva Pathognomonic of Vitamin A deficiency

13. Corneal Xerosis & Keratomalacia Dry, hazy cornea Rapid softening and ulceration Ocular emergency

14. Corneal Scarring (XS) Permanent visual impairment Leucomatous or adherent leukoma scars May require keratoplasty

15. Differential Diagnosis Sjögren’s syndrome Stevens-Johnson syndrome Ocular cicatricial pemphigoid Trachoma

16. Field Screening Techniques Identify children with night blindness Examine under natural light or torch Observe conjunctiva and cornea

17. Community-Level Recognition & Documentation WHO community surveys for xerophthalmia Use of photographic records Maintain case registers

18. Nutritional & Systemic Clues Growth retardation Frequent infections Dietary history lacking vitamin A-rich foods

19. WHO Therapeutic Regimen 200,000 IU oral vitamin A immediately, repeat next day and after 2 weeks Adjust dose for infants and special cases

20. Injectable Vitamin A Indicated in rare cases with malabsorption or unconscious child Never inject oil-based oral preparation IM

21. National Vitamin A Programme (MoHFW) Prophylactic 9-dose schedule for 9 months to 5 years First dose with MR vaccine: 100,000 IU Subsequent doses every 6 months: 200,000 IU

22. Missed Dose Protocol Give missed dose as soon as possible Continue remaining doses at 6-month intervals Do not restart schedule

23. Role of ASHA & Anganwadi Workers Community mobilization & awareness Screening for night blindness and xerosis Distribution of vitamin A supplements Referral to health centers

24. Doctor Guidance & Training Conduct periodic training sessions Provide pictorial job aids and symptom checklists Develop referral protocols Supervise field activities and reporting

25. Challenges & Recommendations Overburdened workers and competing tasks Inadequate training or materials Geographic constraints and coverage gaps Recommendations: regular training, incentives, integration with other programs

26. Prevention Strategies Dietary diversification Food fortification (oil, milk) Vitamin A supplementation during immunization Community education and outreach

27. Role of Ophthalmologists Early recognition in clinics and outreach Training field workers Advocacy for vitamin A programs Monitoring coverage and follow-up

28. Summary Vitamin A deficiency is a leading cause of preventable blindness Early recognition is critical Ophthalmologists play key role in detection, management, and prevention

29. References WHO. Global prevalence of vitamin A deficiency. Geneva. AIOS Manual of Community Ophthalmology. ICMR-NIN Recommended Dietary Allowances, 2020 WHO Xerophthalmia Classification, 2014 CNNS 2016–18, India