• Six measures of nutritional status were studied in 162 consecutive cases of presumed nutritional keratopathy ranging from mild xerosis through full-thickness necrosis (keratomalacia) and in a variety of control subjects. The severity of corneal involvement was related to the severity of wasting, prevalence of edema, and serum levels of albumin, transferrin, and vitamin A. Even the most severe corneal alterations were compatible with normal indices of protein and anthropometric status, but not with normal serum vitamin A levels. Analysis suggests that interaction between vitamin A and protein status determines cellular adequacy of vitamin A metabolism, which virtually collapses in keratomalacia. Serum levels of holoretinol-binding protein were severely and uniformly depressed in all degrees of corneal involvement.
Sommer A, Muhilal . Nutritional Factors in Corneal Xerophthalmia and Keratomalacia. Arch Ophthalmol. 1982;100(3):399-403. doi:10.1001/archopht.1982.01030030401002