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December 1982

Corneal Xerophthalmia and Keratomalacia-Reply

Arch Ophthalmol. 1982;100(12):1974. doi:10.1001/archopht.1982.01030040954023

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In Reply.  —I am delighted that Dr Valenton has addressed the issue of bacterial corneal ulceration in xerophthalmia, a subject we were unable to explore in our article. Using careful bacteriologic techniques, Dr Valenton isolated pathogenic bacteria from a large proportion of ulcerated eyes with xerophthalmia.1 Animal experiments indicate vitamin A deficiency increases the risk of bacterial ulceration and melting.2,3 Unfortunately, neither of these observations proved that bacterial infection plays an important role in naturally occurring disease.The question is a difficult one to answer. We approached it in three different ways.4 Children with active xerophthalmia of varying severity and their normal, matched control subjects had corneal swabs or scrapings smeared and cultured for bacteria. The rate of positive cultures for pathogenic bacteria increased dramatically with the onset of corneal xerosis. The prevalence of positive cultures increased, but to a less dramatic and nonstatistically significant extent, in

Valenton MJ, Tan RV:  Secondary bacterial infection in hypovitaminosis A xerophthalmia . Am J Ophthalmol 1975;80:673-677.
DeCarlo JD, Van Horn DL, Hyndiuk RA, et al:  Increased susceptibility to infection in experimental xerophthalmia . Arch Ophthalmol 1981;99:1614-1617.Article
Sendele D, Kenyon K, Wolf G, et al:  Epithelial abrasion precipitates stromal ulceration in the vitamin A deficient rat cornea . Invest Ophthalmol Vis Sci 1981;20( (suppl) ):173.
Sommer A: Nutritional Blindness: Xerophthalmia and Keratomalacia . Oxford, England, Oxford University Press, 1982, pp 94-96.
Kuming BS, Politzer WM:  Xerophthalmia and protein malnutrition in Bantu children . Br J Ophthalmol 1967;51:649-665.Article
Liebowitz HM, Ryan WJ, Kupferman A:  Route of antibiotic administration in bacterial keratitis . Arch Ophthalmol 1981;99:1420-1423.Article
Davis SD, Sarff LD, Hyndiuk RA:  Comparison of therapeutic routes in experimental pseudomonas keratitis . Am J Ophthalmol 1979;87:710-716.
Sommer A, Green WR, Kenyon KR:  Clinicohistopathologic correlation in xerophthalmic ulceration and necrosis . Arch Ophthalmol 1982;100:953-963.Article