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—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
Sommer A. Corneal Xerophthalmia and Keratomalacia-Reply. Arch Ophthalmol. 1982;100(12):1974. doi:10.1001/archopht.1982.01030040954023