Keratomalacia

KERATOMALACIA (from Greek keras - horn and malacos - soft), a very severe disease of the cornea, usually affecting both eyes, mainly in very young children suffering from a sharp decline in nutrition and severely exhausted by profuse diarrhea or past general diseases (measles, scarlet fever, typhus, bronchitis, pneumonia, congenital syphilis, etc.). Numerous cases of the disease in infants, especially during fasting periods, were described in old Russia, as well as in Brazil in the children of enslaved negroes (ophthalmia brasiliana, Gama Lobo). The corneal lesion is often preceded by conjunctival xerosis in a peculiar form; older children report complaints of night blindness (hemeralopia). Xerosis spreads from the conjunctiva to the cornea, which becomes dull and insensitive. The opacification increases, especially in the center, where a grayish infiltrate forms, rapidly spreading to the entire cornea; in severe cases, the cornea disintegrates within a few hours into a yellow purulent mass. Striking is the discrepancy between the severe condition of the perishing cornea and the very weak reactive phenomena of irritation. The eye remains pale, vascular injection on the eyeball has a venous character; there is no photophobia, blepharospasm; the eye is dry. Keratomalacia serves as a bad omen: not only do the eyes perish; the majority of children die with phenomena of progressive exhaustion. In older children, the disease proceeds more mildly; but even they, upon recovery, retain leukomas or staphylo-mas for the rest of their lives. The basis of the disease is necrosis of the cornea, resembling marantic corneal decay in adults with general nutritional decline, especially in severe liver diseases (cirrhosis, carcinomas). A deficiency of fat-soluble vitamin A in the diet is considered the main cause of the severe general condition and keratomalacia. By eliminating factor A from food, it was possible to obtain keratomalacia experimentally in animals. Histologically, one finds in the cornea during keratomalacia (Jaensch), besides necrosis, an abundant deposition of lipoids in the epithelium and corneal lamellae with the transformation of the disintegrated lamellae into a structureless fatty mass. Numerous microbes (staphylo-, strepto-, pneumococci) belong to the role of secondary exogenous infection, completing the destruction of the cornea. The assumption of endogenous infection is unlikely. Prophylactically, eye care in children during acute (toxicosis) and chronic (atrophia) nutritional disorders is very important, as is the prevention of xerosis by frequent moistening of the conjunctiva, introduction of sterile vaseline oil, etc. Treatment aims to raise the general nutrition of the body by appropriate measures directed against the underlying disease: suitable food (breast milk), vitamins, care (light, air, etc.); incidentally, fats treated with ultraviolet rays (A. Fuchs); milk with lime water (Baer) are recommended. The eyes should be closed with a moist dressing, warming compress. Prevention of the disease also consists in good nutrition (vitamins!).