Xerophthalmia with Hypopyon in PEM: A Rare Case Report

Xerophthalmia refers to the ocular manifestations associated with vitamin A deficiency. We report a case of 7 year old child presenting with diminition of vision (DOV) at night since 1 month and pain, redness, mucopurulent discharge and DOV in daytime in Left eye (LE) since 2 days along with foreign body sensation in Right eye (RE) since 2 days. Anthropometric measurements indicated severe protein energy malnutrition (PEM). Visual acuity of RE and LE were 6/12, N8 and hand movement close to face (HM - CF) respectively. RE showed dry conjunctiva, bitot?s spots and superficial epithelial defect in cornea. LE showed dry conjunctiva, bitot?s spots, a sloughed corneal lesion and a hypopyon in the anterior chamber. Rest of the examination was normal in both the eyes. Blood investigations revealed microcytic hypochromic anemia. On treating the child with oral vitamin A solution, her vision improved gradually to 6/6, N6 and 6/12, N8 in the RE and LE respectively by day 40. Conclusion: Corneal ulceration and keratomalacia due to vitamin A deficiency (VAD) are more common in children with severe malnutrition. Prompt recognition and treatment of xerophthalmia can lead to rapid recovery and can avert significant visual morbidity.