Xerophthalmia and protein malnutrition in Bantu children.

XEROPHTHALMIA and malnutrition are worldwide problems, and their relationships to each other are of special interest. It is the purpose of this paper to show that: (1) Xerophthalmia occurs not uncommonly in the Republic of South Africa. Previous reports of xerophthalmia in the Republic of South Africa are few. Kark (1943) and Klenerman (1950) stated that xerophthalmia infrequently accompanies protein malnutrition, and eye symptoms, when present, seemed to be due to vitamin B deficiency. Oomen, McLaren, and Escapini (1964a) did not mention the Republic of South Africa in their recent survey of xerophthalmia. (2) Xerophthalmia is closely related to protein malnutrition. McLaren (1963d) stated that the lone occurrence of either disease is the rule, and that they occur in association only where both are at their worst; Oomen, McLaren, and Escapini (1964b) stated that protein malnutrition always accompanies the more severe manifestations of vitamin A deficiency. Oomen (1961a) argued that xerophthalmia is a precursor of protein malnutrition, and considered that the eye signs are primarily related to hypovitaminosis A, although he did state that "there are strong reasons to regard every degree of xerophthalmia as a case of general malnutrition". In any event, it is acknowledged that malnutrition may often be associated with xerophthalmia. (3) The syndrome of discrete colliquative keratopathy, as described by Blumenthal (1950), always occurs in association with protein malnutrition. It constitutes a variant of the general syndrome of xerophthalmia. (4) Local infection may play a more important role in the pathogenesis of the lesions of xerophthalmia than previously emphasized.