What is keratomalacia?

Keratomalacia is an eye condition in which the cornea, the clear front part of the eye, gets cloudy and softens. This eye disease often starts as xerophthalmia, which is severe dryness of the cornea and conjunctiva.

The conjunctiva is the thin mucous membrane that lines the inside of your eyelid and covers the front of your eyeball. Once your conjunctiva dries, it thickens, wrinkles, and becomes cloudy while the cornea (the clear layer that forms the front of the eyeball) softens.

If Keratomalacia is not treated, the softening of your corneas can lead to infection, rupture, and tissue changes that may result in blindness. Keratomalacia is also known as xerotic keratitis and corneal melting.

Keratomalacia is caused by a severe deficiency in vitamin A. There’s not a medical consensus on whether the vitamin A deficiency is due to a dietary deficiency or due to a metabolic inability to absorb the vitamin. Keratomalacia usually affects both eyes and is most commonly found in developing countries where the population has a low dietary intake of vitamin A, or a protein and calorie deficiency.

The symptoms of keratomalacia include:

  • night blindness, or difficulty adjusting your vision in dim or dark light
  • extreme dryness of the eyes
  • cloudiness in your corneas
  • Bitot’s spots, or a buildup of debris that lodge in your conjunctiva; the spots appear as foamy, light gray, patches

To diagnose keratomalacia, your doctor will perform an eye examination and blood tests to determine a vitamin A deficiency. Electroretinography, a test that examines the light sensitive cells of the eye, can also be used to diagnose keratomalacia.

Along with increasing vitamin A consumption, people who suffer from keratomalacia are typically prescribed lubricating and antibiotic eye drops or ointments.

In cases where the cornea has been sufficiently damaged, keratoplasty is recommended. Keratoplasty is a surgical corneal transplant to replace scar tissue that restricts vision.

Keratomalacia is a progressive disease that starts as xerophthalmia. Caused by a vitamin A deficiency, xerophthalmia is an eye disease that, if left untreated, can progress to keratomalacia. It’s characterized by abnormal dryness of the eyes. The condition starts with dryness of the conjunctiva, also known as conjunctival xerosis. It then progresses to dryness of the cornea, or corneal xerosis. In its late stages, xerophthalmia develops into keratomalacia.

Those at risk of developing keratomalacia can be divided into two primary groups: people who do not receive enough vitamin A in their diet and people who are unable to absorb vitamin A.

People who consume low amounts of vitamin A:

  • infants and young children who live in poverty
  • people, particularly children, who are malnourished
  • people, particularly children, who live in developing countries

People who have difficulty absorbing vitamin A:

If you have a risk factor, it does not mean that you have or will develop keratomalacia. It is, however, a good idea to discuss with your doctor any conditions that you’re in a risk group for.

Keratomalacia is not common in developed countries, such as the United States and Great Britain, where diets generally include food rich in vitamin A. However, if you’re in a high-risk group, are experiencing extremely dry eyes, or are having trouble adjusting your vision in dim light, consider calling your doctor for a consultation. It might not be early stage keratomalacia, but noticeable physical changes are always worth bringing to your doctor’s attention.