Conjunctival Appearance in Corneal Xerophthalmia

We studied the appearance of the conjunctiva in 50 consecutive cases of vitamin A-responsive conjunctival xerosis (X1) and 162 consecutive cases of nutritional keratopathy (corneal xerosis [X2] and stromal loss [X3]). Conjunctival xerosis, most extensive at or shortly after the onset of frank corneal involvement, was present in 101 (95%) of 106 eyes of cases of X2 but in only 99 (64%) of 155 ulcerated/necrotic eyes (X3A and X3B). Forty-four percent of involved eyes were inflamed, the percentage increasing with the severity of corneal disease. In 20 patients with nutritional keratopathy, conjunctival xerosis was monocular: inflammation was more prevalent and corneal involvement more severe in the nonxerotic eyes. In patients with precipitous deterioration of vitamin A status, clinically recognizable alterations of the cornea sometimes developed before any changes appeared in the conjunctiva.