Increased risk of xerophthalmia following diarrhea and respiratory disease

Preschool-age rural Indonesian children were reexamined every 3 mo for 18 mo. An average of 3228 were free of xerophthalmia at the examination initiating each of the six, 3-mo follow-up intervals. Children with respiratory disease and/or a recent history of diarrhea at the start of an interval developed xerophthalmia by the end of the interval at more than twice the rate of their healthier peers (p < 0.05) independent of anthropometric status. It appears that vitamin A deficiency and infections, especially diarrhea and respiratory disease, can establish a vicious cycle that induces and perpetuates ocular and systemic disease.