Slit-lamp examination of 78 cases of xerophthalmia and 29 controls matched for age, sex, and locale indicated a direct correlation between the presence, density, and extent of punctate epithelial keratopathy and the severity of corneal and noncorneal involvement. Only 7% (four of 58) of control eyes but 60% (six of ten) of cases with confirmed night blindness, 75% (47 of 63) of eyes with conjunctival xerosis, and all eyes with corneal xerosis (47) were affected. Within one week of high-dose systemic vitamin A therapy all affected corneas had improved. None of ten patients receiving low-dose systemic therapy showed any improvement over a two-month period, whereas 61% of involved corneas actually deteriorated in the interim. Punctate epithelial keratopathy appears to be the earliest corneal manifestation of xerophthalmia, and is already present in the vast majority of cases classically considered free of corneal involvement.
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