Hesperian Health Guides

Hesperian Health Guides

Why did Kesi lose her sight?

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HealthWiki > Helping Children Who Are Blind > Chapter 16: Why Children Lose Their Vision and What We Can Do > Why did Kesi lose her sight?


There are several causes:

father dies
— family
very
poor
stops
breast-
feeding
early
not
enough
money for
nutritious
food
 not
 knowing
 about
 foods
 with
vitamin A
no money
for doctor
–treatment
is delayed
Kesi's eye
swells,
oozes liquid,
dries out
Kesi loses sight in left eye.
The rest of the chapter can help you learn about the medical causes and treatments for sight problems. But to prevent blindness, communities must do something about the social causes that medicine cannot fix.


Causes of blindness and eye problems

Child blindness is usually caused by poor nutrition or infection. Many children go blind because:

  • they do not have enough food, or their food does not give them the vitamins they need to keep their eyes healthy
  • in crowded living conditions, disease and infection spread from person to person
  • in communities where garbage and human waste are in the open, flies and other insects spread infection that can also cause blindness
  • traditional medicines are misused, making infections worse


These problems cannot be solved by one person working alone. But people can work together to build latrines, get rid of garbage, and find ways to grow the food they need to stay healthy. If communities work together, most blindness in children can be prevented.

a woman speaking.
How can your child eat enough foods with vitamin A if you cannot afford to buy them? Some communities grow small vegetable gardens so they can prevent blindness in their children.

Contents

Night Blindness, Dry Eyes, and Xerophthalmia (Lack of Vitamin A)

To keep the eyes healthy, people need to eat foods that have vitamin A, which is found in certain fruits, vegetables, and some meat. When a child eats enough foods with vitamin A, the surface of the eye stays wet and healthy. Many poor children do not get enough foods that are rich in vitamin A and their eyes begin to dry out. This is called "dry eyes."

Dark yellow and dark green vegetables, and some red or orange fruits and vegetables, are rich in vitamin A. Fish, milk, eggs, and liver also contain vitamin A.

Not getting enough vitamin A is the most common cause of blindness in children, especially in Africa and South Asia. It usually happens to children who are between 6 months and 6 years old. Children under 6 months who only breastfeed usually get enough vitamin A from their mother's milk.

Signs:
1. First, a child has trouble seeing in the dark or does not want to play outside after dark. 2. Then, the eyes may
begin to look dry. The
white part becomes less
shiny, starts to wrinkle,
and forms small gray
spots that look like soap
bubbles (Bitot's spots).
3. Later, the colored
part of the eye also
gets dry and dull,
and may have little
pits.
4. Finally, the colored part may get soft, swell, or burst, causing blindness.
Treatment:
  • Give 3 doses of vitamin A. The first dose should be given as soon as you find out your child has 'night blindness' or 'dry eyes'. Give the second dose the next day, then a third dose 14 days later.


In the chart below, one capsule contains 50,000 IU (international units) of vitamin A.

Age Number of capsules
in one dose
under 6 months 1 capsule
6 months to 1 year 2 capsules
more than 1 year 4 capsules


Note: Once a child loses some of her sight, treatment will not get back that part of her sight. But starting treatment right away can keep her from losing any more of her sight.

Prevention:
  • Breastfeed your children as long as possible — at least for 1 year, but even longer if you can.
  • Try to make sure your child eats food rich in vitamin A every day.
  • If a child is sick with measles, try to give her extra foods with vitamin A.

Measles (Rubeola)

Measles is a sickness that passes from person to person. If a child is already weak from not eating enough good foods or from diarrhea, being sick with measles can make her lose some or all of her sight.

Signs of measles:
  • fever, runny nose, and cough
  • red eyes
  • red rash all over the body
Treatment:
  • Your child should rest, drink a lot, and eat healthy foods. If a baby cannot breastfeed, give her breast milk with a cup.
  • Give one dose of vitamin A as soon as you find out your child has measles. This will prevent 'dry eyes.'
  • Give rehydration drink for diarrhea (see below). This will help replace the liquids and nutrients lost when a child has diarrhea.


2 ways to make rehydration drink
If you can, add half a cup of fruit juice, coconut water, or mashed ripe banana to either drink. These contain potassium, a mineral which helps a sick person accept more food and drink.
1. With sugar and salt. (You can use raw sugar or molasses instead of sugar.) 2. With powdered cereal and salt.
(Powdered rice is best. But you can use finely ground maize, wheat flour, sorghum, or cooked and mashed potatoes.)
In 1 liter
of clean
WATER
put
half of a
level
teaspoon
of SALT
and 8 level
teaspoons of
SUGAR.
In 1 liter of
clean
WATER
put half
of a level
teaspoon
of SALT
and 8 heaping
teaspoons of
powdered CEREAL.


Boil for 5 to 7
minutes to
form a liquid
gruel or
watery
porridge.
Cool the
drink quickly
and begin to
give it to the
sick child.
CAUTION: Before adding the sugar, taste the drink and be sure it is less salty than tears.
CAUTION: Taste the drink each time before you give it to make sure that it has not spoiled. Cereal drinks can spoil within a few hours in hot weather.
Prevention:
  • have your child immunized against measles. Your child can get the measles immunization as early as 6 to 9 months of age. See a health care worker to find out if this vaccine is available in your community.
  • keep children away from anyone with measles.
  • if someone has measles, wash their bedding, clothes, and eating tools separately from the rest of their family.
a man speaking.
Usually, measles is not a serious sickness. But when children are weakened because they do not get enough to eat, or because of diarrhea from drinking unsafe water, sicknesses like measles can be very dangerous. It is really poverty that makes these children blind.

Infected Eyes in Newborn Babies (Neonatal Conjunctivitis)


If a baby gets an eye infection soon after birth, he can go blind. Eye infections can be caused by germs that get into the baby's eyes during birth, if the mother has an infection herself. The germs are from gonorrhea or chlamydia, which are infections that spread from one person to another during sex. Many people have these infections without knowing it because they have no signs of sickness. Because it is difficult to tell if a woman has an infection, it is important to treat all babies with eye ointment within a few hours after birth (see box above).

If a baby who is a few days old gets red, swollen eyes or has pus coming out of his eyes, he may have an eye infection and needs to be treated right away, whether or not he was given eye ointment after birth. The mother and her partner or partners should also be treated.

Signs of infection in a baby:
  • red, swollen eyes
  • pus in eyes
  • lids matted shut, especially upon waking
Signs of gonorrhea or chlamydia in a woman:
  • yellow or green discharge from the vagina or anus
  • pain or burning when passing urine
  • fever
  • pain in the lower belly
  • pain or bleeding during sex
  • or no signs at all


Remember even if the mother has no signs of infection, if the baby has signs of infection then the baby needs to be treated. The mother and her partner will also need treatment.

Treatment for the baby:

Pus should be cleaned from the eyes as soon as possible with a clean cloth and clean water.

The baby needs 2 different medicines
Give erythromycin
syrup by mouth. Give
40 mg of syrup 4 times
a day for 14 days.
sunrise
noon
sunset
night
Also:
Inject 125 mg ceftriaxone
into muscle one time only.
The best place
to inject a baby
is the upper
outer part of
the thigh.


If an infant has redness, swelling or pus in the eyes for more than 2 weeks, or these problems come and go for longer than 2 weeks, the baby may need more or different medicine. See a health worker. Note: If your baby has lost some sight, the medicine will not help her get her sight back. But the medicine can help prevent her from losing more of her sight.

Treatment for the mother and her partner:


The mother and her partner need 2 different medicines
These are safe to take even if a woman is breastfeeding
Take 500 mg of erythromycin by mouth
4 times a day for 7 days.
OR Take 500 mg of amoxicillin 3 times a day
for 10 days.
Also:
Take 400 mg of cefixime by mouth one
time only.
OR Inject 250 mg ceftriaxone into muscle
one time only.


a woman speaking.
When women cannot speak with their partners about using condoms and protecting their sexual health, they risk becoming infected with gonorrhea and chlamydia. If more women were able to protect themselves, fewer babies would go blind.



Trachoma

Trachoma is a disease that is spread by flies. Once a person is infected, the disease gets worse slowly, usually over many years,unless it is treated. Trachoma is most common in poor, crowded living conditions, where there is little access to clean water.

Signs:
  1. Trachoma begins with red, watery, sore eyes. But sometimes there are no early signs.
  2. After about a month:
    • small yellowish-white or pink-gray dots form inside the upper eyelids
    • the top edge of the colored part of the eye may look cloudy
    • the white upper part of the eye gets a little red
  3. Years later, the lumps inside the eyelids begin to go away, leaving white scars. These scars may pull the eyelashes down into the eye, scratching it and eventually causing blindness.
Treatment:


Learn how to put medicine in the eye
Put 1% tetracycline or
erythromycin eye
ointment inside both eyes
3 times each day.
OR Use 3% tetracycline or
erythromycin eye ointment
1 time each day.
Do this for 30 days. Put this ointment in the eyes of other children in the house, too.
For severe cases of trachoma, when the infection covers half or more of the inside of the eyelid, also give erythromycin by mouth for 14 days:
Age Dose of erythromycin
under 3 years 75 to 150 mg 4 times a day, with food
3 to 7 years 150 mg 4 times a day, with food
Prevention:

Keep latrines covered and be strict about training your children to wash their hands with soap and water after they use the latrine.

4 women speaking together.
We know flies spread all sorts of
infections. They live in our latrines and garbage. We should build covers for the latrines and make the men take the garbage far outside of the village.
I can’t wait to watch you ask the men to do that!
At least we can teach our children not to rub their eyes with their hands.
I tell my children to wash their hands before we eat together — and after they’ve used the latrine. And to wash their face every day.

Cataracts

When a child has a cataract, the lens (a part of the eye just behind the black circle in the center) becomes white or milky. This causes a child to not see very well, as though everything were covered by a cloud. Cataracts may affect one or both eyes.

Cataracts are most common in older people. But some babies and children also get cataracts. Cataracts may be passed down in families (hereditary) or be caused by an eye injury. Often the cause of cataracts is unknown. Sometimes cataracts are caused by a German measles (rubella) infection during the first 3 months of pregnancy. Rubella can cause hearing loss as well as cataracts, so a child who has cataracts should also have his hearing tested. Cataracts are painless.

Signs:
  • Blurred eyesight and a dimming of vision which get worse over time.
  • The cataract may be seen from the outside. At first the center of the eye looks gray and then it becomes white.
Treatment:

Cataracts cannot be treated with medicine. An operation is needed to remove the cataract. After the operation, strong glasses may be needed.

Prevention:
  • Pregnant women should stay away from people with German measles (rubella) or anyone sick with a fever and rash.
  • Look for the signs of cataracts in children so they can be treated as early as possible.

River blindness (onchocerciasis)

The black fly has a humped back and looks like this but is much smaller, like this
a black fly, about 3 mm long, or 1/8 inch.

River blindness is a disease caused by tiny worms that are spread by tiny black flies or "buffalo gnats." When the fly bites you, the worms carried by the fly get under your skin. If these worms get in the eye, they can cause blindness.

a child with lumps under the skin on her back.
Signs:
  • Lumps under the skin that slowly grow to a size of 2 to 6 cm (about 1 to 2½ inches).
  • There may be itching when the baby worms are spreading.
  • Pain in the back, shoulders, or hips (or pains all over).
  • Skin changes. The skin on the back or belly may become thicker, darker, or scaly. Later, the skin becomes wrinkled, like the skin of an old person.
  • Eye problems. First the eyes get red and watery, then very painful and itchy. Next, the center of the eye gets dull and pitted, as in 'dry eyes'. Finally, the person becomes blind.
Treatment:

Some of the medicines used to treat river blindness may be harmful for children and should only be given by a health worker. Try to take your child to a health worker as soon as the first signs of river blindness appear. If treated early, your child can be cured.

Prevention:
  • Black flies usually breed near fast-running water. Cleaning brush and vegetation back from the banks of fast-running streams may help reduce the number of flies.
  • Avoid sleeping out-of-doors — especially in the daytime, which is when the flies usually bite. Mosquito nets can keep the flies away from you while you sleep.
  • Cooperate with programs for the control of black flies.
  • Watch for the signs of river blindness in children so they can get treatment as soon as possible.
Be careful not to get water in the other eye. Tilt the child's head to the side and put the eye you are washing closest to the ground.

Eye injuries

Many chemicals in the house — like acid, lye, and cleaning solutions — are common causes of eye problems in children. If one of these chemicals gets in the eye, immediately rinse the eye with cool, clean water for 15 to 20 minutes, and see a health worker right away.

a child who cannot reach a locked cabinet labeled "Cleaning Supplies."

Injuries to the eye or scrapes on the eye can also cause blindness or problems seeing. Keep all sharp pointed objects, and also chemicals, out of the reach of children and keep play areas safe by removing objects that could cause eye injury. Warn children about the danger of throwing things at other people, or of throwing closed bottles, cans, or bullets into the fire. Also warn them about local plants and medicines that can injure the eyes.

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