This content is from
pages 156 to 165 of Helping Children Who Are Blind

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.

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.

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.

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)

All newborn babies should be protected from eye infections by applying 1% tetracycline, erythromycin, or chloramphenicol eye ointment as soon as possible after birth. If these medicines are not available, you can also use a 2.5% solution of povidone-iodine.

Clean the baby's eyes with a clean cloth moistened with cool, boiled water. Pull down the lower lid of each eye, and put a little bit of ointment inside the lower lid. Putting ointment outside the eye does not do any good.

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.

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.