The following are some of the signs and symptoms of xerophthalmia, listed in the order they usually happen:

• Night blindness, also called nyctalopia, is the inability to see well at night or in dim light, like in a restaurant or movie theater;
• Drying up of the conjunctiva, called xerosis. The conjunctivae are the inside of your eyelids;
• Bitot spots, described as silvery white triangle spots, develop on the whites of the eyes;
• The cornea is abnormally dry; this condition is known as xerosis (the cornea is the transparent layer on the front of the eye);
• Sores or punctures in the cornea called as corneal ulcers;
• The cornea becomes opaque and mushy due to keratomalacia, a condition that can potentially lead to scarring;
• The retina can change shape and develop lesions in the xerophthalmic fundus.

Xerophthalmia is diagnosed by observing the symptoms and correlating them to the patient's medical history. 

A serum Vitamin A test can verify the diagnosis of xerophthalmia. Night vision problems could be identified with the help of dark adaptometry and night vision threshold testing. 

Electroretinogram and impression cytology are two more tests that can aid in making the diagnosis.

Treatment

Vitamin A should be given orally in increments of 200,000 IU, as recommended by the WHO. 

Topical antibiotics are used in cases of subsequent bacterial infection, such as preservative-free artificial tears and antibiotic eye drops.

Dietary Vitamin A deficiency can be treated in three ways, nutritional supplements, rehabilitation, and education.  

In cases of xerophthalmia that are not caused by poor nutrition, underlying disorders such as liver diseases and inflammatory bowel disease must be treated.

Adequate vitamin A intake is the most effective preventative measure against xerophthalmia. Vitamin A can be found in these foods:

• Dark green leafy vegetables, such as spinach, malunggay, kangkong 
• Fruits that are yellow or orange, such as papayas and oranges
• Yellow and orange vegetables such as squash and carrots, respectively
• Liver
• Egg yolks
• Vitamin-A enriched foods and beverages.

References

Feroze KB, Kaufman EJ. Xerophthalmia. [Updated 2022 Apr 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK431094/

Cleveland Clinic (2022). Xerophthalmia. Retrieved December 23, 2022, from https://my.clevelandclinic.org/health/diseases/24430-xerophthalmia