Abstract
In Reply. —Xerophthalmia (dry inflamed eye) refers to clinically detectable disease. 1-4 As defined by the World Health Organization 1-3 and the International Vitamin A Consultative Group 4 nightblindness (XN), conjunctival xerosis (X1A), and Bitot's spots (X1B) represent early, mild xerophthalmia, in contrast to corneal xerosis (X2) and, particularly, destructive corneal melting (X3). Early A deficiency is another matter, and one that is difficult to define. The work of Wolbach et al, 5 Mori, 6 and Blackfan et al 7 suggest squamous metaplasia of the respiratory and genitourinary tracts may well precede xerophthalmia. More sophisticated probes of cellular metabolism and immunologic status would likely identify earlier, milder consequences of vitamin A deficiency. Except when severely depressed, serum vitamin A levels are not a reliable index of either vitamin A stores or their consequences. We viewed impression cytology as one potential approach to the objective determination of physiologically significant vitamin
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