keratomalacia

Softening and necrosis

The working definition requires destructive corneal involvement within vitamin A deficiency-associated ocular disease. WHO places corneal necrosis, termed keratomalacia, at the severe end of xerophthalmia. [WHO](https://www.who.int/data/nutrition/nlis/info/vitamin-a-deficiency)

1. What observed softening, necrosis, or stromal loss supports keratomalacia in each eye? definition
2. Who documented the lesion, when, and by what examination method? provenance

Nutritional versus other corneal melt

Record whether nutritional attribution is established, provisional, or challenged, and distinguish supporting xerophthalmic signs from the destructive lesion itself.

1. Does the record show active corneal destruction, earlier xerophthalmia alone, or only a healed scar? boundary
2. Which findings support infection, autoimmune disease, exposure, or injury as an alternative or additional cause? boundary

Converging deficiency evidence

Record clinical, dietary, and laboratory evidence together, including sampling time and interpretive limitations, without making laboratory confirmation a prerequisite for recording clinical suspicion.

1. Which dietary history, ocular signs, and laboratory findings support vitamin A deficiency? provenance
2. If serum retinol was measured, what were its value, units, sampling time relative to treatment, and relevant inflammatory context? measurement

Intake, absorption, and systemic context

Vitamin A deficiency may reflect inadequate intake or impaired absorption, storage, or transport; the model links these drivers to their own clinical records. [MSD Manual](https://www.msdmanuals.com/professional/nutritional-disorders/vitamin-deficiency-dependency-and-toxicity/vitamin-a-deficiency?ruleredirectid=742)

1. What evidence identifies restricted intake, malabsorption, or impaired storage or transport in this episode? provenance
2. Which suspected drivers need clinical investigation or continuing nutritional support? action

Extent, depth, and perforation

Record lesion location, affected surface area, thinning, and perforation status separately for each eye, retaining uncertainty when examination cannot safely establish a measurement.

1. What proportion and region of each cornea are affected, and how much stromal tissue remains? measurement
2. What examination evidence establishes intact cornea, threatened perforation, or actual perforation? measurement

Anatomical and functional trajectory

Compare dated examinations using compatible methods and distinguish anatomical closure from recovery of visual function.

1. Between examinations, has tissue loss progressed, stabilized, or begun to heal in each eye? measurement
2. How has per-eye visual function changed, and which assessment limitations affect that comparison? measurement

Urgent assessment and treatment status

Keratomalacia requires emergency treatment because corneal destruction can progress rapidly. Track vitamin A replacement and ocular management as clinician-directed interventions. [AAO EyeWiki](https://eyewiki.aao.org/Xerophthalmia)

1. When was emergency assessment requested and received, and what barriers remain? action
2. What vitamin replacement and ocular interventions were prescribed and actually delivered, under whose supervision? provenance

Healing with residual risk

Record residual scarring, visual impairment, and structural consequences separately from active keratomalacia, while retaining links to unresolved deficiency drivers.

1. Which findings show that active destruction has ceased, and what anatomical or visual deficits remain? boundary
2. What follow-up addresses visual rehabilitation and persistent risk of vitamin A deficiency? action

Check these first

Recalled without web access and unsourced; every item is a lead to verify.

1. Which of these check these first hold for the sense of keratomalacia this model covers, and on what evidence? provenance

Kinds and varieties

Recalled without web access and unsourced; every item is a lead to verify.

1. Which of these kinds and varieties hold for the sense of keratomalacia this model covers, and on what evidence? provenance

Identifiers and schemes

Recalled without web access and unsourced; every item is a lead to verify.

1. Which of these identifiers and schemes hold for the sense of keratomalacia this model covers, and on what evidence? provenance

Standards and regulation

Recalled without web access and unsourced; every item is a lead to verify.

1. Which of these standards and regulation hold for the sense of keratomalacia this model covers, and on what evidence? provenance

Real-world use

Recalled without web access and unsourced; every item is a lead to verify.

1. Which of these real-world use hold for the sense of keratomalacia this model covers, and on what evidence? provenance

Typical measurements

Recalled without web access and unsourced; every item is a lead to verify.

1. Which of these typical measurements hold for the sense of keratomalacia this model covers, and on what evidence? provenance

Failure modes and hazards

Recalled without web access and unsourced; every item is a lead to verify.

1. Which of these failure modes and hazards hold for the sense of keratomalacia this model covers, and on what evidence? provenance

Regional variation

Recalled without web access and unsourced; every item is a lead to verify.

1. Which of these regional variation hold for the sense of keratomalacia this model covers, and on what evidence? provenance

Neighbouring kinds and how to tell them apart

Recalled without web access and unsourced; every item is a lead to verify.

1. Which of these neighbouring kinds and how to tell them apart hold for the sense of keratomalacia this model covers, and on what evidence? provenance