AN INQUIRY INTO THE ORIGIN OF THE ABNORMAL PIGMENTATION OF THE SKIN AND CONJUNCTIVA IN CASES OF KERATOMALACIA IN ADULTS

Abstract

ONE of the most striking clinical symptoms of xerosis epithelialis conjunctivae and of keratomalacia of adults in China is the pig- mentation of the conjunctiva.In certain cases there is also a dark staining of the skin, though this is not always so easily recognizable.The pigmentation of the conjunctiva was visible in about 70-80 per cent. of all the cases of keratomalacia seen in Peking in the spring of 1929, but in varying intensity.As far as the literature is obtainable, only in India and Japan has a similar pigmentation in cases of keratomalacia been reported.But there are considerable differences in the description of the pigmentation, as well as in the real nature of the pigment described, and there are nothing but theories about the origin of the pigmentation.Wright,2 in his paper on " Keratomalacia in Southern India," quotes the description of keratomalacia by Kirkpatrick,' who passes the pigmentation witlh the words (p. 168)" a well-marked icteric tinge is often now (i.e., in advanced cases) added to the pigmentation of the conjunctiva."His description deals more or less with the keratomalacia of children.Wright,2 speaking of the pigmentation seen in keratomalacia in adults, makes the following statement: (p. 171)" A very important, but inconstant feature is jaundice.Sometimes it is very marked and gives the scanty conjunctival d6bris in the fornix a greenish yellow colour.It appears to be more common in adults.It is sometimes associated with a small cirrhotic liver, at other times the liver is large.In one case a fairly well-to-do woman of middle age developed kera- tomalacia in association with an irregular, enlarged and painful liver, and intense jaundice probably of a malignant nature."And later in his paper he continues: " There are certain clinical obser- vations which suggest that the liver plays a very important part in keratomalacia, but it cannot be assumed that this is more than secondary in its relation to the disease."Contrary to Kirkpatrick and Wright, who seem to believe that copyright.