Patients presenting with clinical signs of xerophthalmia (or, in the case of a pediatric patient, their parents) must be questioned on dietary, medical, and social history, including alcohol intake. Be sure to ask about any malabsorptive process, as described above, or risk factors such as living in a resource-poor country or current pregnancy or lactation. Because xerophthalmia is a manifestation of moderate-to-severe VAD, it is important to ask about the systemic signs of milder VAD, including frequent GI and respiratory tract infections, anemia, iron deficiency, and development of xeroderma and phrynoderma (follicular hyperkeratosis often found on extensor surfaces, shoulders, and buttocks)[10] [7].
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