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Conjunctival xerosis caused by vitamin A deficiency

22 Sep 2017

An 11-year-old boy presented with a several week history of bilateral blurred vision, eye pain, photophobia and nyctalopia. His medical history included severe autism. He met the Diagnostic and Statistical Manual of Mental Disorders-V criteria for avoidant-restrictive food intake disorder, consuming virtually only potato-containing foods. There was no history of gastrointestinal (GI) disease or weight loss.

Clinical examination revealed reduced visual acuity: both eyes 6/18 (6/12 pinhole correction), superficial punctate keratopathy and severe conjunctival xerosis (figure 1). Serum vitamin A level was extremely low (<0.01 µ/mol). His ocular signs and symptoms reversed following systemic vitamin A administration (400 000 IU in two divided doses over 2 days, and additional dose 2 weeks later) (figure 2). As multiple nutritional deficiencies were evident, paediatrician and dietitian referrals were arranged.

Conjunctival xerosis (X1A, WHO classification) is usually bilateral and reflects severe conjunctival dryness. It is a sign of long-standing vitamin A deficiency (VAD).1 In...

Click here to view the full article which appeared in Archives of Disease in Childhood