Vitamin A deficiency

Background

• One of the most common vitamin deficiencies in developing countries
• Most common cause of blindness in developing world
• In US, most commonly found in conjunction with fat malabsorption syndromes (e.g. IBD, pancreatic insufficiency, sprue, cystic fibrosis, laxative abuse)

Clinical Features

White patches over conjunctivae representing Bitot spots seen in Vitamin A deficiency

• Visual loss
  • Night blindness (early)
  • Dry conjunctivae with small white patches (Bitot spots)
  • Corneal ulceration/necrosis (keratomalacia), perforation, endophthalmitis, and blindness (late)
• Dry, hyperkeratinized skin, hair, and nails
• Pruritus
• Loss of taste

Differential Diagnosis

Acute Vision Loss (Noninflamed)

• Painful
  • Arteritic anterior ischemic optic neuropathy
  • Optic neuritis
  • Temporal arteritis^†
• Painless
  • Amaurosis fugax
  • Central retinal artery occlusion (CRAO)^†
  • Central retinal vein occlusion (CRVO)^†
  • High altitude retinopathy
  • Open-angle glaucoma
  • Posterior reversible encephalopathy syndrome (PRES)
  • Retinal detachment^†
  • Stroke^†
  • Vitreous hemorrhage
  • Traumatic optic neuropathy (although may have pain from the trauma)

^†Emergent Diagnosis

Vitamin deficiencies

• Vitamin A deficiency
• Vitamin B deficiencies
  • Vitamin B1 deficiency (Thiamine)
    • Beriberi
    • Wernicke-Korsakoff syndrome
  • Vitamin B3 deficiency (Pellagra)
  • Vitamin B9 deficiency (Folate)
  • Vitamin B7 deficiency (Biotin)
  • Vitamin B12 deficiency
• Vitamin C deficiency (Scurvy)
• Vitamin D deficiency (Rickets)
• Vitamin E deficiency
• Vitamin K deficiency

Evaluation

• Eye exam
• Serum Vitamin A level below 30–65 mg/dL

Management

• Early: vitamin A 30,000 IU PO daily x 1 week
• Advanced: vitamin A 20,000 IU/kg PO daily for at least 5 days

See Also

• Hypervitaminosis A
• Vitamin deficiencies