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
- 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)
- Arteritic anterior ischemic optic neuropathy
- Amaurosis fugax
- Central retinal artery occlusion (CRAO)†
- Central retinal vein occlusion (CRVO)†
- High altitude retinopathy
- Open-angle glaucoma
- Optic neuritis
- Posterior Reversible Encephalopathy Syndrome (PRES)
- Retinal detachment†
- Temporal arteritis†
- Traumatic optic neuropathy
- Vitreous hemorrhage
- Stroke†
†Emergent Diagnosis
Vitamin deficiencies
- Vitamin A deficiency
- Vitamin B deficiencies
- Vitamin B1 deficiency (Thiamine)
- 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
Disposition
See Also
External Links
References
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