Keratomalacia caused by psychiatric-induced dietary restrictions

Abstract

Purpose: To describe the unique presentation, clinical course, management, and outcome of vitamin A deficiency-induced keratomalacia leading to bilateral corneal melts and ulcers in a patient with severe dietary restrictions because of psychiatric disease.

Methods: Review of patient's record and literature pertinent to her condition.

Results: A 33-year-old woman with a phobia of consuming most foods presented with bilateral corneal ulcers and melts from an unusual case of keratomalacia caused by vitamin A deficiency. The disease process progressed to bilateral perforations necessitating emergent bilateral penetrating keratoplasties. Pathologic examination confirmed classic signs of xerosis and keratomalacia. To our knowledge, our case is unique in that it is the only one in which the histopathology of the corneal lesion is described.

Conclusions: Psychiatric diseases, particularly eating disorders limiting sufficient nutrient intake, can lead to severe ocular surface disease that can be both vision- and life threatening.