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Case Reports
. 2015 Dec 3;6(3):427-34.
doi: 10.1159/000441969. eCollection 2015 Sep-Dec.

Vitamin A Deficiency Presenting with 'Itchy Eyes'

Matthew Hao Lee  1 , Marc G Sarossy  2 , Ehud Zamir  2
Affiliations
Case Reports

Vitamin A Deficiency Presenting with 'Itchy Eyes'

Matthew Hao Lee et al. Case Rep Ophthalmol. .

Abstract

We present the case of an 88-year-old female living in metropolitan Melbourne, Australia who developed vitamin A deficiency manifesting as 'itchy eyes' due to a bizarre dietary habit. Slit lamp examination revealed Bitot's spots and a subsequent vitamin A serum level test revealed severe deficiency. An electroretinogram showed grossly reduced a- and b-wave amplitudes consistent with generalised rod and cone dysfunction - these parameters showed marked improvement 5 months post supplementation. This case highlights the presence of vitamin A deficiency in the developed world and that a careful dietary history should be taken when assessing a patient complaining of 'itchy eyes'. Timely diagnosis and treatment may result in dramatic resolution of symptoms and signs as well as prevention of serious morbidity.

Keywords: Bitot's spots; Electroretinogram; Hypovitaminosis A; Nyctalopia; Xerophthalmia.

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Figures

Fig. 1
Fig. 1
Bitot's spot on the patient's temporal conjunctiva. Note frothy (a) or dry-looking (b) patches on the temporal bulbar conjunctiva. They are easier to see with fluorescein staining and blue light (c).
Fig. 2
Fig. 2
Goldmann visual field analysis showed full visual fields when tested with the larger III4e target but showed constriction to approximately 30° on both sides when tested with the smaller Ie target (normal: 100°). This suggested a relative scotoma and was likely related to rod photoreceptor deficiency.
Fig. 3
Fig. 3
Pretreatment ERG. Scotopic rod responses and the maximal or standard mixed rod-cone response were grossly subnormal. Photopic ERGs demonstrated borderline a-wave amplitudes, while b-waves had amplitudes that were approximately one-third of normal and had increased latencies. 30-Hz flicker responses were half of normal bilaterally.
Fig. 4
Fig. 4
Post-treatment ERG. Scotopic rod and standard responses showed normalisation of amplitudes after the standard course of vitamin A supplementation. The photopic response had improved amplitudes to about half of normal but no change in implicit time compared to initial testing. The 30-Hz responses demonstrated marginal improvements in amplitudes.
See this image and copyright information in PMC

References

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