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. 2022 Oct;36(10):1896-1899.
doi: 10.1038/s41433-021-01569-z. Epub 2021 Sep 16.

Bitot-like spots in children with normal vitamin A levels

Anu Maudgil  1   2   3 , Diyaa Rachdan  4   5   6   7 , Muhammad Saad Khan  5 , Amir Siddiqui  5 , Lil-Naz Hazrati  8 , Michael D Richards  4   5   9 , Nasrin Najm-Tehrani  4   5 , Asim Ali  4   5
Affiliations

Bitot-like spots in children with normal vitamin A levels

Anu Maudgil et al. Eye (Lond). 2022 Oct.

Abstract

Background/aims: A Bitot spot is a conjunctival lesion, classically associated with severe vitamin A deficiency. In this paediatric series, we describe conjunctival lesions indistinguishable from Bitot spots, seen in the presence of normal vitamin A levels.

Methods: This descriptive case series was performed by retrospective review of case notes, including all patients with Bitot-like spots found to have normal serum vitamin A levels, seen at the Hospital for Sick Children, Toronto, between 2006 and 2016. Data collected included age at presentation, ophthalmic and systemic diagnoses, and the presence of recognised genetic mutations. Histopathology was reviewed in one case.

Results: Ten patients with Bitot-like spots with laboratory-confirmed normal serum vitamin A levels were identified. The conjunctival lesions were indistinguishable clinically and histopathologically from classic Bitot spots and were noted to occur in a range of anterior segment pathologies, including aniridia, WAGR syndrome, Axenfeld-Rieger syndrome, and blepharokeratoconjunctivitis.

Conclusions: Bitot-like spots are found in children with a number of anterior segment pathologies in the absence of vitamin A deficiency.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1. Photographs of Bitot- like spots in children.
A Inferotemporal lesion with foamy appearance in right eye of patient 1. B Nasal lesion in right eye of patient 3. C Close-up image of foamy appearance of lesion in patient 4. D Nasal lesion in right eye of patient 9.
Fig. 2
Fig. 2. Microphotograph shows a keratinised squamous epithelium covering a fibrovascular tissue.
The scale bar represents 300 microns.
See this image and copyright information in PMC

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