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Review
. 2022 Apr 1;34(2):241-247.
doi: 10.1097/MOP.0000000000001110.

Recognizing vitamin A deficiency: special considerations in low-prevalence areas

Ailin Song  1 , Hazem M Mousa  2   3 , Matias Soifer  2   3 , Victor L Perez  2   3
Affiliations
Review

Recognizing vitamin A deficiency: special considerations in low-prevalence areas

Ailin Song et al. Curr Opin Pediatr. .

Abstract

Purpose of review: Although vitamin A deficiency (VAD) is rare in well resourced countries, there is a growing trend of VAD in at-risk pediatric populations. Early diagnosis is critically important to prevent its associated morbidity and mortality. This review highlights key lessons for evaluation, diagnosis, and management of children with xerophthalmia in the United States. It synthesizes the latest findings from the literature on the pathophysiology, epidemiology, risk factors, evaluation, and management of VAD in low-prevalence areas.

Recent findings: Vitamin A is crucial for maintaining the functional integrity of the eye, immune system, skin, and mucous membranes. Despite the scarcity of VAD in developed countries, there are increasing reports of VAD in at-risk children, including those with autism spectrum disorder and gastrointestinal conditions. There is a broad range of manifestations of VAD, posing a diagnostic challenge. Familiarity with the variable presentations of VAD and having a high index of suspicion in at-risk populations can aid in its early diagnosis. Systemic vitamin A supplementation and a multidisciplinary approach are important components of the management of VAD.

Summary: Even in well resourced countries, VAD should remain on the differential in patients with risk factors who present with relevant signs and symptoms. Early diagnosis and appropriate involvement of a multidisciplinary care team can help prevent morbidity and mortality associated with VAD.

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Conflict of interest statement

Conflicts of interest:

There are no conflicts of interest.

Figures

Figure 1:
Figure 1:
Images taken during examination under anesthesia of a 9-year-old boy with autism spectrum disorder who presented with eye pain, redness, photophobia, and decreased visual acuity. Examination reveals A) Diffuse corneal keratinization with epitheliopathy, sterile paracentral corneal ulcer (arrow), and B) diffuse keratinization in bulbar conjunctiva.
Figure 2:
Figure 2:
One month after vitamin A supplementation, patient presented with resolution of signs and symptoms. A) Clear cornea with minimal epitheliopathy; B) clear conjunctiva.
Figure 3:
Figure 3:
Bitot’s spots are an indication of vitamin A deficiency. Note the typical white, foamy appearance on the surface of the bulbar conjunctiva, next to the iris. Available at: https://www.cehjournal.org. Reproduced from “Managing eye health in young children.” Community Eye Health Journal Vol. 23 No. 72 March 2010. License: CC BY-NC 2.0.
See this image and copyright information in PMC

References

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