Ocular Microbiology and Immunology Group
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2021 OMIG Abstract

Vitamin A Deficiency: A Consideration When Evaluating Patients with
Potential Microbial Keratitis

Ayodele K. Maja, Xiao Y. Li, George Sanchez, Sowmya Srinivas, Michael E. Zegans
Department of Ophthalmology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire

Purpose: To describe a series of three adult cases of xerophthalmia in the U.S. secondary to vitamin A deficiency of varying etiology.

Introduction: The evaluation of keratitis and corneal ulceration requires the search for infection, whether bacterial, fungal, or viral. However, it is critical to consider other causes that may predispose or mimic corneal ulceration and keratitis. In addition to systemic effects, Vitamin A deficiency often causes a spectrum of ocular manifestations with effects ranging from reduced immune function to changes in epithelial biology. We report a case series outlining three instances of keratopathy secondary to Vitamin A deficiency.

Methods: The medical records of three patients were collected and analyzed for initial presentation, exam findings, lab values, treatment and outcomes. All identifying data was removed. A systematic literature review was jointly performed to identify similar cases of vitamin A deficiency-related keratopathy in adults.

Results: In the first case, our patient presented with bilateral conjunctival keratinization and punctate epithelial keratitis in both eyes with best corrected visual acuity improving from 20/150 to 20/40+ in the left eye following vitamin A supplementation. Our second case presented with a central corneal ulcer with loss of 70% of stromal tissue as well as a dense central punctate epithelial keratitis that demonstrated healing following supplementation in the right eye. Corneal cultures were negative, though pulmonary cultures grew MRSA. Our third patient presented with lagophthalmos and inferior epithelial defects in both eyes as well as perforated corneal ulcers with corneal cultures positive for MSSA. Serum vitamin A levels were 6.4 mcg/dL,16.1 mcg/dL, and undetectable, respectively. Two of the three patients died during treatment.

Conclusions: Concomitant corneal infection was seen in one case. In two of three cases, vitamin A supplementation significantly improved corneal health. Though microbial infection commonly is the primary cause of corneal ulceration, it is important that physicians consider vitamin A deficiency as a potential underlying etiology when evaluating patients with keratitis.

Disclosure: N

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