Optical coherence tomography of Bitot’s spot in vitamin A deficiency

Abstract

Severe vitamin A deficiency can manifest as xerophthalmia in the eyes resulting in clinical features, such as night blindness, conjunctival xerosis, corneal xerosis, corneal ulcers and Bitot’s spots. We present the multimodal imaging results of a patient who underwent an ileocecal resection for Crohn’s disease and presented with nyctalopia and bilateral central scotomas. Report of a single case. The patient’s best-corrected visual acuity was 20/50 in the right eye and 20/32 in the left eye. Anterior segment examination identified small elevated focal translucent foamy Bitot’s spots on the superficial bulbar conjunctiva near the temporal limbus, and these lesions were also detected using swept-source optical coherence tomography (OCT). Additionally, fundus photography revealed small yellow lesions in the peripheral retina, and swept-source OCT showed focal irregularities of the ellipsoid zone in the retina. Initial work-up revealed a vitamin A level of 0.05 mg/L (normal range 0.3–1.2 mg/L), and the patient was treated with a daily 10,000 IU dose of vitamin A. After 6 months of treatment, the patient’s retinal sensitivity improved in both eyes, as detected by microperimetry. The use of OCT can have utility in imaging anterior segment abnormalities as well as retinal changes in patients presenting with xerophthalmia associated with vitamin A deficiency. Patients who have undergone intestinal resection should have regular check-ups for vitamin A levels, and be promptly treated to prevent eye pathologies and visual symptoms.