Corneal perforation due to vitamin A deficiency in a patient with short bowel syndrome

Abstract

A 55-year-old Caucasian woman presented with a 1-week history of left eye redness and blurred vision. Her medical history included previous small bowel resection and ileostomy for ischaemic bowel. Ophthalmic examination revealed a left corneal ulcer requiring hospital admission for intensive topical antibiotics. Overnight she became systemically unwell and was diagnosed with urinary tract infection requiring intravenous antibiotics. Her corneal condition deteriorated resulting in corneal perforation, which required a surgical gluing procedure. Despite surgery, the cornea perforated on two further occasions. At this stage, vitamin A deficiency (VAD) was suspected, due to the corneal melting response that was occurring. VAD was subsequently confirmed by serology and had occurred in this case due to malabsorption as a result of short bowel syndrome caused by previous small bowel surgery. The patient was treated with intramuscular vitamin A and eventually made a good visual and systemic recovery.

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

“…In areas with low prevalence of VAD, a delay in evaluation, diagnosis and management often occurs, leading to major systemic and ocular morbidity and even mortality in some children [5,7]. In recent years, reports of VAD in children with risk factors such as selective eating habits and gastrointestinal pathology have increased in well resourced regions [8 ▪▪ ,9 ▪ ,10 ▪▪ ,11 ▪ ,12 ▪▪ ]…”