White Spots on the Conjunctiva

Abstract

A three-year-old boy was treated for malnutrition at a hospital in Tanzania. According to family members, his diet included daily portions of milk, corn meal, and kidney beans, as well as chicken once a week (all of these foods are poor in vitamin A). Physical examination revealed foamy white spots on the conjunctiva lateral to the limbus in both eyes. Vision was normal. These pathognomonic Bitot spots, due to keratin production in metaplastic conjunctival squamous epithelium and most commonly seen in three-to six-year-olds, indicate marked chronic vitamin A deficiency on a nutritional basis (WHO stage X1B). Preschool children with vitamin A deficiency in this stage have an at least threefold elevation of mortality and of the risk of blindness. The patient was given 200 000 IU of vitamin A on two consecutive days, as recommended in the WHO guidelines, and the lesions gradually improved. Now that many refugees are coming to Europe from Africa and elsewhere, attention should be paid to this clinical sign, generally unknown in Germany up to the present, so that vitamin A deficiency can be clinically recognized early.