Corneal Perforation Associated with Vitamin A Deficiency
Heinz C., Steuhl K.-P., Meller D.
Dept. of Ophthalmology, Essen University
Purpose: Vitamin A is a crucial factor for maintenance of ocular surface integrity. Vitamin A deficiency, which can be caused by different aetiologies, may lead to severe complications including corneal perforation.
Method: Case reports of three patients with vitamin A deficiency. The observed aetiologies leading to vitamin A deficiency were: 1) biliary cirrhosis, 2) malnutrition induced by alcohol abuse, and 3) malabsorption syndrome caused by a graft versus host disease of the intestine after bone marrow transplantation.
Results: In all three cases vitamin A serum level were below normal values. In two patients retinol binding protein was also reduced. Two of three had corneal perforation, which required penetrating keratoplasty (pKP). In one of these cases, pKP was performed three times on both eyes due to a rapid corneal stromal melting leading always to corneal perforation. The third case developed on both eyes severe corneal thinning with the formation of a decemetocele. Vitamin A substitution improved symptoms and ocular surface integrity.
Conclusions: Vitamin A in combination with zinc is a crucial factor responsible for conjunctival and corneal ocular surface integrity. Moreover, regulatory mechanisms for mucin production of the ocular surface are also known. Several different primary diseases might cause Vitamin A deficiency. Especially patients with sterile and rapid progressive corneal ulceration should be examin
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