Woman, 88, had ‘burning’ eyes due to vitamin A deficiency

Dr Hilary Jones explains importance of vitamin A and D

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Our bodies rely on certain vitamins and minerals to stay healthy. Without them we can become deficient, which can lead to illnesses and unwanted side effects. Vitamin A is one such vitamin that our bodies need.

Vitamin A deficiency is a leading cause of childhood blindness and mortality across the world but is “rare” in developed countries.

However, one woman from Melbourne in Australia fell foul of this deficiency due to her “bizarre” eating habits.

Her story was published in Case Reports Ophthalmology in 2015.

The case study explained: “An 88-year-old woman with a history of chronic lymphocytic leukaemia presented for routine ophthalmologic examination.

“She complained of ‘itchy, burning eyes’ and general visual decline. Her past ocular history included uneventful bilateral cataract surgery.”

An examination revealed she had Bitot’s spots, which are caused by a build-up of keratin in the conjunctiva.

This “raised the suspicion” of a vitamin A deficiency.

The study continued: “On further questioning, the patient reported ‘food intolerance’ for over 20 years.

“She had undergone extensive and unrevealing investigations but said she was intolerant to ‘anything oily or fatty’, and kept a strict diet limited to rice porridge, canned tuna and vitamin B supplements.”

A vitamin A test showed her levels to be 0.1 micromole per litre (μmol/l) far below the normal level of 1.6-2.3 μmol/l.

She was immediately started on 100,000 international units (IU) of oral vitamin A supplements for three days.

This was lowered to 50,000 IU daily for two weeks.

The study said: “She showed rapid resolution of symptoms and reported marked improvement in vision within 24 hours.

“A repeat electroretinography (ERG) test five months later showed normalisation of scotopic responses and a mild improvement in photopic responses compared to the initial test.”

Vitamin A in food

Sources of vitamin A include:

• Leafy green vegetables
• Orange and yellow vegetables
• Tomatoes
• Red bell pepper
• Mango.
• Beef liver
• Fish oils
• Milk
• Eggs.

“Vitamin A is an essential fat-soluble vitamin absorbed through the small intestine either as retinol (animal-derived) or carotene (plant- and vegetable-derived),” the study added.

“Common food sources include milk, eggs and meat as well as dark leafy vegetables. It has a role in photoreceptor transduction of light to electrochemical energy as well as in the differentiation of epithelial cells on the ocular surface.

“Vitamin A is stored in the liver, and the typical liver storage amount is sufficient for two years.”

Symptoms of a vitamin A deficiency include:

• Night blindness
• Bitot’s spots – which cause hazy vision
• Xerophthalmia – dry and crusty eyes
• Contracting infections more easily
• Skin irritation
• Drying and clouding of the cornea
• Stunted growth among children
• Fertility issues.

If you think you are suffering from a vitamin A deficiency and changing your diet has not helped, speak to your GP.

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