Four Unique Cases of Keratopathy From Vitamin A Deficiency in a Tertiary Care Center in the United States: A Case Series.

Abstract

Purpose: To identify ocular manifestations of vitamin A deficiency in a case series of patients presenting with keratopathy at a tertiary care center of a high-income country, and to highlight clinical features and treatment outcomes.

Methods: A retrospective chart review was conducted of patients diagnosed with xerophthalmia at as single institution between January 1, 2025, and May 31, 2025. Patients were identified using diagnostic codes for xerophthalmia and related ocular surface disease. Inclusion criteria were a clinical diagnosis of xerophthalmia during the study period with documented ocular findings. Data collected included ocular findings, serum vitamin A levels, nutritional history, medical history, treatment, and outcomes. Data were deidentified and analyzed descriptively.

Results: Four patients were found to fit the inclusion criteria. Cases were complicated by malignancy, alcoholism, severe autism, and end-stage renal disease requiring dialysis. Most cases were late presentations and severe being complicated by corneal perforations caused by sterile stromalysis or superimposed infections. One case was more minor in nature and involved a Bitot spot.

Conclusions: Vitamin A deficiency remains a notable cause of preventable vision loss and keratopathy in high-income countries, especially in certain at-risk populations. Prompt recognition of ocular signs and timely vitamin A repletion can lead to reversal or stabilization of keratopathy; however, at the institution in this study, patients more frequently presented after significant corneal damage had occurred.