Bilateral Corneal Melting in a Pediatric Patient with Severe Vitamin A Deficiency: A Case Report and Review of Literature

BACKGROUND: Keratomalacia refers to an ocular destructive dryness of the cornea that results from severe vitamin A deficiency. It is an ocular condition, usually affecting both eyes. It affects infants, children and women of reproductive age. In developing countries, vitamin A deficiency in the diet and associated keratomalacia are a major cause of childhood blindness. PURPOSE: To report the clinical finding of a patient with bilateral keratomalacia arising from severe vitamin A deficiency from a malnourished diet. PATIENTS AND METHODS: Case report. RESULTS: A two-year-old female with severe malnutrition presented with 3 weeks of watering and tonic blepharospasm affecting the right and left eyes. She exhibited trichomegaly, severe weight loss, abnormal hairs with complete corneal melt in the right and left eyes and inflamed iris tissue in the right eye. She was treated with high dose vitamin A, but the right eye required evisceration and tarsorrhaphy was done in the left eye. CONCLUSION: The visual morbidity associated with xerophthalmia secondary to vitamin A deficiency can be devastating. Diet-induced vitamin A deficiency is prevalent in developing and war-torn countries. A good history taking and review of systems are valuable in evaluating malnourished patients with corneal melt.