Vitamin A deficiency–associated corneal perforation in a boy with autism spectrum disorder: A case report and literature review

Adachi, Shunichi; Torio, Michiko; Okuzono, Sayaka; Motomura, Yoshitomo; Ichimiya, Yuko; Sonoda, Yuri; Nagata, Jyunya; Okamoto, Misato; Noutomi, Shouji; Sanefuji, Masafumi; Sakai, Yasunari; Ohga, Shouichi

doi:10.1016/j.nut.2021.111275

Cited by 7 publications

(9 citation statements)

References 22 publications

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“…Children with ASD frequently have nutritional deficits owing to picky eating habits, which held true for this patient. His serum vitamin A level was very low at 3.58 μg/dL (normal range, 28.65-94.56 μg/dL ) …”

Section: Discussionmentioning

confidence: 99%

“…Xerophthalmia is reversible within days to weeks of timely supplementation. However, up to 55% of children with ASD and xerophthalmia may have irreversible vision impairment owing to corneal scarring …”

Section: Discussionmentioning

confidence: 99%

“…His serum vitamin A level was very low at 3.58 μg/dL (normal range, 28.65-94.56 μg/dL ). 6 The most common ophthalmic symptom of vitamin A deficiency is nyctalopia secondary to rod photoreceptor dysfunction. 3 This can be missed in children with ASD, as they may be unable to express difficulty seeing in the dark.…”

Section: Jama Ophthalmology Clinical Challengementioning

confidence: 99%

“…However, up to 55% of children with ASD and xerophthalmia may have irreversible vision impairment owing to corneal scarring. 6 Allergy testing and treating with topical steroids (choice A) would be correct for a patient with vernal keratoconjunctivitis (VKC). This patient is a young boy with bilateral ulcers and frequently rubs his eyes, which may suggest the diagnosis.…”

Section: Jama Ophthalmology Clinical Challengementioning

confidence: 99%

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A Child With Severe Autism Spectrum Disorder With Bilateral Corneal Ulcers

2022

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A 6-year-old boy with severe autism spectrum disorder (ASD) was brought to the hospital by his mother for whitening in the right eye. The patient was nonverbal at baseline and exhibited restrictive and repetitive behaviors. His diet consisted exclusively of cookies, apples, potato chips, and Gatorade. His mother noticed him frequently rubbing his eyes for several weeks, which she initially attributed to new-onset allergies. She did not describe any reduction in visual function or ability to perform low-luminance tasks.The patient was admitted and ophthalmology was consulted. He required an examination under sedation. His visual acuity could not be determined. There was no relative afferent pupillary defect in either eye. The eyelids were mildly erythematous with bilateral eyelash hypertrichosis. The conjunctiva and cornea appeared dry and leathery bilaterally. The right cornea was diffusely hazy with a 3-mm paracentral epithelial defect with 60% stromal thinning and a 1-mm infiltrate. There was a small crescentic fibrin deposit nasally in the right anterior chamber. The left cornea was diffusely hazy with a 1-mm epithelial defect without stromal thinning (Figure). Dilated examination showed bilateral grade 3 optic nerve head edema and otherwise normal retinal findings. Fortified vancomycin eye drops, 25 mg/mL, and tobramycin eye drops, 15 mg/mL, were initiated. Results of magnetic resonance imaging of the brain were normal.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Jama Ophthalmology Clinical Challengementioning

confidence: 99%

Section: Jama Ophthalmology Clinical Challengementioning

confidence: 99%

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A Child With Severe Autism Spectrum Disorder With Bilateral Corneal Ulcers

2022

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“…In areas with low prevalence of VAD, a delay in evaluation, diagnosis and management often occurs, leading to major systemic and ocular morbidity and even mortality in some children [5,7]. In recent years, reports of VAD in children with risk factors such as selective eating habits and gastrointestinal pathology have increased in well resourced regions [8 ▪▪ ,9 ▪ ,10 ▪▪ ,11 ▪ ,12 ▪▪ ]…”

Section: Introductionmentioning

confidence: 99%

Recognizing vitamin A deficiency: special considerations in low-prevalence areas

Song

Mousa

Soifer

et al. 2022

Current Opinion in Pediatrics

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Purpose of reviewAlthough vitamin A deficiency (VAD) is rare in well resourced countries, there is a growing trend of VAD in at-risk pediatric populations. Early diagnosis is critically important to prevent its associated morbidity and mortality. This review highlights key lessons for evaluation, diagnosis, and management of children with xerophthalmia in the United States. It synthesizes the latest findings from the literature on the pathophysiology, epidemiology, risk factors, evaluation, and management of VAD in low-prevalence areas. Recent findingsVitamin A is crucial for maintaining the functional integrity of the eye, immune system, skin, and mucous membranes. Despite the scarcity of VAD in developed countries, there are increasing reports of VAD in atrisk children, including those with autism spectrum disorder and gastrointestinal conditions. There is a broad range of manifestations of VAD, posing a diagnostic challenge. Familiarity with the variable presentations of VAD and having a high index of suspicion in at-risk populations can aid in its early diagnosis. Systemic vitamin A supplementation and a multidisciplinary approach are important components of the management of VAD.

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Retinol

2021

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Vitamin A deficiency–associated corneal perforation in a boy with autism spectrum disorder: A case report and literature review

Cited by 7 publications

References 22 publications

A Child With Severe Autism Spectrum Disorder With Bilateral Corneal Ulcers

A Child With Severe Autism Spectrum Disorder With Bilateral Corneal Ulcers

Recognizing vitamin A deficiency: special considerations in low-prevalence areas

Retinol

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