Sidney M Gospe1, Bozho Todorich, Yevgeniya G Foster, Gary Legault, Suzanne K Woods, Alan D Proia, Melissa Daluvoy. 1. *Department of Ophthalmology, Duke University Medical Center, Durham, NC; †Associated Retinal Consultants, P.C. and William Beaumont Hospital, Royal Oak, MI; ‡Department of Internal Medicine, Duke University Medical Center, Durham, NC; §Department of Ophthalmology, William Beaumont Army Medical Center, El Paso, TX; and Departments of ¶Pediatrics, and ‖Pathology, Duke University Medical Center, Durham, NC.
Abstract
PURPOSE: To report the clinical and histopathological findings of a patient with bilateral keratomalacia arising from severe vitamin A deficiency from panic disorder-related malnutrition. METHODS: Case report. RESULTS: A 47-year-old male with panic disorder presented with 1 month of painful vision loss sequentially affecting the right and left eyes. He exhibited bilateral conjunctival xerosis with complete corneal melt in the right eye and a large corneal epithelial defect with underlying anterior chamber inflammation in the left eye. Laboratory investigation revealed undetectable serum vitamin A levels attributed to self-induced vomiting and starvation. He was treated with high-dose vitamin A, but the right eye required enucleation. The histological findings are reported. CONCLUSIONS: Vitamin A deficiency in the absence of organic gastrointestinal abnormalities is exceedingly rare in the developed world. A strong index of suspicion and thorough review of systems are invaluable in evaluating patients with unexplained corneal melt.
PURPOSE: To report the clinical and histopathological findings of a patient with bilateral keratomalacia arising from severe vitamin A deficiency from panic disorder-related malnutrition. METHODS: Case report. RESULTS: A 47-year-old male with panic disorder presented with 1 month of painful vision loss sequentially affecting the right and left eyes. He exhibited bilateral conjunctival xerosis with complete corneal melt in the right eye and a large corneal epithelial defect with underlying anterior chamber inflammation in the left eye. Laboratory investigation revealed undetectable serum vitamin A levels attributed to self-induced vomiting and starvation. He was treated with high-dose vitamin A, but the right eye required enucleation. The histological findings are reported. CONCLUSIONS: Vitamin A deficiency in the absence of organic gastrointestinal abnormalities is exceedingly rare in the developed world. A strong index of suspicion and thorough review of systems are invaluable in evaluating patients with unexplained corneal melt.