Vitamin A Deficiency

Vitamin A is essential for retinal function, epithelial integrity and immune function. Deficiency occurs particularly with malnutrition, fat malabsorption, chronic diarrhoea and inadequate dietary intake.

Severe deficiency causes xerophthalmia and irreversible blindness.

Progression may include:

• Night blindness
• Conjunctival xerosis
• Bitot spots
• Corneal xerosis
• Corneal ulceration or keratomalacia
• Corneal scarring

Children may also have increased susceptibility to severe infection.

Diagnosis is primarily clinical where characteristic ocular findings are present.

Serum retinol can support diagnosis but falls during acute inflammation and should not be interpreted in isolation.

For xerophthalmia or clinically significant vitamin A deficiency:

• Under 6 months: vitamin A 50,000 IU PO

• 6 to 11 months: 100,000 IU PO

• 12 months and older: 200,000 IU PO

Give the dose immediately, repeat the following day, and give a third dose approximately 2 weeks later.

Urgent ophthalmology assessment is required for corneal involvement because keratomalacia can progress rapidly to perforation and permanent blindness.

Treat associated malnutrition, diarrhoea and infection.