Vitamin A deficiency is a known concern in developing countries, but it is often overlooked in developed regions. A history of conditions causing alimentary malabsorption should be considered when patients present with complaints of nyctalopia.
A case of vitamin A deficiency with nyctalopia in a patient with chronic pancreatitis including pertinent diagnostic testing, treatment, and management is presented. The intent is to draw attention to the condition as a differential diagnosis for nyctalopia due to increased prevalence of conditions causing malabsorption.
A patient with a history of chronic pancreatitis and pancreatic tumor presented with symptoms of nyctalopia and xerophthalmia. Given his systemic history, testing was ordered to determine serum vitamin A levels and retinal function. After results had confirmed depleted vitamin A levels and diminished retinal function, treatment with both oral and intramuscular vitamin A supplementation was initiated to normalize vitamin A levels and improve retinal photoreceptor function. Subjective improvement in symptoms was reported shortly after beginning supplementation, and ultimately, vitamin A levels and retinal function showed improvement after intramuscular treatment.
Detailed case history and a careful review of systems along with serum vitamin A testing and, if available, electroretinography to assess retinal function can help to make a definitive diagnosis. With appropriate comanagement with the patient's primary care physician, it is possible for those with nyctalopia to begin vitamin A supplementation and regain retinal function.
1VA Southern Nevada Healthcare System, North Las Vegas, Nevada
2Southern California College of Optometry at Marshall B. Ketchum University, Fullerton, California
3Illinois College of Optometry, Chicago, Illinois *firstname.lastname@example.org
Submitted: February 19, 2018
Accepted: January 20, 2019
Funding/Support: None of the authors have reported funding/support.
Conflict of Interest Disclosure: None of the authors have reported a financial conflict of interest.
Author Contributions and Acknowledgments: Supervision: NT, JM, DM; Writing – Original Draft: AL; Writing – Review & Editing: AL, NT, JM.
A poster of this case was presented at the 2013 meeting of the American Academy of Optometry in Seattle, WA. A multimedia poster of this case was presented at the 2014 meeting of the Southeastern Educational Congress of Optometry in Atlanta, GA.
Online date: May 17, 2019