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Klin Monbl Augenheilkd. 2006 May;223(5):443-6.

Night blindness, yellow vision, and yellow skin: symptoms and signs of malabsorption.

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1
Department of Neuro-Ophtalmology, Hôpital Ophtalmique Jules Gonin, Lausanne, Switzerland.

Abstract

BACKGROUND:

Rapidly progressing bilateral night blindness in an elderly patient suggests primarily a diagnosis of paraneoplastic retinopathy. Occasionally diffuse rod dysfunction can result from vitamin A deficiency.

HISTORY AND SIGNS:

A 70-year-old man complained of progressive night blindness and xanthopsia for the past 6 months. Visual acuity was 0.8 in both eyes with severe dyschromatopsia. Slit-lamp and fundus examination were normal. Visual field disclosed bilateral depression. Scotopic full-field ERG was severely reduced. The patient's medical history revealed an acute pancreatitis one year ago, followed by chronic jaundice and an increased blood bilirubin. Serum vitamin A level was decreased to 0.1 micromol/L (normal range 1.5 to 4.0).

THERAPY AND OUTCOME:

Intramuscular injections of vitamin A were provided. Subjective visual improvement was reported already one day after initiation of therapy. Scotopic full-field ERG was markedly improved 3 days after the injection and was only slightly subnormal 3 months later.

CONCLUSIONS:

In developed countries, vitamin A deficiency usually results from malabsorption syndromes and manifests initially by rod more than cone dysfunction. This diagnosis should be entertained early as vitamin A supplementation induces a rapid restoration of vision.

PMID:
16705527
DOI:
10.1055/s-2006-926830
[Indexed for MEDLINE]
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