Xerophthalmia and keratomalacia from vitamin A deficiency
B. Check serum vitamin A levels
The clinical examination revealed bilateral xerophthalmia, a manifestation of vitamin A deficiency. Thus, serum vitamin A levels should be checked (choice B). While vitamin A deficiency is one of the most common causes of malnutrition in low-income countries, it is rarely seen in high-income countries.
In 2009, the World Health Organization estimated that 5.2 million preschool-aged children had night blindness and 190 million had low serum retinol concentrations.1 Those with a serum retinol concentration of less than 20.06 μg/dL (to convert to micromoles per liter, multiply by 0.0349) are vitamin A deficient, and severe deficiency is indicated at levels below 10.03 μg/dL.1 Eye findings include hyperemia, conjunctival and corneal keratinization, and Bitot spots. Yellow or white punctate peripheral retinal lesions may be seen, indicating photoreceptor dysfunction. Pediatric idiopathic intracranial hypertension and nerve atrophy have also been associated with vitamin A deficiency.2,3 Children with ocular signs of vitamin A deficiency have reduced immunity and a higher mortality rate.3,4