Xerophthalmia Secondary To Vitamin A Deficiency In A Patient With Alcohol Use Disorder

To present a rare case of xerophthalmia in a patient with chronic alcohol dependence, leading to profound bilateral vision loss. This case highlights the ophthalmic manifestations of vitamin A deficiency and underscores the importance of early diagnosis through thorough clinical history and examination to prevent irreversible visual impairment.

This case was managed at the ophthalmology department of Hospital Clinic de Barcelona (Barcelona, Spain). The patient was admitted for inpatient care, including ophthalmologic treatment, systemic evaluation, and nutritional support.

A Case Report

A 56-year-old male with alcohol abuse disorder presented with bilateral vision loss over three weeks and persistent ocular discomfort. Visual acuity was light perception in the right eye and 20/200 in the left. Slit-lamp exam showed bilateral conjunctival keratinization, hyperemia and Bitot’s spots. The right cornea had a large ulcer with stromal melting, while the left exhibited severe epithelialopathy. Given the clinical findings and systemic history, xerophthalmia was diagnosed. The patient was admitted for alcohol withdrawal, high-dose vitamin A supplementation and close follow-up. Ophthalmic therapy included topical antibiotics, lubrication with vitamin A ointment in both eyes along with an amniotic membrane graft in the right eye. 

Xerophthalmia is a rare but severe condition in developed countries, often associated with malnutrition due to chronic systemic diseases such as alcohol-related pancreatic insufficiency. This case underscores the importance of recognizing vitamin A deficiency as a potential cause of severe ocular pathology. Early identification and intervention with vitamin A supplementation and supportive ocular therapy can prevent irreversible visual impairment. A multidisciplinary approach is crucial in managing these patients effectively.