Keratomalacia Secondary To Hypovitaminosis A Following Gastrectomy In A Middle-Aged Man

To report a rare case of bilateral xerophthalimia and left eye keratomalacia, proven by AS-OCT, in a 49-year-old male smoker who underwent a gastrectomy five years prior to his visual complaint. This case underscores the significance of nutritional vigilance in patients who have undergone post-gastrointestinal surgery & emphasizes the importance of long-term nutritional monitoring and supplementation to prevent irreversible corneal complications caused by hypovitaminosis A.

The patient was evaluated and treated at a tertiary referral hospital with multidisciplinary facilities, where subspecialty of ophthalmic services and laboratory investigations were available.

 Observational case report conducted at a tertiary hospital. Clinical evaluation included history & ophthalmic examination 

• Best-corrected visual acuity showed 6/6 in the right eye and 6/9 in the left eye
• Normal intraocular pressure
•  Slit-lamp showed bilateral conjunctival Bitot's spots
• Normal right cornea, left corneal stromal thinning with overlying epithelial faint opacities 

Laboratory investigations including serum vitamin A level were requested.

Anterior segment optical coherent tomography showed normal right cornea, left : showed area of corneal stromal thinning with overlying epithelial hyperplasia 

patient has regular follow up to monitor the progression of his condition with serial anterior segment photos, AS-OCT & clinical examination 

The diagnosis of keratomalacia left eye secondary to hypovitaminosis A was made based on clinical findings supported by AS-OCT & low vitamin A serum level. 

Laboratory tests confirmed a diagnosis of severe hypovitaminosis A, indicated by significantly low serum vitamin A levels.

After the commencement of high-dose systemic vitamin A supplementation and rigorous ocular surface therapy, the right eye displayed clinical improvement, with stabilization of the ocular surface. Conversely, the left eye revealed arc-like stromal thinning accompanied by epithelial hyperplasia, indicative of a remodeling process with stable condition and good vision.

Keratomalacia remains a preventable but devastating complication of vitamin A deficiency. Adults with a history of gastrectomy should be closely monitored for nutritional deficiencies, and supplementation should be reinforced. Early ophthalmic referral is essential to preserve vision.