Photorefractive Keratectomy In A Patient With Bitot's Spots: First Reported Case
Published 2026 - 44th Congress of the ESCRS
Reference: POREF036 | Type: Case Report | DOI: 10.82333/bad1-za40
Authors: Raul H Plasencia Salini* 1 , Justo Luis Noriega Martinez 2
1Ophthalmology,Universidad de San Martin de Porres,Lima,Peru;CorneaClinic,Trujillo,Peru, 2CorneaCuantica,Lima,Peru
Purpose
Bitot's spots are keratinized conjunctival lesions secondary to vitamin A deficiency and may indicate compromised ocular surface integrity. Because epithelial healing is critical after photorefractive keratectomy (PRK), hypovitaminosis A may represent a potential risk factor for postoperative complications. There are no published reports describing PRK in patients with Bitot's spots. We present the first reported case, detailing systemic evaluation, perioperative management, and clinical outcomes.
Setting
Private refractive surgery center.
Report of case
A 30-year-old woman presented for refractive surgery evaluation with uncorrected distance visual acuity (UDVA) of 20/400 in both eyes. She reported mild dry eye symptoms associated with prolonged screen use and soft contact lens wear. Manifest refraction was −4.50 D (OD) and −4.00 −0.50 ×180 (OS). Slit-lamp examination revealed bilateral temporal conjunctival Bitot's spots.
Serum vitamin A level was 0.21 mg/L (reference 0.30–1.00 mg/L). The patient was referred to Internal Medicine for evaluation of hypovitaminosis A. Systemic workup excluded malabsorption, liver disease, and nutritional deficiency, suggesting probable familial hypovitaminosis A. Oral vitamin A supplementation (10,000 IU/day) was initiated for two months with ocular lubrication.
PRK was performed in both eyes three months after treatment initiation. Standard postoperative therapy included topical antibiotics, corticosteroids, and preservative-free artificial tears. Epithelial healing was complete and uneventful. UDVA improved to 20/20 OU by postoperative day 10. No corneal haze or significant dry eye developed.
At one-year follow-up, Bitot's spots had markedly regressed, nearly disappearing, with stable refraction and no complications.
Conclusion/Take home message
Bitot's spots are not an absolute contraindication to PRK. Identification and correction of vitamin A deficiency prior to surgery are essential to ensure normal epithelial healing and prevent ocular surface complications.