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Vitamin A deficiency

What is Vitamin A deficiency?

What are the causes of this deficiency?

What are the signs and symptoms?

How is it diagnosed?

How is it treated?

Are there any precautionary measures?

What is Vitamin A deficiency?

Vitamin A deficiency is one of the leading causes of preventable blindness in developing countries. Vitamin A is a fat-soluble vitamin and is found mainly in fish liver oils, liver, egg yolks, butter and cream, green leafy and yellow vegetables.

What are the causes of this deficiency?

Primary vitamin A deficiency is caused by malnutrition.

Secondary vitamin A deficiency is caused by:

• Celiac disease, inability to tolerate wheat protein (gluten); often accompanied by lactose intolerance.
• Sprue, where nutrients are not absorbed.
• Cystic fibrosis, the most common congenital disease in the west; the child's lungs and intestines and pancreas become clogged with thick mucus; characterised by frequent respiratory tract infections, mal-absorption etc.
• Pancreatic disease.
• Duodenal bypass.
• Congenital partial obstruction of the jejunum.
• Obstruction of the bile ducts.
• Giardiasis, which is the infection of the intestines with protozoa found in contaminated food and water, causing malabsorption.
• Cirrhosis, destruction of the liver parenchyma, the major cause being chronic alcohol intake.

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What are the signs and symptoms?

World Health Organisation has proposed an ocular symptom classification of vitamin A deficiency, which is as follows.

• XN: Night Blindness is the earliest symptom of vitamin A deficiency, which is often reported by the mother as reduced visual acuity of the child in the evening and the night-time.
• X1A: Conjunctival xerosis or drying of the conjunctiva.
• X1B: Bitot’s spots on the conjunctiva.
• X2: Corneal xerosis or dryness of the cornea with a granular looking surface.
• X3A: Keratomalacia involving less than a third of the cornea. Cornea becomes dry, thin and soft, and then ulcerates. Usually presents with indolent corneal ulcers surrounded by dull lack-luster hazy cornea, ±intolerance to light. The cornea then becomes soft and necrotic with perforation being common.
• X3B: Keratomalacia involving greater than one third of cornea.
• XF: Fundoscopic changes visible on ophthalmoscopy.
• XS: Corneal Scarring compromising severely on visual acuity.

Other signs of vitamin A deficiency are:

• Frequent infections like measles, diarrhea, and malaria.
• Stunted growth.
• Anemia.
• Malnutrition.
• Thickened toad like skin.

How is it diagnosed?

Diagnosis is essentially clinical. Investigations that may help in diagnosis are:·

• Fundoscopic examination.
• Serum retinol and retinol binding protein level.

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How is it treated?

The cause should be corrected.

• Administration of oral vitamin A palmitate for two days regularly and once before discharge from the hospital after 14 days is usually effective.
• In the presence of vomiting or malabsorption, water-miscible vitamin A must be given IM.
• During pregnancy and lactation, prophylactic or therapeutic doses should not exceed two times the RDA to avoid possible damage to the fetus.
• Surgical treatment (keratoplasty) is needed in case of Keratomalacia.

Are there any precautionary measures?

Vitamin A deficiency is an easily preventable disorder. Some of the precautionary measures are:

• Use of oral vitamin A.
• Treatment of malnutrition.
• Usage of vitamin A rich foods.
• Usage of vitamin A fortified foods.
• Treatment of associated disorders.
• Screening of siblings of children with manifest vitamin A deficiency.
• Administration of vitamin A to lactating women.

** - RDA: Recommended Dietary Allowance, IM: Intramuscular.

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