Hypovitaminosis A in metropolitan adelaide

Hypovitaminosis A is a well-recognized condition in many developing countri es. However, in the developed world the diagnosis is frequently missed or d elayed because of its rarity. A 67-year-old man from metropolitan Adelaide presented to us with gradual but severe bilateral visual loss. He had marke d punctate epithelial keratopathy in both eyes. Hypovitaminosis was suspect ed because of his bizarre dietary habit, and this was confirmed by a combin ation of impression cytology of the ocular surface and biochemical testing of his venous blood. His vision responded dramatically to vitamin A supplem entation. Hypovitaminosis A should be suspected in severe cases of 'dry-eye ', especially in those patients with unusual dietary habit or malabsorption .