Vitamin A Deficiency Due to Malabsorption

Ocular Manifestations

The American Academy of Ophthalmology notes that xerophthalmia (dry eyes) develops as an early manifestation, caused by loss of mucus-secreting goblet cells and reduced tear production 1
Night blindness remains the earliest symptom, resulting from insufficient rhodopsin synthesis in the retina 2
Bitot spots appear as gray/white foamy lesions on the conjunctiva, representing keratinized epithelium 2
Corneal keratinization and ulceration represent more severe stages 1
Keratomalacia (corneal softening and melting) can develop even without bacterial infection or inflammatory infiltration 1
Permanent blindness results from corneal maceration and secondary infection if left untreated 1

Dry hair has been reported in patients with vitamin A deficiency 3
Impaired immune function increases susceptibility to secondary infections that worsen eye damage 2

The American Gastroenterological Association notes that short bowel syndrome carries significant risk due to reduced fat absorption 1
Cystic fibrosis patients are at elevated risk 1
Celiac disease increases deficiency risk 1
Chronic diarrhea of any etiology increases deficiency risk 1
Bariatric surgery patients, particularly after malabsorptive procedures like BPD/DS and RYGB, show the highest risk 4, 3
Chronic liver disease shows high prevalence of deficiency, with severity correlating to disease progression 1
Liver transplant candidates demonstrate deficiency in 69.8% of cases 1
Chronic alcohol consumption depletes hepatic vitamin A stores, though serum levels may remain falsely normal 1
Chronic kidney disease requires regular monitoring as levels fluctuate unpredictably 1

The National Institute of Diabetes and Digestive and Kidney Diseases notes that serum retinol levels may remain in the normal range despite depleted liver stores, particularly in chronic alcohol consumption, creating a false sense of adequacy 1
Interpretation of serum levels should therefore be treated with caution as they do not directly reflect total body vitamin A stores 4
During inflammation, retinol-binding protein release is reduced, potentially masking deficiency 2

Corneal scarring leads to permanent vision loss, resulting from advanced vitamin A deficiency, as reported by the American Academy of Ophthalmology 5
Permanent blindness results from corneal maceration and secondary infection if left untreated, highlighting the importance of early intervention, as noted by the American Academy of Ophthalmology 5

Benign intracranial hypertension (pseudotumor cerebri) has been reported in specific populations, such as cystic fibrosis patients, with vitamin A deficiency, according to the European Society for Clinical Nutrition and Metabolism 6
Uni- or bilateral facial palsy in infants is a rare manifestation of vitamin A deficiency, particularly in high-risk populations, as reported by the European Society for Clinical Nutrition and Metabolism 6

Clinical signs of overt vitamin A deficiency are extremely rare in developed countries, despite biochemical deficiency being present, emphasizing the need for early evaluation and correction of suboptimal levels, as recommended by the National Institute of Nutrition 6
Serum retinol levels should not be assessed during acute infection or inflammation, as retinol concentrations fall in response to inflammation independent of true vitamin A status, potentially masking deficiency, according to the World Health Organization 6