Fukuoka Hideki, Sotozono Chie
Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan.
Diagnostics (Basel). 2025 Jul 30;15(15):1910. doi: 10.3390/diagnostics15151910.
Vitamin A deficiency (VAD) remains a significant cause of preventable blindness worldwide, with ocular surface changes representing early manifestations that require prompt recognition and treatment. Conventional examination methods are capable of detecting advanced changes; however, subtle conjunctival abnormalities may be overlooked, potentially delaying the administration of appropriate interventions. We herein present the case of a 5-year-old Japanese boy with severe VAD due to selective eating patterns. This case demonstrates the utility of infrared photography as a novel diagnostic approach for detecting and monitoring conjunctival surface abnormalities. The patient exhibited symptoms including corneal ulcers, night blindness, and reduced visual acuity. Furthermore, blood tests revealed undetectable levels of vitamin A (5 IU/dL), despite relatively normal physical growth parameters. Conventional slit-lamp examination revealed characteristic sandpaper-like conjunctival changes. However, infrared photography (700-900 nm wavelength) revealed distinct abnormal patterns of conjunctival surface folds and keratinization that were not fully appreciated on a routine examination. Following high-dose vitamin A supplementation (4000 IU/day), complete resolution of ocular abnormalities was achieved within 2 months, with infrared imaging objectively documenting treatment response and normalization of conjunctival surface patterns. This case underscores the potential for severe VAD in developed countries, particularly in the context of dietary restrictions, thereby underscoring the significance of a comprehensive dietary history and a meticulous ocular examination. Infrared photography provides a number of advantages, including the capacity for non-invasive assessment, enhanced visualization of subtle changes, objective monitoring of treatment response, and cost-effectiveness due to the use of readily available equipment. This technique represents an underutilized diagnostic modality with particular promise for screening programs and clinical monitoring of VAD-related ocular manifestations, potentially preventing irreversible visual loss through early detection and intervention.
维生素A缺乏症（VAD）仍然是全球可预防失明的一个重要原因，眼表变化是早期表现，需要及时识别和治疗。传统检查方法能够检测到晚期变化；然而，细微的结膜异常可能会被忽视，从而可能延误适当干预措施的实施。我们在此介绍一名5岁日本男孩因挑食导致严重VAD的病例。该病例证明了红外摄影作为一种检测和监测结膜表面异常的新型诊断方法的实用性。患者表现出角膜溃疡、夜盲和视力下降等症状。此外，血液检查显示维生素A水平无法检测到（5 IU/dL），尽管身体生长参数相对正常。传统的裂隙灯检查显示出特征性的砂纸样结膜变化。然而，红外摄影（波长700 - 900 nm）揭示了结膜表面褶皱和角化的明显异常模式，这些在常规检查中并未完全显现。在高剂量补充维生素A（4000 IU/天）后，2个月内眼部异常完全消失，红外成像客观记录了治疗反应以及结膜表面模式的正常化。该病例强调了发达国家严重VAD的可能性，特别是在饮食限制的情况下，从而突出了全面饮食史和细致眼部检查的重要性。红外摄影具有许多优点，包括能够进行非侵入性评估、增强细微变化的可视化、客观监测治疗反应以及由于使用现成设备而具有成本效益。这项技术是一种未得到充分利用的诊断方式，对于VAD相关眼部表现的筛查项目和临床监测具有特别的前景，有可能通过早期检测和干预预防不可逆的视力丧失。
