Sadowski B, Rohrbach J M, Steuhl K P, Weidle E G, Castrillón-Oberndorfer W L
Abteilung für Pathophysiologie des Sehens und Neuroophthalmologie, Universitäts-Augenklinik Tübingen.
Klin Monbl Augenheilkd. 1994 Aug;205(2):76-85. doi: 10.1055/s-2008-1045496.
Vitamin A, the fat soluble vitamin, must be supplied orally before resorption in the mucosa of the small intestine and storage in the liver. Vitamin A deficiency can cause alterations in the anterior segment of the eye, from Bitot spots, which are reversible, to irreversible keratomalacia.
5 patients suffering from manifestations at the cornea underwent ophthalmological, general and dermatological investigation and measurements of the vitamin A, retinol-binding protein and, in one patient, zinc were performed. 4 patients suffered from cornea manifestations, reaching from almost a reactive ulceration to spontaneous perforation. One patient had relapsing episcleritis. All patients were alcoholics, had hepatopathies and dermatological diseases. Vitamin A and retinol-binding protein were decreased and in one patient a highly decreased zinc was measured. In one patient a systemical and local substitution of vitamin A increased the clinical findings significantly. Two eyes had to undergo a keratoplasty à chaud, one evisceration had to be done.
Vitamin A deficiency can be the reason for bilateral painless cornea manifestations. An interdisciplinary cooperation is essential for the elaboration of the diagnosis and the treatment.
脂溶性维生素A必须经口服后才能在小肠黏膜吸收并储存于肝脏。维生素A缺乏可导致眼部前段出现病变，从可逆的毕脱斑到不可逆的角膜软化症。
对5例有角膜表现的患者进行了眼科、全身及皮肤科检查，并检测了维生素A、视黄醇结合蛋白，其中1例患者还检测了锌。4例患者有角膜表现，从几乎是反应性溃疡到自发性穿孔。1例患者有复发性巩膜炎。所有患者均为酗酒者，患有肝病和皮肤病。维生素A和视黄醇结合蛋白水平降低，1例患者锌水平显著降低。1例患者经维生素A全身及局部替代治疗后临床症状明显改善。2只眼不得不接受急诊角膜移植术，1只眼进行了眼球摘除术。
维生素A缺乏可能是双侧无痛性角膜表现的原因。跨学科合作对于明确诊断和治疗至关重要。
