You are correct. Vitamin A deficiency was confirmed by extremely low serum vitamin A levels. Conjunctival xerosis, a sign of long-standing vitamin A deficiency, is usually bilateral and reflects severe conjunctival dryness. In advanced cases, the entire conjunctiva may appear dry, roughened, thickened, corrugated, and sometimes skin-like. This pt’s ocular s/sx reversed following systemic vitamin A tx. As multiple nutritional deficiencies were evident, pediatrician and dietitian referrals were arranged.

Arch Dis Child 2018;103:890