Picture Quiz Poll: A Boy Who Ate Only Potatoes
(BMJ)—An 11-yo boy w/ autism who ate only potato-containing foods presented w/ bilateral blurred vision, eye pain, and nyctalopia for several weeks. Exam: visual acuity 20/60 in both eyes; superficial punctate keratopathy; severe conjunctival xerosis. What is the dx?
Sjögren syndrome
Vitamin A deficiency
Vitamin E deficiency
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