title: Clinical and subclinical ophthalmic findings with retinol deficiency.
abstract: BACKGROUND
  Patients at risk for retinol deficiency in developed countries include those with hepatic dysfunction and malabsorption states. Symptoms of retinol deficiency may go unrecognized or unreported.
  
  
  METHODS
  The authors describe 15 patients with hepatic dysfunction, two of whom had procedures that would predispose to malabsorption and were ophthalmologically symptomatic of retinol depletion. The other 13 patients were ophthalmologically asymptomatic liver transplant candidates examined prospectively for subclinical evidence of retinol deficiency. Combined laboratory analysis, Schirmer's testing, conjunctival impression cytology, and electroretinography were performed.
  
  
  RESULTS
  Twelve of 15 patients had serum retinol levels below the lower limit of normal. Aqueous tear production was reduced in 7 of 14 patients. Abnormal conjunctival morphology was noted in 6 of 12 patients. Electroretinograms were abnormal in the two patients who were visually symptomatic and in seven of nine patients who were ophthalmologically asymptomatic.
  
  
  CONCLUSIONS
  Subclinical, physiologically significant retinol deficiency may be a frequent and unrecognized problem among patients with hepatic dysfunction.
authors.affiliation: Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA.
authors.forename: N J
authors.initials: NJ
authors.lastname: Newman
authors.forename: A
authors.initials: A
authors.lastname: Capone
authors.forename: H F
authors.initials: HF
authors.lastname: Leeper
authors.forename: D G
authors.initials: DG
authors.lastname: O'Day
authors.forename: B
authors.initials: B
authors.lastname: Mandell
authors.forename: S R
authors.initials: SR
authors.lastname: Lambert
authors.forename: R A
authors.initials: RA
authors.lastname: Thoft
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004596:Electroretinography; D005260:Female; D006801:Humans; D008107:Liver Diseases / Q000150:complications; D008286:Malabsorption Syndromes / Q000150:complications; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012160:Retina / Q000503:physiopathology*; D014786:Vision Disorders / Q000175:diagnosis* / Q000209:etiology; D014794:Visual Fields; D014802:Vitamin A Deficiency / Q000150:complications*