Night blindness, yellow vision, and yellow skin: symptoms and signs of malabsorption.
BACKGROUND
Rapidly progressing bilateral night blindness in an elderly patient suggests primarily a diagnosis of paraneoplastic retinopathy. Occasionally diffuse rod dysfunction can result from vitamin A deficiency.


METHODS
A 70-year-old man complained of progressive night blindness and xanthopsia for the past 6 months. Visual acuity was 0.8 in both eyes with severe dyschromatopsia. Slit-lamp and fundus examination were normal. Visual field disclosed bilateral depression. Scotopic full-field ERG was severely reduced. The patient's medical history revealed an acute pancreatitis one year ago, followed by chronic jaundice and an increased blood bilirubin. Serum vitamin A level was decreased to 0.1 micromol/L (normal range 1.5 to 4.0).


RESULTS
Intramuscular injections of vitamin A were provided. Subjective visual improvement was reported already one day after initiation of therapy. Scotopic full-field ERG was markedly improved 3 days after the injection and was only slightly subnormal 3 months later.


CONCLUSIONS
In developed countries, vitamin A deficiency usually results from malabsorption syndromes and manifests initially by rod more than cone dysfunction. This diagnosis should be entertained early as vitamin A supplementation induces a rapid restoration of vision.
Pitchon
E
E
Department of Neuro-Ophtalmology, Hôpital Ophtalmique Jules Gonin, Lausanne, Switzerland.
Sahli
O
O
Borruat
F-X
FX
D000368:Aged; D003117:Color Vision Defects / Q000517:prevention & control*; D006801:Humans; D008286:Malabsorption Syndromes / Q000175:diagnosis / Q000188:drug therapy*; D008297:Male; D009755:Night Blindness / Q000517:prevention & control*; D010859:Pigmentation Disorders / Q000517:prevention & control*; D012880:Skin Pigmentation; D014801:Vitamin A / Q000008:administration & dosage*; D014802:Vitamin A Deficiency / Q000188:drug therapy*; D014985:Xerophthalmia / Q000517:prevention & control*
D014801:Vitamin A