Keratomalacia caused by psychiatric-induced dietary restrictions.
OBJECTIVE
To describe the unique presentation, clinical course, management, and outcome of vitamin A deficiency-induced keratomalacia leading to bilateral corneal melts and ulcers in a patient with severe dietary restrictions because of psychiatric disease.


METHODS
Review of patient's record and literature pertinent to her condition.


RESULTS
A 33-year-old woman with a phobia of consuming most foods presented with bilateral corneal ulcers and melts from an unusual case of keratomalacia caused by vitamin A deficiency. The disease process progressed to bilateral perforations necessitating emergent bilateral penetrating keratoplasties. Pathologic examination confirmed classic signs of xerosis and keratomalacia. To our knowledge, our case is unique in that it is the only one in which the histopathology of the corneal lesion is described.


CONCLUSIONS
Psychiatric diseases, particularly eating disorders limiting sufficient nutrient intake, can lead to severe ocular surface disease that can be both vision- and life threatening.
Cooney
Theresa M
TM
Department of Ophthalmology, University of Michigan, Ann Arbor, MI, USA.
Johnson
C Starck
CS
Elner
Victor M
VM
D000328:Adult; D003315:Cornea / Q000473:pathology; D003320:Corneal Ulcer / Q000175:diagnosis / Q000523:psychology*; D001068:Feeding and Eating Disorders / Q000175:diagnosis / Q000523:psychology*; D005260:Female; D006801:Humans; D015948:Keratoplasty, Penetrating; D012422:Rupture, Spontaneous; D014802:Vitamin A Deficiency / Q000175:diagnosis / Q000523:psychology*; D014985:Xerophthalmia / Q000175:diagnosis / Q000523:psychology