title: Keratomalacia in a Patient With Psychogenic Vitamin A Deficiency.
abstract: OBJECTIVE
  To report the clinical and histopathological findings of a patient with bilateral keratomalacia arising from severe vitamin A deficiency from panic disorder-related malnutrition.
  
  
  METHODS
  Case report.
  
  
  RESULTS
  A 47-year-old male with panic disorder presented with 1 month of painful vision loss sequentially affecting the right and left eyes. He exhibited bilateral conjunctival xerosis with complete corneal melt in the right eye and a large corneal epithelial defect with underlying anterior chamber inflammation in the left eye. Laboratory investigation revealed undetectable serum vitamin A levels attributed to self-induced vomiting and starvation. He was treated with high-dose vitamin A, but the right eye required enucleation. The histological findings are reported.
  
  
  CONCLUSIONS
  Vitamin A deficiency in the absence of organic gastrointestinal abnormalities is exceedingly rare in the developed world. A strong index of suspicion and thorough review of systems are invaluable in evaluating patients with unexplained corneal melt.
authors.affiliation: *Department of Ophthalmology, Duke University Medical Center, Durham, NC; †Associated Retinal Consultants, P.C. and William Beaumont Hospital, Royal Oak, MI; ‡Department of Internal Medicine, Duke University Medical Center, Durham, NC; §Department of Ophthalmology, William Beaumont Army Medical Center, El Paso, TX; and Departments of ¶Pediatrics, and ‖Pathology, Duke University Medical Center, Durham, NC.
authors.forename: Sidney M
authors.initials: SM
authors.lastname: Gospe
authors.forename: Bozho
authors.initials: B
authors.lastname: Todorich
authors.forename: Yevgeniya G
authors.initials: YG
authors.lastname: Foster
authors.forename: Gary
authors.initials: G
authors.lastname: Legault
authors.forename: Suzanne K
authors.initials: SK
authors.lastname: Woods
authors.forename: Alan D
authors.initials: AD
authors.lastname: Proia
authors.forename: Melissa
authors.initials: M
authors.lastname: Daluvoy
mesh_terms: D003320:Corneal Ulcer / Q000188:drug therapy; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000150:complications; D008875:Middle Aged; D016584:Panic Disorder / Q000150:complications*; D014802:Vitamin A Deficiency / Q000150:complications* / Q000209:etiology; D014985:Xerophthalmia / Q000209:etiology