Vitamin A deficiency due to malabsorption after intestinal surgery should be suspected in patients with unexplained vision loss, based on data from several cases seen in one neuro-ophthalmic practice between January and December 2005.
Dr. Teresa Chae and Dr. Rod Foroozan of Baylor College of Medicine in Houston described three cases where past intestinal surgery was linked to vision loss. All surgeries took place more than 18 years before onset of symptoms. The patients were older than 65 years, and their vitamin A deficiencies were confirmed with blood tests (Br. J. Ophthalmol. 2006;90:955–6).
Patient 1, a 69-year-old man, presented with a 4-month history of night blindness. He had undergone intestinal bypass sur-gery 20 years earlier, and had a history of childhood hepatitis. Patient 2, an 80-year-old man, reported 4 months of decreased vision in one eye that worsened at night. His history included Crohn's disease and a partial small- and large-bowel resection for a ruptured ileum at age 44 years.
Patient 3, a 79-year-old woman, reported several months of decreased vision, and her history included cholecystectomy with subsequent surgeries to manage complications. Her surgeries occurred 18–20 years before her vision problems began.
Patients 1 and 2 were treated successfully with vitamin A therapy (200,000 IU per day), administered by intramuscular injection. Patient 3 declined vitamin A therapy and had no additional follow-up care.