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Rosalind C. Vo, John C. Affeldt; Transdermal Vitamin A: a novel treatment for xerophthalmia?. Invest. Ophthalmol. Vis. Sci. 2012;53(14):2349.
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© ARVO (1962-2015); The Authors (2016-present)
To describe for the first time the use of transdermal vitamin A for the treatment of xerophthalmia.
Interventional case report.
Results: A 55-year old Caucasian female with malabsorption syndrome and an associated vitamin A deficiency presented with severe xerophthalmia manifested by large culture-negative central corneal epithelial defects OU. Both corneal as well as conjunctival epithelium stained heavily with fluorescein and lissamine green. Schirmer’s with anesthesia measured 11mm OD and 10mm OS. Serum retinol measured 25.7 mcg/dL (normal 32.5-78.0 mcg/dL). The patient remained clinically unresponsive to aggressive topical lubrication, bandage contact lenses, and cautery occlusion of all 4 puncta, as well as supplemental oral vitamin A (100,000 units PO/day). Efforts to provide intramuscular vitamin A (Aquasol A®) failed secondary to a national supply and manufacture shortage. An alternative approach was then devised through consultation with Leiters Pharmacy (San Jose, CA) consisting of a compounded cream-based Vitamin A formulation (100,000 units/mL) applied topically to the forearms BID. Within a few days, the patient’s signs and symptoms improved dramatically in association with normalized serum retinol levels (34.5mcg/dL, 33.3mcg/dL). At this point, the patient was unfortunately lost to follow-up.
Transdermal vitamin A may represent a novel clinically attractive and "patient friendly" therapeutic alternative for treatment of xerophthalmia, particularly in the setting of unavailable IM Aquasol A®.
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