Abstract
Purpose :
Vitamin A is a micro-nutrient critical to retinal functioning. We report a rare case of night blindness secondary to poor vitamin A metabolism due to severe liver cirrhosis. The purpose of presenting this case is to highlight that even though vitamin A deficiency is very uncommon in developed nations, it should be considered as an etiology of nyctalopia in patients with liver diseases.
Methods :
A 62-year-old Caucasian female presented with loss of vision in dim and dark lighting that had gotten progressively worse over the past 8 months. She was asymptomatic in daylight, but almost blind in the dark to the extent that she was unable to navigate and thus afraid to go outside at night. There was no personal or family history of night blindness or retinal disorders. Her ocular health was unremarkable with dilation. Her visual fields were full under bright illumination, but after dark adaptation, there were dense peripheral defects encroaching central fixation in both eyes. The patient had a medical history of stage 4 non-alcoholic liver cirrhosis, which led to a malabsorption of vitamin A, as confirmed by the very low vitamin A level in the serum analysis.
Results :
Patient’s primary care physician and endocrinologist were notified of the findings, and vitamin A repletion therapy was implemented to prevent further vision loss. Repeated vitamin A level testings, in addition to visual fields after dark adaptation, were performed periodically to monitor for the resolution of the condition. Subjective improvement in symptoms, along with better performance on visual field, were noted after initiating oral vitamin A supplementation for 6 months.
Conclusions :
This case report emphasizes the rare possibility of nyctalopia secondary to severe liver cirrhosis-induced vitamin A deficiency. Due to the presence of abundant storage of vitamin A in the liver, symptoms of vitamin A deficiency, such as nyctalopia, likely do not occur till late stage of liver disease. In the literature, cases of vitamin A deficiency have been reported in patients with a history of gastric and intestinal surgery; to our knowledge, this is the first case of nyctalopia reported in a patient with liver cirrhosis that improved after supplementation with exogenous vitamin A. Although vitamin A deficiency is an extremely rare disorder in the United States, it should be suspected in patients with severe liver disease experiencing a loss of night vision.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.