Xerophthalmia as the Initial Finding in a Patient with Multiple Vitamin Deficiencies and Alcoholic Cirrhosis: a Case Report

Introduction Vitamin A deficiency is uncommon in developed countries but can be recognized clinically in patients who develop signs and symptoms of xerophthalmia. This case report presents a patient with signs and symptoms of xerophthalmia who was found to have multiple vitamin deficiencies due to alcoholic liver cirrhosis. Case Report A 53-year-old woman presented to the clinic with symptoms of severe dry eye. Conjunctival lesions consistent with Bitot spots were noted, prompting testing for serum levels of vitamin A and several other vitamins. The patient was ultimately found to have multiple vitamin deficiencies secondary to alcoholic liver cirrhosis. Supportive care and vitamin supplementation resolved the patient’s nutritional deficiencies and improved her ocular and systemic health. Conclusion Many diseases that cause vitamin A deficiency can also cause other vitamin deficiencies. Therefore, signs and symptoms of xerophthalmia should prompt testing for vitamin A in addition to several other vitamins, including vitamins B1, B12, and folate. Patients also need testing for ocular manifestations of these vitamin deficiencies, including oculomotor deficiencies and nutritional optic neuropathy. Timely diagnosis, testing, and intervention can help these patients obtain better health outcomes.