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Corneal perforation due to vitamin A deficiency in a patient with short bowel syndrome
  1. Hannah Fieldhouse1,
  2. Achim Nestel2,
  3. Byron Theron3 and
  4. Nathaniel Knox Cartwright4
  1. 1 Ophthalmology, Musgrove Park Hospital, Taunton, UK
  2. 2 Ophthalmology, North Devon District Hospital, Barnstaple, UK
  3. 3 Gastroenterology, North Devon District Hospital, Barnstaple, UK
  4. 4 Ophthalmology, Royal Devon and Exeter Hospital, Exeter, UK
  1. Correspondence to Dr Hannah Fieldhouse; hkefieldhouse{at}


A 55-year-old Caucasian woman presented with a 1-week history of left eye redness and blurred vision. Her medical history included previous small bowel resection and ileostomy for ischaemic bowel. Ophthalmic examination revealed a left corneal ulcer requiring hospital admission for intensive topical antibiotics. Overnight she became systemically unwell and was diagnosed with urinary tract infection requiring intravenous antibiotics. Her corneal condition deteriorated resulting in corneal perforation, which required a surgical gluing procedure. Despite surgery, the cornea perforated on two further occasions. At this stage, vitamin A deficiency (VAD) was suspected, due to the corneal melting response that was occurring. VAD was subsequently confirmed by serology and had occurred in this case due to malabsorption as a result of short bowel syndrome caused by previous small bowel surgery. The patient was treated with intramuscular vitamin A and eventually made a good visual and systemic recovery.

  • anterior chamber
  • small intestine
  • vitamins and supplements
  • ophthalmology

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  • Contributors AN and NKC conceived the idea to write up the case report. HF reviewed the patient data and performed the literature review. HF drafted the manuscript. HF, AN, NKC and BT all performed critical revision of the manuscript. HF, AN and NKC all contributed to the ophthalmology perspective. BT provided the gastroenterology perspective. HF, AN, NKC and BT all approve the final version of the manuscript to be published. All persons who meet authorship criteria are listed as authors, and all authors certify that they have participated sufficiently in the work to take public responsibility for the content, including participation in the concept, design, analysis, writing or revision of the manuscript. All the four authors satisfy the following four International Committee of Medical Journal Editors criteria: Substantial contributions to the conception or design of the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published; and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer-reviewed.