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Editor,—Vitamin A deficiency due to malnutrition is the leading cause of childhood blindness worldwide1 but is rarely seen in developed countries. Although case reports of xerophthalmia in developed countries have appeared in the general medical2 3 and ophthalmic literature,4 5the relative rarity of the condition can lead to delay in diagnosis with potentially serious consequences. We present a patient with short bowel syndrome whose grossly depleted vitamin A stores only came to light with the onset of severe ocular surface disease.
CASE REPORT
The patient, now 8 years old, was born after a normal pregnancy by breech delivery at 36 weeks. At age 1 day he developed abdominal distension with bile stained vomiting. At laparotomy multiple small bowel atresia were excised and a jejunostomy fashioned. This was closed 3 weeks later and replaced by a jejuno-jejunal anastomosis. The latter required two revisions (at 10 days and 2 months after the initial anastomosis) with excision of more bowel and division of adhesions. For the first few months he was fed only intravenously, this being very gradually replaced by oral feeding over the subsequent 4 months. Vitamin and mineral supplements were included in his diet up to age 2 years. He has always been of small …