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Br J Ophthalmol 2005;89:1531-1532 doi:10.1136/bjo.2005.074195
  • Letter

Total parenteral nutrition, vitamin E, and reversible macular dysfunction morphologically mimicking age related macular degeneration

  1. L Porter1,
  2. N Reynolds2,
  3. J D Ellis3
  1. 1Dundee Medical School, Dundee, UK
  2. 2Department of Medicine, Dundee Medical School, Dundee, UK
  3. 3Department of Ophthalmology Ninewells Hospital and Medical School, Ninewells Road, Dundee DD1 9SY, UK
  1. Correspondence to: Dr John Ellis Department of Ophthalmology, Ninewells, Dundee DD1 9SY, UK; john.ellistuht.scot.nhs.uk
  • Accepted 23 May 2005

A variety of nutrient deficiencies may predispose to the development of age related macular degeneration (AMD).1 Patients receiving parenteral nutrition (TPN) may be at particular risk of early onset AMD, because of inadequate or excess nutritional supplementation.1 Studies including the Eye Disease Case-Control Study and Beaver Dam Eye Study have evaluated the relation between antioxidant and micronutrient levels, and the risk of AMD.2–4 A protective effect of high plasma vitamin E levels was convincingly demonstrated.5

We describe a patient treated with parenteral fluid support who developed visual symptoms and signs of AMD, in conjunction with longstanding vitamin E deficiency. Isolated cases of visual disturbance in patients undergoing TPN have been reported in the literature6,7; however, to our knowledge, no case of visual disturbance attributed to vitamin E deficiency has been …

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