■维生素A是一种脂溶性维生素,通过饮食获得。维生素A缺乏是发展中国家儿童由于摄入受损而可预防失明的主要原因(Phanachet等人。2018)。然而,在发达国家,吸收不良起着重要作用的情况并不常见。
■一名51岁的女性抱怨有异物感,疼痛,撕裂,视力波动,夜蛾,腹泻,多食和体重减轻。她有Roux-en-Y胃空肠旁路手术史,Lynch综合征和右半结肠切除术伴回结肠吻合术,她还提到了另一项未指明的肠切除术。在眼科检查中,双眼最佳矫正视力为20/30,眼压为11mmHg。前节段生物显微镜检查显示结膜干燥增厚,有皱纹,多个灰白色小,圆形,汇合,双眼眼睑结膜的泡沫状病变,与Bitot的斑点兼容,和浅表点状角膜炎。
■减肥手术的兴起,在发达国家,炎症性肠病和终末期肝病导致吸收不良综合征和营养缺乏病例增加。类维生素A对角膜和结膜上皮细胞分化至关重要,其缺乏与称为干眼症的广泛眼表表现有关。在这种情况下,胃旁路术和另一次未指明的肠切除术应引起吸收不良和营养缺乏的怀疑。在我们的病人身上,早期诊断,并在出现不可逆转的损害之前实施适当的治疗,然而,维生素A缺乏很容易被忽视。
■在患有干眼症的患者中,询问应包括胃肠道手术史,尤其是减肥手术已经成为一种流行的技术。这是,根据我们的知识,1例林奇综合征患者干眼症的首例报告。
UNASSIGNED: Vitamin A is a fat-soluble vitamin, obtained through diet. Vitamin A deficiency is the leading cause of preventable blindness in children in developing countries due to impaired intake (Phanachet et al. 2018). Nevertheless, it is uncommon in the developed world where malabsorption takes a prominent role.
UNASSIGNED: A fifty-one-year-old female presented complaining of foreign body sensation, pain, tearing, fluctuating visual acuity, nyctalopia, diarrhea, polyphagia and weight loss. She had history of Roux-en-Y gastro-jejunal bypass, Lynch syndrome and right hemicolectomy with ileo-colonic anastomosis, she also referred to an additional unspecified bowel resection. In the ophthalmologic examination, best corrected visual acuity was 20/30, intraocular pressure was 11 mmHg in both eyes. Anterior segment biomicroscopy revealed a dry and thickened conjunctiva with wrinkles, multiple grey-white small, round, confluent, foamy lesions in the interpalpebral conjunctiva of both eyes, compatible with Bitot\'s spots, and superficial punctate keratitis.
UNASSIGNED: The rise of bariatric surgery, inflammatory bowel disease and end stage liver disease has led to an increase in cases of malabsorption syndrome and nutrient deficiencies in the developed world. Retinoids are essential for corneal and conjunctival epithelial cells differentiation and its deficiency is associated with a wide spectrum of ocular surface manifestations known as xerophthalmia. In this case, a gastric bypass and another unspecified bowel resection should raise the suspicion of malabsorption and nutrient deficiencies. In our patient, the diagnosis was made early and appropriate treatment was implemented before irreversible damage arose, however, vitamin A deficiency can be easily overlooked.
UNASSIGNED: In patients with xerophthalmia, interrogation should include previous history of gastrointestinal surgery, especially since bariatric surgery has become a popular technique. This is, to our knowledge, the first case report of xerophthalmia in a patient with Lynch syndrome.