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  • Title: Night blindness, yellow vision, and yellow skin: symptoms and signs of malabsorption.
    Author: Pitchon E, Sahli O, Borruat FX.
    Journal: Klin Monbl Augenheilkd; 2006 May; 223(5):443-6. PubMed ID: 16705527.
    Abstract:
    BACKGROUND: Rapidly progressing bilateral night blindness in an elderly patient suggests primarily a diagnosis of paraneoplastic retinopathy. Occasionally diffuse rod dysfunction can result from vitamin A deficiency. HISTORY AND SIGNS: A 70-year-old man complained of progressive night blindness and xanthopsia for the past 6 months. Visual acuity was 0.8 in both eyes with severe dyschromatopsia. Slit-lamp and fundus examination were normal. Visual field disclosed bilateral depression. Scotopic full-field ERG was severely reduced. The patient's medical history revealed an acute pancreatitis one year ago, followed by chronic jaundice and an increased blood bilirubin. Serum vitamin A level was decreased to 0.1 micromol/L (normal range 1.5 to 4.0). THERAPY AND OUTCOME: Intramuscular injections of vitamin A were provided. Subjective visual improvement was reported already one day after initiation of therapy. Scotopic full-field ERG was markedly improved 3 days after the injection and was only slightly subnormal 3 months later. CONCLUSIONS: In developed countries, vitamin A deficiency usually results from malabsorption syndromes and manifests initially by rod more than cone dysfunction. This diagnosis should be entertained early as vitamin A supplementation induces a rapid restoration of vision.
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