Abstract
Background/aims
A Bitot spot is a conjunctival lesion, classically associated with severe vitamin A deficiency. In this paediatric series, we describe conjunctival lesions indistinguishable from Bitot spots, seen in the presence of normal vitamin A levels.
Methods
This descriptive case series was performed by retrospective review of case notes, including all patients with Bitot-like spots found to have normal serum vitamin A levels, seen at the Hospital for Sick Children, Toronto, between 2006 and 2016. Data collected included age at presentation, ophthalmic and systemic diagnoses, and the presence of recognised genetic mutations. Histopathology was reviewed in one case.
Results
Ten patients with Bitot-like spots with laboratory-confirmed normal serum vitamin A levels were identified. The conjunctival lesions were indistinguishable clinically and histopathologically from classic Bitot spots and were noted to occur in a range of anterior segment pathologies, including aniridia, WAGR syndrome, Axenfeld–Rieger syndrome, and blepharokeratoconjunctivitis.
Conclusions
Bitot-like spots are found in children with a number of anterior segment pathologies in the absence of vitamin A deficiency.
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Acknowledgements
Many thanks to Cynthia VandenHoven and Leslie MacKeen for photo collation and editing.
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AM collected data and wrote and revised the paper. DR wrote an early draft of the paper. MSK and AS collected data. L-NH reported histopathological findings. MDR edited the paper. NN-T contributed patients to the study. AA conceived the idea of the study, contributed patients, collected data, and oversaw writing and editing of the paper.
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Maudgil, A., Rachdan, D., Khan, M.S. et al. Bitot-like spots in children with normal vitamin A levels. Eye 36, 1896–1899 (2022). https://doi.org/10.1038/s41433-021-01569-z
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DOI: https://doi.org/10.1038/s41433-021-01569-z
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