# Differential Diagnosis of Corneal Manifestations in Hypovitaminosis and Retinitis Pigmentosa

## TL;DR

A 62-year-old woman with retinitis pigmentosa and vitamin deficiencies experienced corneal issues, which improved after surgery and vitamin therapy.

## Contribution

The case emphasizes the need for integrative diagnosis in complex ocular conditions involving multiple factors.

## Key findings

- The patient showed significant functional recovery after tectonic keratoplasty and vitamin supplementation.
- Hypovitaminoses A, D, D3, and E were identified as contributing factors to corneal involvement.
- Comprehensive history and targeted lab tests were crucial for accurate diagnosis and treatment.

## Abstract

To report on the diagnostic and therapeutic approach in a patient with retinitis pigmentosa (RP), hypovitaminoses, and bilateral corneal involvement.

A 62-year-old woman, diagnosed with RP, presented with photophobia, sudden bilateral visual decline, and known long-term night blindness. Ophthalmic examination showed corneal perforation in the right eye, corneal ulcer in the left eye, and bilateral corneal hypoesthesia. She had undergone bariatric surgery and recently suspended vitamin supplementation. Blood tests revealed hypovitaminoses A, D, D3, and E. The patient underwent tectonic keratoplasty in the right eye and received topical therapy in the left eye, and then restarted vitamin supplementation as recommended by the nutritionist. Significant functional recovery was documented in both eyes at 1-, 3-, and 10-month follow-ups.

The case highlights the importance of an integrative approach that includes comprehensive history taking, targeted laboratory work-up, as well as accurate differential diagnosis, especially given the potential multifactorality of ocular symptoms and signs.