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Ophtalmology

Ocular problems and bariatric surgery

Objectives

- To report a case of severe hypovitaminosis A, responsible for bilateral blindness, which occurred 10 years after a bilio-pancreatic bypass.

- To recall the necessity of an early vitamin supplementation to obtain a remission of visual manifestations.

Method

Case report, review of the literature

Results

A 36-year-old man, who was followed-up and treated for keratoconus, was referred to our unit due to a progressive bilateral visual loss. The medical history revealed a gastric bypass surgery 10 years earlier, which had been followed by a biliopancreatic bypass.

Ophthalmological examination revealed bilateral blindness and severe dry eyes. The fundus was only visible at the right eye. On fundoscopy, the optic nerve was pale, and the retina showed diffuse pigmentary changes. There was a lack of response on the electroretinogram. Biological analysis revealed undetectable vitamin A levels, along with low levels of Cu, Zn, 25OHvitamin D, and vitamin E. The diagnosis of retinopathy and optic neuropathy due to nutritional deficiencies was made. Following treatment with vitamin supplementation, vision improved, yet in the right eye only.

Conclusions

Vitamin A deficiency associated with irreversible blindness is a clinical picture that is only rarely encountered in industrialized countries. Digestive malabsorption, especially if induced by bariatric surgery with biliopancreatic diversion, is a common cause. Recognition of the early symptoms, including xerophthalmia and night blindness, is essential to enable curative treatment to be initiated.

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