Differential Diagnosis of Corneal Manifestations in Hypovitaminosis and Retinitis Pigmentosa

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

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