DEFICIENCY

MANIFESTATIONS ,
HYPERVITAMINOSIS
AND THERAPEUTIC
USE OF VITAMIN -A
 OBJECTIVE

DEFICIENCY MANIFESTATIONS

HYPERVITAMINOSIS

THERAPEUTIC USES OF VITAMIN -

A
DEFICIENCY MANIFESTATIONS
1. BITOT’S SPOT
2. PHOTOTRANSDUCTION DISORDERS
3. PREVENTABLE BLINDNESS
4. XEROPTHLMIA
5. KERATOMALACIA
6. KERATOMALACIA
7.NIGHT BLINDNESS OR
NYCTALOPIA
1. BITOT’S SPOT
These are the buildup of keratin located superficially
in the conjunctiva, which are oval, triangular or
irregular in shape . These spots are a sign of vitamin A
deficiency and are associated with conjunctival xerosis .
In 1863;Pierre Bitot (1822-1888), a French physician,
first described these spots.
◦Exposure:
Bitot's spots are generally worse in areas
of the eye not covered by the eyelids
when exposed to the elements (ultraviolet
light, wind, smoke and dust). In some
cases, Bitot's spots may appear after
prolonged exposure to the elements, even
in patients who do not have VAD.
CAUSES;
Major cause of Bitot's spot is vitamin A
deficiency (VAD).Rarely, pellagra due to
deficiency of vitamin B3 (niacin) may also
cause Bitot's spots. It can also be caused by
cholestyramine, which is a bile acid
sequestrant which can reduce the
absorption of fat soluble vitamins
(Vitamins A, D, E, K)
2.PHOTOTRANSDUCTION
DISORDERS

◦ PHOTOTRANSDUCTIO
N:Process by which photon
of light is changed to
electrical signal.Occurs in
photoreceptors present
in retina of eye.
TYPES OF PHOTOTRANSDUCTION
DISORDERS:
a. BRADYOPSIA
b. RETINITIS PIGMENTOSA
c. EXTRA OCULAR SIGNGROWTH
RETARDATION
a.BRADYOPSIA
Occurs due to mutation in TRANSDUCTION ACTIVATING
PROTEIN leading to defective vision with changes in light
intensity.
Inability to rapidly shut off the phototransduction cascade
following the stimulation of photoreceptors by photon of light.
Trouble in adjusting to change in light intensity and conditions.
There is temporary blindness when first exposed to bright light.
b.RETINITIS
PIGMENTOSA
◦ Mutation in gene for RHODOPSIN (light sensitive protein in retina of eye)
◦ Progressive loss of vision
◦ The number of functional cones and rods decrease due to degenerative
changes and leads to blindness.
◦ Inherited condition:
•autosomal dominant-10-15%
•autosomal recessive-20%
•X Linked-10%
◦ Seen in 1:4000 individuals
◦ As retinitis pigmentosa progresses, peripheral vision is severely
diminished yet the central vision remains relatively unaffected.The central
vision is too affected in severe conditions.
c. EXTRA OCULAR SIGN
GROWTH RETARDATION
◦Due to deficiency of Vitamin A
◦Mainly skeletal muscle growth is retarded
◦Due to defective synthesis of
CHRONDOITIN SULFATE
3.PREVENTABLE BLINDNESS
◦ The deficiency of vitamin A is the most common cause of
blindness in Indian children below the age of 5.
◦ One-third of the world's blind populations are residing in
India.
◦ About 40%of blindness is preventable. Vitamin A deficiency
is a major public health problem.
◦ A single dose of vitamin A is given, as a prophylactic
measure, to children below 1 year age.
4.XEROPTHALMIA
 Xero -> dry ; ophthalmia -> eye*
It is abnormal dryness of the conjunctiva and cornea of the
eye, with inflammation and ridge formation, typically
associated with vitamin A deficiency
It is reserved to cover all the ocular manifestations of vitamin A
deficiency, including structural changes affecting the
conjunctiva, cornea and occasionally retina and the biophysical
disorders of retinal rods and cones
6. Keratomalacia
When the xerophthalmia persists for a long time, it progresses to
keratomalacia (softening of the cornea).
There is degeneration of corneal epithelium which may get
vascularized. Later, corneal opacities develop. Bacterial infection
leads to corneal ulceration, perforation of cornea and total blindness.
Keratomalacia is a severe eye condition characterized by the
softening and degeneration of the cornea, the transparent front part
of the eye.
This disorder is primarily caused by a deficiency in vitamin A, an
essential nutrient for maintaining eye health.
In regions with malnutrition or inadequate dietary intake of
vitamin A, keratomalacia may develop.
Symptoms include night blindness, dryness, and ulceration of
the cornea, leading to visual impairment or blindness if left
untreated.
Prevention involves addressing vitamin A deficiency through
dietary changes or supplements.
Early detection and intervention are crucial in managing
keratomalacia and preserving vision.
Regular eye examinations and proper nutrition are key
components of preventive measures.
7.Night blindness or nyctalopia
Bright light depletes stores of rhodopsin in rods therefore when
a person shifts suddenly from bright light to dimly lit area there
is difficulty in seeing (for example entering into cinema
theatre). After a few minutes rhodopsin is resynthesized and
vision is improved. This is called DARK ADAPTATION TIME.
In VITAMIN A deficiency this dark adaptation time is
increased.So visual acuity is diminished in dim light .
The patient cannot read or drive a car in poor light
8.Acne
◦ It is the most common disease of the skin .It affects 85% of
teenagers, and 50% persons between the ages of 20 and 30 years.
The role of hormones, particularly as a trigger of sebum production
and sebaceous growth and differentiation, is well known.
◦ Excessive androgens, GH, IGF-1, CRH and glucocorticoids, are
associated with the acne. Acne may be a feature in many endocrine
disorders, including polycystic ovary disease, Cushing syndrome,
CAH, androgen secreting tumors and acromegaly.
HYPERVITAMINOSI
S
◦ Excessive intake can lead to toxicity since the vitamin is stored.It has
been reported in children where parents have been overzealous in
supplementing the vitamins.
◦ Eskimos refrain from eating the liver of polar bear due to its high
vitamin A content. Symptoms of toxicity include anorexia,
irritability, headache, drowsiness and vomiting. Some of these signs
are due to increased intracranial tension. Sometimes swelling over
long bones (bony exostosis) may occur with painful bones.
◦ Enlargement of liver is also seen in children. Higher concentration
of retinol increases lysosomal enzymes, leading to cellular death.
◦ Hypercarotenemia can result from persistent excessive consumption
of foods rich in carotenoids. The skin becomes yellow, but no
staining of sclera as in jaundice is observed.
THERAPEUTIC USES
OF VITAMIN –A
THERAPEUTIC
USES OF VIT-A:

 As Supplements in Its deficiency disorders

◦* Mode of supplementation: capsules or
injection
◦ * Therapeutic dose: 20–50 times the RDA
 Retinoic acid has a role in the regulation growth
(mainly in epithelium) differentiation of
tissues.
 All-trans-retinoic acid is used as adjuvant in
the treatment of promyelocytic leukaemia.
 All-trans retinoic acid and 9-cis-retinoic acid act like steroid
hormones.
 Alteration Of gene expression along with Nuclear Receptors
[Retinoic acid receptors (RAR)]
 Vitamin A and its derivatives may be used in treating skin
disorders (inflammatory skin disorders like psoriasis) and eye
diseases.
 Others: Measles Treatment, Cancer Prevention
By :-
1. Pugazharasi
2. Rahul Vikram Anand
3. Sadhana
4. Samreet
5. Samyuktha
6. Sangamithra
7. Sanjana
8. Saranya
9. Saravanakumar