From the Guidelines
Bitot's spots are a clinical sign of vitamin A deficiency, characterized by grey/white, foamy appearance on the conjunctiva, and are typically seen in individuals with inadequate dietary intake of vitamin A, particularly in malnourished children in developing countries. These spots consist of keratinized epithelial cells and debris that accumulate on the conjunctival surface, resulting from the replacement of normal mucus-secreting cells by keratin-producing cells due to vitamin A deficiency 1. The condition is part of the spectrum of xerophthalmia, which includes night blindness, Bitot's spots, and keratomalacia, and can lead to severe consequences such as blindness if left untreated 1. Key factors that contribute to vitamin A deficiency include malnutrition, liver disease, chronic alcohol consumption, liver transplantation, chronic kidney disease, short bowel syndrome, and obesity 1. Treatment of Bitot's spots involves vitamin A supplementation, which can reverse the condition if administered before permanent damage occurs, with a recommended dose of 200,000 IU for adults, adjusted for children based on age, given immediately upon diagnosis, followed by a second dose the next day and a third dose 2-4 weeks later. It is essential to address the underlying cause of vitamin A deficiency and ensure adequate ongoing dietary intake to prevent recurrence 1. In cases of severe deficiency, monitoring of serum retinol levels and periodic supplementation may be necessary, particularly in individuals with conditions that increase the risk of vitamin A deficiency, such as liver disease or chronic kidney disease 1. Overall, prompt recognition and treatment of Bitot's spots are crucial to prevent long-term consequences and improve outcomes in individuals with vitamin A deficiency.
From the Research
Definition of Bitot's Spot
- Bitot's spots (BS) are defined as the buildup of superficially located keratin in the conjunctiva and are early indicators of vitamin A deficiency (VAD) 2.
- They are characterized as white foamy triangular or round-shaped spots with the base located at the temporal limbus and the apex towards the lateral canthus 3.
Causes of Bitot's Spot
- The primary cause of Bitot's spots is vitamin A deficiency (VAD), primarily due to malnutrition and malabsorption, leading to xerophthalmia 2.
- Other factors associated with Bitot's spots include congenital aniridia, dry-eye syndrome, post-thermal or chemical injury, and the usage of benzalkonium chloride (BAK) eyedrops 3.
- Vitamin D deficiency and allergies, such as birch and Phleum genus pollen allergy, may also contribute to the development of Bitot-like spots 3.
Treatment and Response
- Vitamin A supplementation is effective in healing Bitot's spots, with either a 100,000-IU or 200,000-IU dose being similarly effective 4.
- The response to treatment is influenced by baseline serum retinol concentration, with children having lower pretreatment concentrations being more likely to have responsive lesions 4.
- Mega-dose vitamin A supplementation (MVAS) has been shown to resolve Bitot's spots in children between 1 and 5 years of age, with a significant proportion of children being cured at 6 months and 1 year of follow-up 5.