# Vitamin A deficiency - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: Vitamin A Deficiency - StatPearls (NCBI Bookshelf NBK567744) - https://www.ncbi.nlm.nih.gov/books/NBK567744/ · Vitamin A deficiency - disease-level clinical article (vitamin-a-deficiency-full.txt) · Vitamin A deficiency - disease-level clinical article (vitamin-a-deficiency-clinical.txt) - Verified date: 2026-08 ## Verified against - Vitamin A Deficiency - StatPearls (NCBI Bookshelf NBK567744) - https://www.ncbi.nlm.nih.gov/books/NBK567744/ - Vitamin A deficiency - disease-level clinical article (vitamin-a-deficiency-full.txt) - Vitamin A deficiency - disease-level clinical article (vitamin-a-deficiency-clinical.txt) ## Treatment metadata - Recognise the eye signs, then treat - the corneal stage blinds - Vitamin A — oral.solid ## Complete treatment card ```text VITAMIN A DEFICIENCY Sources: Vitamin A Deficiency - StatPearls (NCBI Bookshelf NBK567744) - https://www.ncbi.nlm.nih.gov/books/NBK567744/ · Vitamin A deficiency - disease-level clinical article (vitamin-a-deficiency-full.txt) · Vitamin A deficiency - disease-level clinical article (vitamin-a-deficiency-clinical.txt) Review status: REVIEWED against 3 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (3) - Difficulty seeing in dim light develops gradually as the deficiency progresses - Increasingly frequent gut, lung, and urinary infections - Dry, thickened skin with rough follicular bumps on the shoulders, buttocks, and extensor surfaces SIGNS - what you find (3) - Small foamy, triangular or oval patches on the conjunctiva (Bitot spots) with conjunctival wrinkling - Advanced disease shows corneal drying and ulceration, healing into scarring that causes blindness [loss of vision · scarring] - With measles, corneal drying and ulceration can appear even without prior night blindness or Bitot spots TESTS (4) - Xerophthalmia on exam is nearly diagnostic by itself - Serum retinol below 20 micrograms/dL confirms deficiency when the picture is unclear - Serum retinol can look normal even when the body's actual stores are low - Liver retinol measured on biopsy is the most accurate test but is reserved for research use IF NOT THIS - what else fits (4) - Retinitis pigmentosa and other retinal dystrophies also cause night blindness as an early symptom - Cataracts and myopia can likewise present with poor night vision - Niacin deficiency can also produce Bitot spots - Pinguecula and pterygium can resemble Bitot spots Source Vitamin A deficiency - disease-level clinical article (vitamin-a-deficiency-full.txt) Status traced to the source above 1. RECOGNISE THE EYE SIGNS, THEN TREAT - THE CORNEAL STAGE BLINDS[1st line] Adult Source Vitamin A Deficiency - StatPearls (NCBI Bookshelf NBK567744) - https://www.ncbi.nlm.nih.gov/books/NBK567744/ Why The early signs are reversible and the late ones are not, which is the whole argument for treating on the clinical picture rather than waiting for a blood level. The dose row below carries the WHO regimen; what follows here is what to look for and who to treat. Caution THE EYE SIGN IS THE DIAGNOSIS - xerophthalmia points to vitamin A deficiency and to almost nothing else. The blood test is for the case that is not clear: order a serum retinol where the history and examination leave doubt, and read anything under 20 micrograms/dL as deficient. A NORMAL BLOOD LEVEL DOES NOT CLEAR IT - the serum retinol can read normal while the body's stores are already low, because the liver keeps the circulating level up. Do not use a normal retinol to overrule Bitot spots. WHICH EYE SIGNS COME BACK AND WHICH DO NOT - the early ones - night blindness, a dry conjunctiva, Bitot spots - clear entirely on supplementation, generally inside 2 months. Once the cornea dries and ulcerates it scars, and the sight can be lost for good even with treatment. Everything before the cornea is reversible; that is the window. THE MORTALITY, WHICH IS THE REAL REASON TO TREAT - a child with night blindness dies at three times the rate of a child whose deficiency is subclinical. With Bitot spots and night blindness together the rate is nine times that. And of children with keratomalacia, close to two-thirds are dead within months. These children do not mostly die of their eyes: once the eye signs appear, the child has become far easier to infect. WHAT ELSE CAUSES NIGHT BLINDNESS AND WHITE CONJUNCTIVAL PATCHES - losing night vision is the first thing retinitis pigmentosa does, and some rare retinal dystrophies do the same. Cataract and myopia are degenerative eye diseases that can present that way too. As for the spots: niacin deficiency also goes with Bitot spots, and a pinguecula or a pterygium can be mistaken for one. TREAT THE ZINC AT THE SAME TIME - a child who is short of zinc responds poorly to vitamin A, and should have zinc given alongside it. A child who does not respond to vitamin A may be zinc-deficient rather than mis-diagnosed. IF THE GUT IS THE PROBLEM, THE MOUTH IS THE WRONG ROUTE - where the deficiency comes of malabsorption, think about giving the vitamin A intramuscularly instead. Coeliac disease, cystic fibrosis and chronic giardiasis all belong in the history. WHO DOES NOT NEED IT - above 30 micrograms/dL there is nothing to be gained from supplementing, and the recommended dietary allowance is what such a patient should follow. For a well-nourished child, a varied diet rich in nutrients keeps vitamin A deficiency away, so long as the child is generally well and absorbing food. THE LONG-TERM ANSWER IS FOOD, NOT CAPSULES - more programmes are turning to what causes the deficiency in the first place, fortifying food and teaching families, rather than handing out supplements alone. 2. VITAMIN A [1st line] Adult Children with xerophthalmia, by age band: under 6 months 50,000 IU; 6 to 12 months 100,000 IU; over 12 months 200,000 IU. Give that amount once daily for 2 days, then one further dose after 2 weeks. Severe measles: the same age-band amount once daily for 2 days, whether or not deficiency is known. Pregnancy: 10,000 IU daily or 25,000 IU weekly for 12 weeks - never the high single doses. - Two days, then a single repeat dose at 2 weeks Peds THIS DOSE IS BY AGE BAND IN INTERNATIONAL UNITS, NOT BY WEIGHT. The weight-based fields are deliberately empty: there is no mg/kg figure to calculate, and putting international units into a milligram field would misread on any calculator. Read the age bands in the dose line above and check the strength on the capsule in hand - Egyptian preparations differ and the arithmetic must be done from the label, not assumed. Source Vitamin A Deficiency - StatPearls (NCBI Bookshelf NBK567744) - https://www.ncbi.nlm.nih.gov/books/NBK567744/ Why Indication: the treatment for vitamin A deficiency is vitamin A supplementation, and the article records that it makes a definitive clinical difference once the serum retinol is under 20 micrograms/dL. Amount: for xerophthalmia the WHO's schedule is 50,000 IU in an infant under 6 months, 100,000 IU from 6 to 12 months, and 200,000 IU above 12 months, each given daily for 2 days with one further dose 2 weeks later. Caution PREGNANCY IS THE DANGEROUS ONE - a pregnant woman at risk is supplemented at a lower dose, for fear of harming the fetus: 10,000 IU a day, or 25,000 IU once a week, over 12 weeks. A 200,000 IU capsule given to a pregnant woman is a teratogenic dose. Ask before giving it to any girl or woman who could be pregnant. GIVE IT IN MEASLES WITHOUT WAITING TO PROVE DEFICIENCY - in severe measles WHO advises the dose above, once a day for 2 days, whether or not the patient is known to be short of vitamin A. This is one of the highest-value things here in a country where measles still circulates - see the measles entry. THE POPULATION PROGRAMME DOSE IS A DIFFERENT THING FROM THE TREATMENT DOSE - where deficiency is widespread, the World Health Organization (WHO) advises supplementing whole selected populations: a single 100,000 IU dose between 6 and 11 months of age, then 200,000 international units (IU) at intervals of 4 to 6 months until the child turns 5 years. Do not add a treatment course on top of a campaign dose given weeks earlier without checking. AND SOME GROUPS ARE NO LONGER INCLUDED - WHO has dropped its advice to supplement every infant below 6 months of age, and every woman after childbirth. The under-6-month figure in the dose line is a treatment dose for established xerophthalmia, not a routine one. NO DOSE IS PRINTED FOR THE ASYMPTOMATIC CHILD, BECAUSE NONE IS AGREED - the international guidelines do not set out any dose for vitamin A deficiency without symptoms in a well-resourced country; the dose is instead pitched to how severe the deficiency is, and left to the prescriber's judgement. Treat eye signs, measles, and a proven low retinol; do not hand out high-dose capsules for vague symptoms. PREMATURE AND VERY LOW BIRTHWEIGHT BABIES ARE A RESEARCH QUESTION, NOT A ROUTINE - for the premature infant there are as yet no guidelines on supplementing at all. The figures the article quotes from recent studies are neonatal-unit protocols, not primary-care doses, and they are not offered as a regimen here. EXPECT A RESPONSE WITHIN A WEEK - treated at any degree of severity, improvement can show inside a week. Treat a subclinical deficiency promptly and the outlook is very good, with nothing left behind. A child who does not improve needs the diagnosis revisited rather than a bigger dose. Egypt A-VITON 50.000 I.U. 20 CAPS. KAHIRA 5.00 EGP (0.25/unit) VITAMIN A 10 000 IU 100 SOFTGELS (ILLEGAL IMPORT) PURITANS PRIDE 63.00 EGP Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)