Question:
A patient presented with dryness in eye with a gritty sensation along with corneal softening. What is the most probable cause?
A patient presented with dryness in eye with a gritty sensation along with corneal softening. What is the most probable cause?
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Think about which fat-soluble vitamin is essential for maintaining conjunctival goblet cells and corneal epithelial integrity.
Updated On: Jun 23, 2026
- Vitamin A deficiency
- Riboflavin Deficiency
- Viral Keratitis
- Follicular conjunctivitis
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The Correct Option is A
Solution and Explanation
Step 1: Interpret the clinical features.
The patient has:
- Dryness of eye (xerophthalmia)
- Gritty sensation (due to dry, keratinized conjunctiva)
- Corneal softening (keratomalacia)
Together, these are hallmark features of Vitamin A deficiency.
Step 2: Explain the pathophysiology.
Vitamin A (retinol) is essential for maintaining normal epithelial differentiation. In its absence, mucus-secreting goblet cells of the conjunctiva undergo squamous metaplasia, reducing tear film production. This leads to:
- Xerophthalmia (dry eye) -- earliest sign
- Bitot's spots (foamy white plaques on conjunctiva)
- Corneal xerosis
- Keratomalacia (softening and ulceration of the cornea) -- most severe stage, can lead to blindness
Step 3: Exclude other options.
- Riboflavin (B2) deficiency causes photophobia, corneal vascularization, and angular stomatitis -- not xerophthalmia or keratomalacia.
- Viral Keratitis (e.g., Herpes simplex) presents with pain, photophobia, dendritic ulcer -- not dryness or corneal softening due to nutritional deficiency.
- Follicular conjunctivitis (e.g., Trachoma) presents with follicles on tarsal conjunctiva, not corneal softening from nutritional cause.
Conclusion: Vitamin A deficiency (xerophthalmia with keratomalacia).
The patient has:
- Dryness of eye (xerophthalmia)
- Gritty sensation (due to dry, keratinized conjunctiva)
- Corneal softening (keratomalacia)
Together, these are hallmark features of Vitamin A deficiency.
Step 2: Explain the pathophysiology.
Vitamin A (retinol) is essential for maintaining normal epithelial differentiation. In its absence, mucus-secreting goblet cells of the conjunctiva undergo squamous metaplasia, reducing tear film production. This leads to:
- Xerophthalmia (dry eye) -- earliest sign
- Bitot's spots (foamy white plaques on conjunctiva)
- Corneal xerosis
- Keratomalacia (softening and ulceration of the cornea) -- most severe stage, can lead to blindness
Step 3: Exclude other options.
- Riboflavin (B2) deficiency causes photophobia, corneal vascularization, and angular stomatitis -- not xerophthalmia or keratomalacia.
- Viral Keratitis (e.g., Herpes simplex) presents with pain, photophobia, dendritic ulcer -- not dryness or corneal softening due to nutritional deficiency.
- Follicular conjunctivitis (e.g., Trachoma) presents with follicles on tarsal conjunctiva, not corneal softening from nutritional cause.
Conclusion: Vitamin A deficiency (xerophthalmia with keratomalacia).
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