One of the most remarkable features in many cases of vitamin A deficiency in adults seen in the Orient is a peculiar brownish pigmentation of the conjunctiva.1 The pigmentation is most marked in the conjunctiva of the lower fornix or of the inner canthus, i. e., the plica, where sometimes a deep brown color, similar to an intensive artificial argyrosis, may be seen. From the lower fornix the pigment extends to the joining lid and bulbar conjunctiva of the lower half of the conjunctival sac. The conjunctiva of the upper fornix and the upper lid may not become involved, and, even if they do, the pigmentation is always less than in the corresponding areas of the lower half of the conjunctival sac. Special mention should be made of the "circular fold," the continuation of the plica semilunaris between the fornix and the bulbar conjunctiva. This
PILLAT A. PRODUCTION OF PIGMENT IN THE CONJUNCTIVA: IN NIGHT BLINDNESS, PREXEROSIS, XEROSIS AND KERATOMALACIA OF ADULTS. Arch Ophthalmol. 1933;9(1):25–47. doi:10.1001/archopht.1933.00830010028003
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