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November 1981

Bitot's Spots Responsive and Nonresponsive to Vitamin A: Clinicopathologic Correlations

Author Affiliations

From the International Center for Epidemiologic and Preventive Ophthalmology, and the Eye Pathology Laboratory, Wilmer Institute, The Johns Hopkins Medical Institutions, Baltimore (Drs Sommer and Green); Helen Keller International, New York, and the Nutritional Blindness Prevention Program, Bandung, Indonesia (Dr Sommer); and the Department of Ophthalmology, Harvard Medical School, the Cornea Service, Massachusetts Eye and Ear Infirmary, and the Cornea Research Department and Morphology Unit, Eye Research Institute of Retina Foundation, Boston (Dr Kenyon).

Arch Ophthalmol. 1981;99(11):2014-2027. doi:10.1001/archopht.1981.03930020890016

• Conjunctival biopsy specimens from patients with Bitot's spots responsive and nonresponsive to vitamin A were studied by light and electron microscopy. In both types, the lesions demonstrated keratinization with granular cells, irregular maturation, inflammatory infiltration of the conjunctival substantia propria, and loss of goblet cells. Only in the responsive cases were these changes generalized. Prominent Bitot's spots represented massive accumulations of Gram-positive bacilli and keratin debris. Responsive cases improved histologically within seven days of treatment, and goblet cells began to return within two weeks. These results support our previous suggestions that there is little basis for attempting to differentiate, clinically, between the two types of lesions and that at least some nonresponsive lesions represent a persistent metaplastic change induced during a prior episode of vitamin A deficiency.

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