In Reply.
—Keratomalacia in the absence of conjunctival xerosis from sudden deterioration of vitamin A status was indeed reported by McLaren et al1 in 1966, as referenced in my article. Their report was certainly not the first. Similar cases were reported by Stephenson2 in 1910 and by Blegvad3 in 1924. Additional references are compiled elsewhere.4The two cases detailed in the 1976 report of Baum and Rao5 may represent the same phenomenon, but are too atypical for firm conclusions in this regard. His first patient had an initial serum vitamin A level of 43 μg/dL, well within the normal range.5,6 The second patient's condition continued to deteriorate long after vitamin A treatment was started and vitamin A levels were within normal limits.