Table 1.

Summary of Ocular Manifestations of Vitamin Deficiencies

Vitamin	Ocular Manifestations	Workup	Treatment
A	Conjunctival and corneal xerosis, Bitot spots, corneal ulceration and scarring, nyctalopia	Serum vitamin A/retinol levels	50,000–200 000 IU IM vitamin A x 1–3 doses based on age
B1	Wernicke’s encephalopathy (nystagmus, ophthalmoplegia, diplopia, papilledema)	Thiamine pyrophosphate levels	200 mg IV or oral thiamine TID until symptoms resolve followed by 10 mg daily maintenance
B2	Blurred vision, nyctalopia	Clinical diagnosis, can check urinary excretion rates of riboflavin	5–100 mg oral riboflavin supplementation daily
B9	Optic neuropathy, increased risk of age-related macular degeneration and retinoblastoma	Serum folate (also check B12)	1–5 mg oral folic acid supplementation daily
B12	Optic neuropathy, increased risk of age-related macular degeneration, dry eye disease	Serum B12 (also check folate)	1000 µg B12 IM weekly for up to 4 weeks
C	Hemorrhage (subconjunctival, orbital), exacerbate age-related macular degeneration	Serum vitamin C levels	1–2 g of vitamin C daily for 3 days, then 500 mg for a week, followed by a daily dose of 100 mg for 3 months
D	Dry eye disease, exacerbate diabetic retinopathy, optic neuritis, and thyroid eye disease	Serum 25(OH)D3 levels	Infants – 400 IU daily Adults – 400–2000 IU daily
E	Ophthalmoplegia, strabismus, nystagmus, retinopathy, exacerbate age-related macular degeneration	Serum α-tocopherol level	2000 mg oral vitamin E supplementation
K	Retinal hemorrhages	Prothrombin time (PT) – elevated	Infants – 1 mg IM injection Adults – 90 µg/day oral (women), 120 µg/day (men)