Bitot-like Spots and Congenital Aniridia: A Case Report

Background: Bitot's spots, defined as white foamy triangular or round-shaped spots with the base located at the temporal limbus and the apex towards the lateral canthus, were initially associated with vitamin A deficiency (VAD). More recently, Bitot's spots were also described in patients with normal vitamin A levels, associated with aniridia, dry-eye syndrome and post-thermal or chemical injury, as well as the usage of benzalkonium chloride (BAK) eyedrops. The aim of this article is to present the management of Bitot-like spots in a patient with congenital aniridia. Methods: An 8-year-old female patient with type 1 congenital aniridia, glaucoma, cataract, strabismus, congenital nistagmus and aniridia-associated keratopathy presented with changes in conjunctival appearance. The ophthalmological examination revealed Bitot-like spots with a foamy appearance, triangular shape, temporal location and proximity to the limbus. Further investigations were required in order to identify the cause of Bitot-like spots. Vitamin D deficiency, dry-eye syndrome, birch and Phleum genus pollen allergy were diagnosed. The patient underwent oral medication with vitamin D and topical treatment with steroids eye solution, preservative-free artificial tears and vitamin A ointment. Results: After three months of treatment, we observed the disappearance of the Bitot-like spots. Conclusions: Congenital aniridia, but also its complications such as glaucoma, dry-eye syndrome and the use of benzalkonium chloride topical medication, increases the risk of Bitot-like spots.