[Acute reversible night blindness caused by vitamin A deficiency in pancreatic carcinoma]

Vitamin A deficiency is a leading cause of blindness in childhood in the developing countries. In developed countries xerophthalmia occurs mainly as secondary hypovitaminosis due to malabsorption in chronic alcoholism or intestinal disorders.

A 24-year-old female patient complained of night blindness since one week. There was a history of pancreas tail resection combined with radiation due to a papillary low grade cystic carcinoma at the age of 15. During a review period of 9 years of follow-up there was a slow disseminated metastatic spread including the liver. Despite a progressive tumor cachexia the patient was practising a profession. Visual acuity was 20/20 OU with normal visual fields. Dark adaptation was reduced to one log unit and scotopic electroretinography was extinguished. Serum vitamin A level was reduced to 75 ng/ml (normal range 400-700 ng/ml).

Under vitamin A substitution dark adaption and scotopic electroretinography normalized and night blindness disappeared within 7 days.

In malabsorption syndromes, especially in combination with liver manifestations, xerophthalmia should be considered as a potential complication. Vitamin A substitution should be administered if necessary. In cases of malignant tumors differential diagnosis includes the cancer associated retinopathy (CAR).