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Bitot's spots
Bitot's spots are the buildup of keratin located superficially in the conjunctiva of human's eyes. They can be oval, triangular or irregular in shape. The spots are a sign of vitamin A deficiency and associated with drying of the cornea. In 1863, the French physician Pierre Bitot (1822–1888) first described these spots.[1] The spots may abate under replacement therapy.[2] In ancient Egypt, this was treated with animal liver, which is where vitamin A is stored.[3] CausesA major cause of Bitot's spots is vitamin A deficiency (VAD).[4] Rarely, pellagra due to deficiency of vitamin B3 (niacin) may also cause Bitot's spots.[5] They can also be caused by Colestyramine , which is a bile acid sequestrant which can reduce the absorption of fat soluble vitamins (Vitamins A, D, E, K) TreatmentVAD is commonly treated with oral vitamin A supplements.[6] Improvement of Bitot's spots is seen with high-dose vitamin A therapy.[7] Bitot's spots non-responsive to vitamin A therapy may be removed surgically.[8] References
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