Bilateral keratomalacia years after biliopancreatic diversion with duodenal switch surgery: A case of severe vitamin A deficiency and literature review

Vitamin A deficiency is an uncommon but serious complication of malabsorptive bariatric surgery in developed nations, which can manifest several years after the procedure. It can easily be overlooked, as patients often present with nonspecific signs and symptoms early in the disease course, and ocular manifestations typically appear once the deficiency reaches a severe stage. A female patient in her early 40s presented with acute vision loss 8 years after undergoing biliopancreatic diversion with duodenal switch bariatric surgery. Ophthalmic examination revealed Bitot's spots and progressive keratomalacia. Laboratory tests showed micronutrient deficiencies of vitamins A, D, E, and K1, which were attributed to noncompliance with bariatric follow-up and vitamin supplementation. Treatment with high-dose intramuscular vitamin A and total parenteral nutrition resulted in significant visual recovery and resolution of keratomalacia at 2 months after hospital discharge. Therefore, this case highlights that vitamin A deficiency can manifest years after the procedure, particularly in patients with poor adherence to nutritional guidelines. Prompt recognition and aggressive multi-modal supplementation are necessary to reverse ocular pathology and prevent permanent vision loss in this population.