xerophthalmia after bariatric surgery

purpose: to report a case of xerophthalmia after bariatric surgery. case report: a 24- year -old man presented to the eye clinic with a 4 -month history of irritable gritty eyes. he complained from night blindness, too. he was being treated for dry eye with artificial tears and ophthalmic ointments during the last month without any significant improvement. his vision was 20/20 unaided in both eyes. on examination, he had subtle corneal epithelial changes with areas of punctuate staining. the bulbar conjunctive showed a triangular gray foamy appearance with keratinization typical of bitot spot. the patient had undergone bariatric surgery to treat obesity 2 years ago. he had lost 90 kilograms weight after surgery. systemic review revealed fatigue and chronic diarrhea. on systemic examination he had pale conjunctiva and skin, dry skin and brittle nales. subsequent testing confirmed vitamin a and other vitamin deficiencies. ocular symptoms and signs improved after vitamin a supplementation. other vitamin deficiencies was addressed, too. conclusion: bariatric surgery has become an accepted treatment option for obesity and could lead to malabsorpsion. in case of dry eye and ocular surface keratinization in these patients, vitamin a deficiency should be considered.