DR AVADHESH OLI

DR. (COL) SHRIKANT WAIKAR, DR. PRADEEP KUMAR

Abstract

Night blindness & ocular manifestations are well documented in vitamin A deficiency.

We present a case of night blindness with severe vitamin A deficiency and role of modified patch test to exhibit Mizou phenomenon.

A young male presented with night blindness and severe dry eye with a BCVA of 20/40 OU. On multimodal imaging he had metallic sheen in the retina which disappeared after patching the eye for 1 hour. OCT showed hyperreflective dots in the outer retina which were clinically evident. He also had chronic liver disease with jaundice. Lab tests revealed severe vitamin A deficiency and on genetic testing for SAG or GRK1 mutation Oguchi disease was ruled out which was labelled 10 years back elsewhere. Oguchi disease is important differential due to the overlapping clinical features of night blindness & Mizou-nakamura phenomenon.

The case highlights multimodal features of vitamin A deficiency and utility of patch test to elicit Mizou phenomenon without a dark room.