Restricted diets can cause xerophthalmia in children with autism spectrum disorder

Children with autism spectrum disorder (ASD) often have restricted diets due to sensory issues or unusual eating habits. Vitamin A deficiency in these children has been found to cause a spectrum of ocular findings associated with xerophthalmia, including chronic ocular irritation, photophobia, tearing, and corneal ulceration.

Study design

The authors present a retrospective case series of 6 children with ASD diagnosed with xerophthalmia at a single academic center over a 5-year period. Patients had histories of eye irritation that were not relieved by medication.

Outcomes

All of the xeropthalmia cases were found to be associated with vitamin A deficiency (serum vitamin A levels <0.06 mL). While 2 children had irreversible vision loss, the corneal pathology in the other children was reversed by vitamin A supplementation.

Limitations

This was a case history that involved only 6 patients, not a larger retrospective study.

Clinical significance

Questions about diet should be incorporated into the history of children with ASD when these patients present with signs and symptoms of chronic ocular irritation not relieved by standard treatments. Examination under anesthesia should be considered in cases in which an adequate clinic exam is not possible. A high index of suspicion and timely diagnosis, with subsequent vitamin A supplementation, can prevent irreversible vision loss.

Financial Disclosures: Dr. Phoebe Lenhart discloses no financial relationships.