Phrynoderma and night blindness

eyes. [3,4] Recently, 3D high-speed OCT has shown to facilitate the understanding of pathophysiologic changes in CSCR.[5] However, this case illustrates that spectral domain HD OCT could pick up the presence of the subretinal fl uid and RPE changes even before they could manifest angiographically in CSCR. This indeed may be a bett er tool for monitoring the asymptomatic eye for the detection of early changes and may obviate the need for fl uorescein angiography in selected cases. However, this is only a case report and a larger study is required.


Phrynoderma and night blindness
Dear Editor, Phrynoderma is traditionally considered to be a skin manifestation of vitamin A defi ciency as is night blindness in the eye. However, most recent investigators deny the link between phrynoderma and vitamin A and the association between phrynoderma and night blindness is highly unusual. We report a three-year-old patient who presented with night blindness and was found to have skin lesions typical of phrynoderma. Both conditions completely resolved with vitamin A therapy suggesting its causative role.
Ocular manifestations of vitamin A defi ciency are referred to as xerophthalmia, earliest manifestation being night blindness. Others include conjuctival xerosis, Bitot's spots, corneal xerosis, keratomalacia, and corneal scarring. [1,2] Skin lesions in the form of follicular keratosis or phrynoderma have been reported. [1,2] Lesions typically are dry, hard, pigmented papules with 2-5 mm central intrafollicular keratotic plug projecting from hair follicles as horny spines resembling toad skin, hence the name phrynoderma. However, the link between phrynoderma and vitamin A defi ciency is controversial and some reports suggest that this condition may be secondary to generalized malnutrition or essential fatt y acid defi ciency. [2][3][4] Night blindness associated with phrynoderma appears to be an exceedingly rare occurrence. [1][2][3][4][5]

Fibrin glue in ophthalmology
Dear Editor, We read with interest the article by Panda et al., [1] wherein the authors have presented the uses of fi brin glue in ophthalmology in detail. They have mainly discussed its use on the ocular surface as a replacement of sutures.
Fibrin glue has exciting intraoperative applications during vitreoretinal surgeries as well. It has been found to not have any toxic eff ects on retinal function or structure in a rabbit model. [2] The intraoperative use of Tisseel VH fi brin sealant (Baxter Healthcare Corporation, Westlake Village, CA, USA) has been described recently in the management of optic disc pit-associated macular detachments. [3,4] The technique involves pars plana vitrectomy, removal of posterior hyaloid, fl uid-air exchange, drainage of subretinal fl uid through optic disc pit, application of the fi brin sealant to the pit and air-C 3 F 8 gas exchange and postoperative prone positioning. This prevents recurrent macular detachment, which is common in this condition.
Fibrin glue has also been used to stabilize keratoprosthetic devices during vitreoretinal surgeries. [5] A three-year-old female Indian child presented with history of night blindness of one month duration as ascertained by her parents. On examination, visual acuity appeared to be normal (central, steady, and maintained fixation in both eyes). The conjunctiva appeared lusterless suggesting xerosis. Anterior segment and dilated fundus examination with indirect ophthalmoscope was unremarkable. Further examination revealed dry, horny, papules with central intrafollicular plugging distributed over extensor aspects of elbows, knees, trunk and the back of the child. She also had dry, coarse and lusterless hair. A clinical diagnosis of phrynoderma and vitamin A defi ciency was made. Serum vitamin A levels were not estimated as the parents were not willing for the test. Based on clinical fi ndings, vitamin A therapy was considered appropriate. Vitamin A in a dose of 100,000 IU IM was administered on the day of presentation, and the following day. She was referred to a pediatrician for the management of malnutrition. One month follow-up showed complete resolution of skin lesions and parents had also noticed improvement of night blindness confi rming the clinical diagnosis of vitamin A defi ciency.
The simultaneous occurrence of night blindness and phrynoderma has rarely been reported in literature; to our knowledge, since Nicholls' original report in 1933, only one other case in the literature has documented the association of phrynoderrma and night blindness. [1][2][3][4][5] The earliest ocular manifestation of vitamin A defi ciency being night blindness is well known. [1] Phrynoderma is traditionally considered to be a manifestation of vitamin A defi ciency, [1] but a number of reports have denied its causative role. Investigators have proposed other causes such as generalized malnutrition and defi ciencies of vitamin B, E, and essential fatt y acids. [2][3][4] Our case demonstrates the simultaneous occurrence of night blindness and phrynoderma, both of which resolved with vitamin A therapy. Though our patient was also malnourished, the eff ectiveness of vitamin A therapy suggests that at least in our patient, phrynoderma was secondary to vitamin A defi ciency.