Intestinal surgery can affect eyes years later

Surgery on the intestines can lead to the malabsorption of vitamin A, and this in turn can create eye problems years or even decades after surgery, especially when other illnesses are present, ophthalmologists report.

Ocular disorders that can result from vitamin A deficiency include dry eye, softening of the cornea, damage to the retina, and night blindness, Drs. T. Chae and R. Foroozan explain in the August issue of the British Journal of Ophthalmology.

The two researchers, from the Baylor College of Medicine in Houston, reviewed the records of patients diagnosed with vitamin A deficiency last year and identified four cases related to gastrointestinal surgery.

One patient developed ocular symptoms within months of gastric bypass surgery, while the other three did not have visual symptoms until at least 18 years after intestinal surgery.

The first of these three with late visual problems was a 69-year-old man who reported having night blindness for four months. He had undergone intestinal bypass surgery 20 years earlier.

The second patient was an 80-year old man who complained of 4 months of decreased vision in the right eye that was worse in dim light. Thirty-six years earlier he had undergone partial small and large bowel resection related to Crohn’s disease.

The third patient reported several months of decreased vision in both eyes that was worse at night. Her medical history included “multiple abdominal surgeries 18 to 20 years earlier” as a result of complications from gallbladder surgery.

Eye tests showed abnormalities in all three cases and lab tests confirmed vitamin A deficiency, the investigators report.

The two male patients were treated with injections of vitamin A, and both reported improvements in vision in both eyes within the first week. The woman refused further treatment.

In a related editorial, two other doctors point out that other investigators have reported severe visual complications, including blindness, that followed gastric bypass surgery. They caution that such surgery is being performed more frequently as a “quick fix” for obesity.”

“When the remarkable rise in gastric bypass surgical procedures is considered across the world,” the physicians write, the possibility of an epidemic of vitamin A deficiency “becomes an alarming reality.”

SOURCE: British Journal of Ophthalmology, August 2006.

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