EpistemisNight blindness
Specialty: Ophthalmology.
Why it occurs
- Retinitis pigmentosa and hereditary rod dystrophies
- High-grade pathological or degenerative myopia
- Severe Vitamin A deficiency (associated with chronic malabsorption syndromes, gastric bypass or severe malnutrition)
- Advanced open angle glaucoma
- Dense cortical or posterior subcapsular cataract
- Radiation retinopathy or phenothiazine toxicity
Initial workup
Scotopic and photopic full-field electroretinogram (ERG) (to quantitatively evaluate the electrical response of the rods and cones); wide range computerized campimetry; High-resolution digital retinography and autofluorescence (to delineate areas of epithelial atrophy or lipofuscin accumulation); Plasma retinol (vitamin A) dosage and lipid profile.
red flags
Nyctalopia that progresses rapidly associated with concentric reduction of the visual field in young patients or children, suggesting a progressive retinal dystrophy of familial inheritance that requires early genetic counseling.
Standard management
- Vitamin A Palmitate — oral therapeutic doses under strict analytical control only in confirmed cases of nutritional or malabsorption deficiency; The use of 15,000 IU/day has been postulated in adults with retinitis pigmentosa to subtly slow down the progression of the disease, under rigorous control of liver enzymes due to the risk of hepatotoxicity.
- Lutein with Zeaxanthin (oral vitamin supplement that protects macular photoreceptors, without evidence of reversal of structural night blindness).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Ophthalmology
- Listed causes
- 6
- Treatment options
- 2