Bitot’s Spot

Introduction

Bitot’s Spots are distinct white patches that

appear on the conjunctiva – the membrane that
covers most of the visible part of the eye.

Bitot's spot is highly suggestive of vitamin A

deficiency and, sometimes, chronic conjunctival
inflammation.
Introduction contd……

Bitot’s Spots look like raised triangular-shaped

areas on the white area of the eyeball and ulcers can
develop with the cornea softening and turning pulp-
like if not treated, resulting in irreversible
blindness.

In 1863, Pierre Bitot (1822-1888), a French

physician, first described these spots.
 Defination

A BITOT'S SPOT is defined as the gray or

white lesion involving the exposed portion of
the bulbar conjunctiva. Frequently bilateral,
it is triangular in shape with its base at the
temporal limbus and its apex extending
toward the lateral canthus. The elevated,
dry, lusterless surface of the Bitot's spot is
distinctively frothy or foamy in appearance.
 Defination

Bitot's spots are the buildup of keratin debris located

superficially in the conjunctiva, which are oval,
triangular or irregular in shape. These spots are a
sign of vitamin A deficiency and are associated with
conjunctival xerosis.
http://en.wikipedia.org/wiki/Bitot's_spot
Charaterstics of Bitot's spot

Bitot’s spots (XIB): A Bitot’s spot has a typical white foamy

appearance and is localised on the surface of the conjunctiva.
Bitot’s spots may be found in both eyes, most often on the
temporal conjunctiva.
The picture shown top left is one example of a Bitot’s spot.
These may appear in children under 3 years but are more
common in older children.
The appearance indicates changes in the squamous
epithelium of the conjunctiva with underlying xerosis.
Charaterstics contd…..

Bitot's Spots are greyish spots that form on the

surface of dry patches of conjunctiva at the sides of
the eyes.
Bitot's Spots consist of fragments of keratinized
epithelium. They can be triangular in shape and vary
in appearance from "cheesy greyish" to silver-grey
and can appear shiny.
 Causes

A common cause of Bitot's Spots is deficiency of Vitamin

A . This condition is more common in developing countries
where child nutrition is often poorer than in developed
nations. If left undiagnosed and untreated, Bitot's spots
may be lead to night blindness, perhaps eventually
to xerophthalmia, and in worst cases, blindness.

Bitot's Spots are an example of a medical condition

directly associated with malnutrition.
 
 
 Sign and Symptoms

Dry skin and hair

Increased incidence of ear infection, sinusitis,
respiratory infection, urinary infection, and digestive
problems
Drying of the cornea with ulceration – xerophthalmia
Inability to gain weight
Nervous disorders
Skin sores
There may be night blindness or a decreased ability
for dark adaptation
 Diagnosis of Bitot's Spot

The diagnosis of Bitot’s spots will be confirmed by

an eye specialist or opthalmologist. Vitamin A
status is measured by tests for retinol, with blood-
serum retinol concentrations of 30-60 mg/dl
considered in the normal range. Levels that fall
below this range indicate Vitamin A deficiency.
 Treatment

Treating Bitot’s spots first and foremost

involves improving the individual’s diet. Regular
and adequate intake of foods rich in Vitamin A can
reduce symptoms of Bitot’s spots such as night
blindness.
Other medical conditions such as respiratory tract
infections, diarrhea and measles that may be present
should also be treated immediately.
Preventing Bitot’s spot

In order to prevent Bitots spots, there are certain lifestyle

changes that need to be adhered to and they include:

Increase
 intake of Vitamin A supplements and beta-
carotene.
A protein rich diet is essential and should include meat,

liver, eggs, milk, dairy products and vegetables.
Drink fresh carrot juice to prevent or alleviate some eye

problems
 Prevention contd….

Two tablespoons of cod liver oil taken daily is also

rich in vitamin A

Avoid straining your eyes

Avoid smoke-filled rooms

Protect your eyes from direct and indirect sunlight

 Dietary recommendation
Guidelines from WHO, the United Nations Children's Fund
(UNICEF), and the International Vitamin A Consultative
Group (IVACG, now the Micronutrient Forum) recommend
high-dose vitamin A supplements in the prevention and
treatment of severe vitamin A deficiency in certain
populations.

In developing countries where vitamin A deficiency is a public

health problem, periodic supplementation with high-dose
vitamin A (50,000–200,000 units, depending on age) has
been recommended in certain high-risk populations (i.e.,
postpartum women, children), with reduced doses
recommended for pregnant women.
 Dietary recommendation contd….

Such high doses of vitamin A generally are not used

in the US except in individuals with vitamin A
deficiency.

WHO and IVACG consider patients with active

xerophthalmia (e.g., night blindness, conjunctival
xerosis with Bitot's spots, corneal xerosis, corneal
ulceration, keratomalacia) to be in imminent danger
of corneal destruction and recommend immediate
treatment with high dosages of vitamin A
 Referance

Bitot's Spot Overlying a Pinguecula

Robert A. Levine, MD; Maurice F. Rabb, MD
en.wikipedia.org/wiki/Bitot's_spots
Wikipedia
http://en.wikipedia.org/wiki/Bitot's_spot