{
  "abstract": "Vitamin A deficiency (VAD) is a well-recognised cause of preventable childhood blindness globally but rarely considered in developed countries. Neurodivergent children (NDC) with avoidant/restrictive food intake disorder (ARFID), may be at risk.We present two cases of neurodivergent children with corneal ulcers secondary to severe VAD.Case 1: A 9-year-old boy with autism, non-verbal and long-standing restrictive diet presented with bilateral vision decline, headache and photophobia. Examination under anaesthesia (EUA) revealed bilateral optic disc swelling and large right corneal ulcer with keratinisation of ocular surface and Bitot spots.Case 2: A 10-year-old girl with autism, non-verbal and coeliac disease, presented with painful red eyes and mucopurulent discharge. EUA revealed right corneal ulcer with keratinisation of ocular surface and Bitot spots.Vitamin A levels were unrecordable in both patients.Both patients underwent EUA with intramuscular vitamin A (100,000 IU), topical antibiotics and lubricants. Significant clinical improvement followed.VAD must be considered in acute, severe ocular surface disease in NDC, who may go under the radar for routine nutritional assessments, increasing the risk of delayed diagnosis and treatment.VAD related eye disease is preventable and reversible if diagnosed and treated early. It is not common in developed countries and may go unrecognised unless we raise awareness of increasing prevalence of VAD and micronutrient deficiencies in NDC. Commissioning restrictions deny nutritional and psychological support for these children. As healthcare professionals, we must advocate for these vulnerable patients to ensure they receive the care they need.",
  "authors": [
    {
      "affiliations": [
        "Royal Stoke University Hospital, UK"
      ],
      "name": "Taiwo Makanjuola"
    },
    {
      "affiliations": [
        "Royal Stoke University Hospital, UK"
      ],
      "name": "Esra Karabulut"
    },
    {
      "affiliations": [
        "Royal Stoke University Hospital, UK"
      ],
      "name": "Paul Haigh"
    },
    {
      "affiliations": [
        "Royal Stoke University Hospital, UK"
      ],
      "name": "Annie Joseph"
    }
  ],
  "title": "130013 Neurodivergent children with corneal ulcer – food for thought?",
  "uid": "dcabb194-8593-5091-95d3-22268dd9bcc9"
}