Bitot’s spots are considered pathognomic of vitamin A deficiency and correspond to triangular patches of squamous keratinous metaplasia of the conjunctival epithelium, usually near the limbus, typically at the three o’clock and/or nine o’clock positions. The foamy aspect is attributable to colonization by gas-producing bacteria (p.e. Corynebacterium xerosis).
The patient is a 49-year-old male that presented to the emergency department with complaints of bilaterally decreased vision, particularly in dim illumination, and eye pain.
His previous medical history was remarkable for hemodialysis due to renal vascular disease and chronic hepatitis due to severe alcoholism; there was also a history of long-standing poor visual acuity in the OD due to a central retinal vein occlusion (CRVO) many years ago.