Bitot’s Spots in Gastric Bypass Patient

A 35-year-old female with a history of multiple small bowel resections, presented with several atypical conjunctival neoplasms. She was previously diagnosed with vitamin B12 deficiency, as well as iron deficiency anemia. A lesion in her right eye demonstrated leukoplakia with a xerotic and foamy appearance. This lead to a clinical suspicion of associated vitamin A deficiency (Fig 1). Histologic examination (Fig 2) revealed a keratinized conjunctiva with parakeratosis, hyperkeratosis, and acanthosis.