Response of Bitot's spots to a single oral 100,000- or 200,000-IU dose of vitamin A

Am J Ophthalmol. 1994 Dec 15;118(6):792-6. doi: 10.1016/s0002-9394(14)72560-7.


Purpose: A randomized, controlled clinical trial was conducted in Indonesia to study the response of Bitot's spots to a 100,000-IU dose of vitamin A, which is known to be associated with fewer acute side effects than the currently recommended 200,000-IU dose.

Methods: A total of 114 children (ages 13 to 59 months) with Bitot's spots were given an ocular examination; serum retinol concentration was measured, and the relative dose response test carried out. After administering one 100,000- or 200,000-IU oral dose of vitamin A, ocular examinations were repeated weekly for seven weeks and then biweekly for 20 more weeks, or until lesions were healed on two consecutive examinations.

Results: Either dose of vitamin A was similarly effective in healing Bitot's spots. The most important factor in predicting responsiveness to treatment was baseline serum retinol concentration: children with lower pretreatment concentrations were more likely to have responsive lesions. No child had a relapse within the first three months after treatment. However, by six months, children who had received the higher dose were 82% less likely to have a relapse compared with children who had received the lower dose.

Conclusions: Although either a 100,000- or 200,000-IU dose of vitamin A is similarly effective in healing Bitot's spots, a 200,000-IU dose provides longer protection. This benefit justifies the higher rates of transient mild side effects associated with the 200,000-IU dose. The current 200,000-IU dose of vitamin A recommended by the World Health Organization for prophylactic dosing should not be reduced.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Administration, Oral
  • Child, Preschool
  • Conjunctiva / pathology*
  • Developing Countries
  • Female
  • Humans
  • Indonesia
  • Infant
  • Male
  • Vitamin A / administration & dosage*
  • Vitamin A / adverse effects
  • Vitamin A / blood
  • Vitamin A Deficiency / complications
  • Vitamin A Deficiency / prevention & control*
  • Xerophthalmia / etiology
  • Xerophthalmia / pathology*


  • Vitamin A