Bitot spots may be present on the conjunctiva in a number of conditions. They are due to accumulation of keratin and may be associated with drying of the conjunctival surface.
Bitot spots are small white or gray areas seen at either side of the limbus, but more often on the temporal side. They may be described as sharply-outlined, cheese-like or foamy. They may be oval, triangular or irregular in shape.
Conditions associated with the presence of Bitot spots include:
(1) vitamin A deficiency
(2) pellagra
(3) malnutrition
(4) keratosis follicularis (Darier-White disease) associated with retinitis pigmentosa
(5) corneal snowflake dystrophy
(6) associated with Rieger anomaly
(7) associated with coloboma of the eyelid
(8) associated with corectopia (displacement of the pupil from its normal central position), nystagmus and absent foveal reflexes
(9) congenital
(10) weather exposure
Bitot spots may also be idiopathic.
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