Vitamin A is an essential fat soluble vitamin that must be obtained solely from diet or vitamin supplementation. Normal vitamin A levels are required for appropriate functioning of our immune system, skin, retina, and ocular surface. Without adequate levels of vitamin A in the body (hypovitaminosis A), serious systemic consequences can occur, including significant ophthalmic complications leading to potential vision loss and ultimate blindness if the deficiency is not recognised and corrected. Hypovitaminosis A remains a major health problem of epidemic proportions worldwide with over 127 million people and 4.4 million preschool children affected. Vitamin A deficiency remains the leading cause of preventable blindness in children with an estimated half a million children rendered blind each year; yet even more alarming is many of those children die of the same disease.¹ While the major cause of hypovitaminosis A across the world remains malnutrition, Chae and Foroozan in this issue of BJO (p 955) have astutely reminded us that iatrogenic vitamin A deficiency from surgical alteration of the small intestine, the site where vitamin A absorption occurs, can create any number of ophthalmic findings as seen with a malnourished vitamin A deficient patient.² This problem has global implications as developed countries, which have typically been spared malnutrition and vitamin A …