Objective: To describe the clinical features of refractory corneal epithelial diseases (CEDs) associated with zinc deficiency in patients with severe motor and intellectual disabilities (SMID). Methods: Using the medical records, we collected the clinical data of three SMID patients with zinc deficiency who developed CEDs and showed poor response to standard ophthalmic treatment. Results: A 27-year-old SMID patient had refractory corneal erosion and ulceration, and two SMID patients (16- and 35-year-old) developed refractory keratoconjunctivitis. Various precipitating factors of corneal injury associated with SMID were identified, including facial paralysis in one and frequent rubbing eyelids with prone keeper or bed sheets in the other two patients. Although they received zinc at a dose larger than the estimated average daily requirement through enteral formula, serum zinc levels were as low as 44-71 μg/dL. Oral zinc supplementation resulted in healing of all CEDs within 2-4 weeks, with increase in serum zinc levels to 77-124 μg/dL after 1-2 months. Conclusions: Based on the high risks of corneal injury and zinc deficiency in patients with SMID, zinc deficiency should be suspected in cases with refractory CED. We recommend the use of oral zinc supplementation in these patients with hypozincemia.

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