A meal plan for the average person should consist of 50% carbohydrates, 30% healthy fats and 20% protein. Clinically, the absence of proteins and vitamins has the most profound effect.

Lack of protein intake results in Kwashiorkor syndrome, characterized by severe weight loss, dermatitis, alopecia and impaired healing. Ocular manifestations include eyelid edema, chemosis and frequent conjunctival infections.

The clinician should record the frequency, onset and duration of infectious conditions and the type of discharge (watery, stringy or mucopurulent). Swollen preauricular nodes could indicate a viral cause. A careful slit-lamp examination should be performed, noting eyelid debris, discharge, palpebral conjunctival papillae, follicles and pseudomembranes.

Chronic alcohol abuse results in protein energy malnutrition, thiamine (B1), riboflavin (B2), pyridoxine (B6), folate and vitamin A deficiencies. Such severe deficiencies are caused by defective gastrointestinal absorption, abnormal nutrient use and storage, increased metabolic needs and increased rate of nutrient depletion. Failure to recognize possible thiamine deficiency in chronic alcoholics may result in irreversible brain damage (Korsakoff psychosis).

It is important to refrain from judgments regarding weight. If a patient is clinically obese (20% over prescribed healthy weight), this must be addressed professionally and politely.

When one's vision is restricted, dietary restrictions can seem like another major loss. There is no reason to miss out on one of life's basic pleasures, eating. Variety is the spice of life. Moderation and balance are essential.

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