Paediatric Ophthalmology

Case 8

Patient Presentation: An 11-year-old boy was referred to a pediatric ophthalmology clinic for two days of blurred vision OS. His mother noted that he was recently diagnosed with a sinus infection due to a few weeks of facial pressure and periorbital pain. He was treated with nasal decongestants, but his symptoms did not improve. The patient denied red eye, photophobia, flashes, floaters or a visual field deficit. He had no past medical or ocular history.

On examination, BCVA was 20/20 OD and 20/70 OS. There was no RAPD and IOP was within normal limits. Extraocular motility was full, but he did note pain OS on abduction and elevation. There was no exophthalmos. Anterior segment examination was within normal limits.

Bilateral fundus photographs were taken and are shown below:

OCT macula images were taken and are shown below:

Question 1: What is the main finding in the OCT macula image above?

Question 2: What is the next imaging modality you would order?

Question 3: Based on the patient presentation, fundus photography, OCT imaging and B-Scan ultrasonography imaging, what is the most likely diagnosis?

Question 4: What is the first-line treatment for patients with this disease process?

One month following initiation of PO Prednisone treatment, the patient was seen in follow-up. His BCVA was 20/20 OD and 20/20 OS. OCT images (shown below) demonstrate resolution of his subretinal fluid and reduced choroidal thickening. His work-up was negative; therefore, he was diagnosed with idiopathic posterior scleritis and is undergoing regular monitoring by Ophthalmology.

References:

Learning Objectives:

Patient Presentation: A 23-year-old obese female was diagnosed with idiopathic intracranial hypertension (IIH) and referred to neurosurgery for ventriculoperitoneal shunt. A baseline ocular examination was performed prior to the procedure.

On examination, vision was 20/200 in the right eye, and 20/40 in the left eye. There was a right relative afferent pupillary defect. Slit lamp examination was normal.

A dilated fundus examination was performed demonstrating the following:

Paediatric Ophthalmology

Case 8

On examination, BCVA was 20/20 OD and 20/70 OS. There was no RAPD and IOP was within normal limits. Extraocular motility was full, but he did note pain OS on abduction and elevation. There was no exophthalmos. Anterior segment examination was within normal limits.

Bilateral fundus photographs were taken and are shown below:

OCT macula images were taken and are shown below:

Question 1: What is the main finding in the OCT macula image above?

Question 2: What is the next imaging modality you would order?

Question 3: Based on the patient presentation, fundus photography, OCT imaging and B-Scan ultrasonography imaging, what is the most likely diagnosis?

Question 4: What is the first-line treatment for patients with this disease process?

Paediatric Ophthalmology Case 8

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On examination, BCVA was 20/20 OD and 20/70 OS. There was no RAPD and IOP was within normal limits. Extraocular motility was full, but he did note pain OS on abduction and elevation. There was no exophthalmos. Anterior segment examination was within normal limits.

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Bilateral fundus photographs were taken and are shown below:

OCT macula images were taken and are shown below:

Question 1: What is the main finding in the OCT macula image above?

Question 2: What is the next imaging modality you would order?

Question 3: Based on the patient presentation, fundus photography, OCT imaging and B-Scan ultrasonography imaging, what is the most likely diagnosis?

Question 4: What is the first-line treatment for patients with this disease process?

Paediatric Ophthalmology

Case 8