The pediatric ophthalmologist confirms leukocoria of the right eye is present. Below is the ocular exam noted at this visit.
External ocular exam:
Eyelids: flat OU, no ptosis OU
Conjunctiva: white and quiet OU
Cornea: Clear OU
Anterior Chamber: OD deep with microhyphema, OS deep and quiet
Iris: flat OU
Lens: clear OU
Intraocular pressures (IOP): Soft to palpation OU
The patient is scheduled for a dilated exam under anesthesia. Fundoscopic exam of the left eye is within normal limits, while fundoscopic exam of the right eye reveals the following:
Above Image Credit: © 2021 American Academy of Ophthalmology
How would you describe the right fundus appearance?
Scattered hemorrhages throughout the macula
Diffuse retinal whitening with cherry red spot centrally
Large cream colored well-circumscribed intraocular mass with smaller adjacent mass inferiorly
B-scan and OCT macula can also be helpful adjunctive tests. Below is an example of what B-scan would likely show:
What’s at the top of your differential diagnosis? Choose at least 1 before moving on!
Retinopathy of Prematurity
Persistent fetal vasculature
What would you like to do next?
Fine needle aspiration of mass
Click here to move on!
Peds Ophtho Case 1 Index
Peds Ophtho Case 1: Introduction
Peds Ophtho Case 1: Physical Exam