Peds Ophtho Case 1: Ophtho Visit

Peds Ophtho Case 1 Index

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:

RB croppedAbove 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
Retinal detachment
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: 

RB image cropped
Above Image Credit

What’s at the top of your differential diagnosis? Choose at least 1 before moving on!
Congenital Cataract
Retinopathy of Prematurity
Ocular Toxocariasis
Retinal detachment
Persistent fetal vasculature
Coats disease

What would you like to do next?
Fine needle aspiration of mass
Serology testing
Genetic Testing
Lumbar puncture 
Bone scan

Click here to move on!

Peds Ophtho Case 1 Index
Peds Ophtho Case 1: Introduction
Peds Ophtho Case 1: Physical Exam