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
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:
What’s at the top of your differential diagnosis? Choose at least 1 before moving on!
Retinoblastoma
Congenital Cataract
Retinopathy of Prematurity
Strabismus
Ocular Toxocariasis
Retinal detachment
Persistent fetal vasculature
Coats disease
What would you like to do next?
Imaging
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