Peds Ophtho Case 2: Additional History

Peds Ophtho Case 2 Index

Answer: All of the questions listed are important things to ask to help generate a broad differential diagnosis.

In contrast to an adult history, a pediatric history should always include questions about the maternal pregnancy, the prenatal and birth history (i.e. gestational age at delivery, complications during pregnancy and neonatal period), as well as the child’s development history (i.e. milestones, behavior). Other good questions to ask include the child’s immunizations and social history (i.e. environmental risks, safety issues, living situation). For a chief complaint of “not seeing straight,” developmental abnormalities and abnormal birth history can be associated risk factors. 

A positive family history for ocular misalignment can increase a patient’s risk for misalignment. Furthermore, certain medical conditions such as Down’s Syndrome and cerebral palsy can be associated with a chief complaint for eye deviation. Exposure to certain drugs/medications or ocular/head trauma can also contribute to this presentation. Moreover, it can be normal for newborns to have some eye deviation, so asking about the duration of the misalignment is important to distinguish between pathology and normal physiology.

Additional History: 

The mother began to observe the eye crossing two months ago. At first, the eye crossing would occur intermittently before naps or when the patient looked sideways. Now, the eye crossing occurs all the time. She denies observing any redness, eye irritation or discharge of the eye. She is unsure if the patient has been having double vision or headaches but has noticed the patient has become fussier. She denies any trauma to the head or eye. 

The patient was born prematurely at 34 weeks and weighed 2200 grams. Following her birth, the patient was briefly in the NICU where she received a breathing tube and dexamethasone. The patient does not take any medications and has no medical conditions. There is no family history of “crossed eyes.” The patient has met all developmental milestones.

What’s on your differential diagnosis? Choose at least 3 before moving on!
Congenital Cataract
Retinopathy of prematurity
Refractive Error

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Peds ophtho Case 2 Index
Peds Ophtho Case 2 Introduction