Peds Ophtho Case 3: Ophtho Visit and Exam

Peds Ophtho Case 3 Index

The pediatric ophthalmologist schedules an exam under anesthesia (EUA) that week. 

What additional tests will likely be performed during the EUA? Select all that apply.
Axial length measurement 
Cycloplegic refraction
Dilated fundus exam
Gram stain

The EUA findings are shown below:

External ocular exam:
Eyelids: flat OU, no ptosis OU
Conjunctiva: white and quiet OU
Cornea: OD Clear (10 mm), OS megalocornea (13 mm) with diffuse corneal edema and few Haab’s striae (horizontal break’s in Descemet’s membrane)
Anterior Chamber: OD deep and quiet, OS appears deep but hazy view of anterior chamber
Iris: OD flat, OS poor view
Lens: OD clear, OS poor view
Intraocular pressures (IOP) via rebound tonometer: OD 18 mmHg, OS 38 mmHg

Gonioscopy of both eyes demonstrates open angles (view in left eye limited by corneal edema). (see case 8 for more information on gonioscopy).

The optic nerve appearance in the right eye is shown on the right. The rest of the dilated eye exam is within normal limits in the right eye. There is no view to the back of the left eye. Therefore, B-scan ultrasound is performed which demonstrates a flat retina and no masses are present. 


What is the expected appearance of the left optic nerve?
Blurring of optic disc margins
Optic disc pallor
Increased cup-to-disc ratio
Normal optic nerve 

What’s at the top of your differential diagnosis? Choose at least 1 before moving on!
Corneal ulcer
Congenital cataract
Congenital glaucoma
Birth related forceps injury 
Congenital Corneal Hereditary Endothelial Dystrophy (CHED)
Orbital cellulitis

Click here to move on!

Peds Ophtho Case 3 Index
Peds Ophtho Case 3: Introduction
Peds Ophtho Case 3: Additional History & Physical Exam