Acute Transient Myopia in a Child

Series Editor: David K. Coats, MD


August 08, 2002


An 8-year-old boy was referred emergently by his neurologist because of acute vision loss in both eyes. The child had a 3-year history of recurrent headaches and a 1-month history of nocturnal headaches. Neuroimaging, including computed tomography (CT) and magnetic resonance imaging (MRI), were negative for central nervous system pathology and sinus disease. His neurologist, therefore, suspected that he was suffering from an atypical form of migraine. The patient was taking propranolol and sertraline, which improved but did not fully alleviate his headaches. Topiramate 25 mg per day had been added to his treatment regimen 5 days prior to evaluation.

The child awoke on the day of presentation complaining to his mother that his vision was severely reduced in both eyes. Examination by an optometrist 6 months earlier had demonstrated 20/20 vision in both eyes. On examination, the child had an uncorrected distance vision of 20/400 in his right eye and 20/300 in his left eye. Slit lamp examination revealed a moderately shallow anterior chamber and obvious thickening of the lens in both eyes. The child would not allow A-scan measurements. Intraocular pressure was 21 mm Hg in both eyes. Cycloplegic refraction, performed 40 minutes after administration of Cyclogyl 1%, revealed a refractive error of -6.50 diopters in both eyes, yielding a visual acuity of 20/20 in both eyes.


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