The Boy With Red Eyes and a Wobbling Gait

Ahmar Sajjad, MD; Jennifer Murdock, MD; Lingkun Kong, MD, PhD; Kimberly G. Yen, MD

August 18, 2016

Clinical Presentation

An 8-year-old boy presented to the pediatric ophthalmology clinic for evaluation of red eyes for the past year with progressive worsening in the past 6 months. The symptoms were not associated with pain, photophobia, or discharge. The child had been diagnosed with congenital ataxia as a toddler. However, the parents also reported worsening of the child's wobbling gait during the 6 months before presentation to the eye clinic.

The child had been born at term via cesarean section. His medical history was significant for asthma and a speech delay. Family history included a "stable resting tremor" in his mother and an aunt. As part of his evaluation for ataxia as a toddler, MRI and chromosomal microarray analysis had been performed and were both negative at that time.

The external ocular examination was normal. Visual acuity was 20/50 in the right eye and 20/70 in the left eye. Pupils were briskly reactive to light, with no relative afferent pupillary defect. Intraocular pressures, extraocular movements, and confrontation visual fields were within normal limits.

On slit-lamp examination, dilated conjunctival vessels were visualized bilaterally (Figures 1-4). Corneas were clear, with a deep and quiet anterior chamber in each eye. The lids, lashes, iris, lens, vitreous, and direct funduscopic examination were normal bilaterally. Refractive error was -1.00 sphere in both eyes.

Figure 1. Medial conjunctiva of the right eye.

Figure 2. Lateral conjunctiva of the right eye.

Figure 3. Lateral conjunctiva of the left eye.

Figure 4. Medial conjunctiva of the left eye.

Because of the child's worsening ataxia, a neurologic examination was also performed. The examination was significant for slow, scanning speech. Finger-to-nose examination revealed dysmetria. The patient was noted to have an unsteady, slightly wide-based gait.

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