Incidental Fundus Finding in a Child With Cataract

Murtaza Saifee; Kimberly G. Yen, MD


December 18, 2017

Case Presentation

A healthy 12-month-old boy was referred to the pediatric ophthalmology clinic for misaligned eyes. A community ophthalmologist noticed a cataract of the right eye and referred the patient for further treatment; incidentally, the ophthalmologist had also noted a "pocket" in the back of the left eye.

According to the patient's parents, the patient has been crossing his eyes since birth, but the crossing had worsened in the past few months. They have been patching the left eye for 1-1.5 hours daily, with no improvement.

On physical exam, the patient was in no acute distress. He was able to fix and follow in both eyes, with a strong fixation preference in the left eye. Cycloplegic refraction revealed an error of +2.00 in both eyes. The patient had esotropia of 10-15 prism diopters in the right eye. He had full extraocular movements and normal pupillary response in both eyes. Posterior segment exam showed a posterior lenticonus cataract with posterior capsular opacification in the right eye, and a small round spot in the temporal part of optic nerve in the left eye.

The patient was taken for cataract extraction and intraocular lens placement in the right eye.

Exam of the left eye was performed under anesthesia, and a color fundus photo of the left eye was taken during this time (Figure).

Figure. Color fundus photo of the left eye.


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