The Infant Who Keeps Turning His Face Leftwards

Kimberly G. Yen, MD; Ariel Chen

Disclosures

March 14, 2018

A 5-month-old boy was referred from his pediatrician to the pediatric ophthalmology clinic for a left face turn.

The patient was born full term; however, he was hospitalized in the neonatal intensive care unit for his first 2 weeks of life due to respiratory distress and feeding difficulties. The patient was noted to have decreased left-sided movement, left face turn, and preference for looking to the right side since 2 months of age. His mother also noticed that his left eye sometimes turned inward. He had been evaluated by physical therapy to improve his head position and left-sided movement but had not yet received a neurology evaluation.

On examination, he was able to fix and follow with each eye. Pupils were equally round and reactive to light, and pressure was normal to palpation. He had an intermittent left esotropia with full motility and no nystagmus. The patient preferred a left face turn up to 30˚. His confrontation visual field exam using toys revealed a left homonymous hemianopia. He consistently ignored objects presented to the left. The remainder of his ocular examination, including anterior segment and fundus, was normal.

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