A 5-Year-Old Boy's Failing Vision

Sean M. Rodriguez; Madhuri Chilakapati, MD; Kimberly G. Yen, MD


August 28, 2018

Case Diagnosis

Myelinated retinal nerve fiber (MRNF) layer of the right eye is the correct diagnosis for this patient.

Retinoblastoma is an embryonic malignant neoplasm of the retina that generally presents with one or more intraocular masses or subretinal fluid. It is often discovered when leukocoria is consistently demonstrated in the patient's eye with flash photography. Retinoblastoma may be inherited in an autosomal dominant fashion or sporadically.

Choroideremia is an X-linked chorioretinal dystrophy characterized by an insidious atrophy of the choroid and retinal pigment epithelium. Patients who are affected may have night blindness as their chief complaint. Funduscopic examination will typically present with bone spiculing changes and well-demarcated areas of retinal atrophy with visible sclera and choroidal vessels.

Coats disease is a nonhereditary exudative retinitis secondary to retinal telangiectasias. Similar to retinoblastoma, the most common initial presenting sign is leukocoria. It is typically unilateral, and funduscopic exam shows dilated and tortuous vessels with subretinal exudates and hemorrhages.

Posterior staphylomas are most commonly congenital and associated with myopia. They occur secondary to thinning of the sclera and protrusion of the uveal tissue outward, and appear as white reflective areas adjacent to the optic nerve.

Clinical Course

The patient was given a glasses prescription of -9.50 in the right eye and plano in the left eye. The importance of wearing glasses was emphasized, as was the use of eye protection and safety glasses in sports or other high-risk activities.

Patching of the patient's left eye also was initiated, and he will be followed in the eye clinic to monitor his vision.


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