What's Your Diagnosis?
- Journal of Pediatric Ophthalmology and Strabismus
- May/June 2011 - Volume 48 · Issue 3: 138-138
An 18-month-old boy was seen for evaluation of a suspected larger left eye. His mother had seen this asymmetry since 9 months of age and his pediatrician first proposed eyelid asymmetry to explain this finding. With its persistence, proptosis was considered and he was seen by the referring ophthalmologist. His mother reported that in infancy epiphora had been present unaccompanied by discharge or photophobia. On examination, good fixation, following, and interest in toys was present. Refraction revealed 1 diopter of myopia in the left eye and low hyperopia on the right side. The corneas were clear and the diameters were 12.5 mm in the right eye and 13.5 mm in the left eye. No breaks in Descemet’s membranes were present. The anterior chambers were deep and the irides were normal with expected stromal architecture. The intraocular pressures were 16 mm Hg in the right eye and 19 mm Hg in the left eye. The corneal thicknesses were 596 μm in the right eye and 556 μm in the left eye. Gonioscopy revealed normal trabecular meshwork in both eyes. The scleral spur was difficult to see on the left side and the ciliary body band in the left eye was more white than in the right eye. The lenses were clear. The optic discs were well vascularized with a small central cup in the right eye and a 0.5 cup in the left eye. A-scan study found an ocular length of 19 mm in the right eye and 20 mm in the left eye. When seen repetitively for re-examination over the next 14 months, his findings have been stable without treatment.