Journal of Pediatric Ophthalmology and Strabismus

Whats Your Diagnosis 

A Painful Right Eye

Helen H. Yeung, MD

Abstract

A 2-year-old boy with pain in his right eye that lasted for several weeks presented for further evaluation. The parents reported that the child had been in good health with no significant family history of eye problems. Several weeks prior, the patient's right eye was noted to turn inward. Two days before the evaluation, he became irritable and refused to open his right eye. Because the office examination was difficult due to limited patient cooperation, an examination under anesthesia was performed. Intraocular pressure was 45 mm Hg in his right eye and 16 mm Hg in his left eye. An anterior segment examination was performed. Prominent iris vessels were present associated with shallowing of the anterior chamber (Figure 1). Gonioscopy in the right eye showed synechial angle closure and a normal filtration angle in the left eye. A relative afferent pupillary defect was present in his right eye. Funduscopy revealed multiple large exudative retinal detachments in the right eye and a normal left eye. B-scan ultrasonography revealed opacities suspected to be calcifications within a large retinal mass in the right eye.

For the correct answer, see page 43.

The answer for What's Your Diagnosis? is neovascularization of the iris associated with retinoblastoma.…

A 2-year-old boy with pain in his right eye that lasted for several weeks presented for further evaluation. The parents reported that the child had been in good health with no significant family history of eye problems. Several weeks prior, the patient's right eye was noted to turn inward. Two days before the evaluation, he became irritable and refused to open his right eye. Because the office examination was difficult due to limited patient cooperation, an examination under anesthesia was performed. Intraocular pressure was 45 mm Hg in his right eye and 16 mm Hg in his left eye. An anterior segment examination was performed. Prominent iris vessels were present associated with shallowing of the anterior chamber (Figure 1). Gonioscopy in the right eye showed synechial angle closure and a normal filtration angle in the left eye. A relative afferent pupillary defect was present in his right eye. Funduscopy revealed multiple large exudative retinal detachments in the right eye and a normal left eye. B-scan ultrasonography revealed opacities suspected to be calcifications within a large retinal mass in the right eye.

What's Your Diagnosis?

For the correct answer, see page 43.

The answer for What's Your Diagnosis? is neovascularization of the iris associated with retinoblastoma.

References

  1. Walton DS, Grant WM. Retinoblastoma and iris neovascularization. Am J Ophthalmol. 1968;65(4):598–599. doi:10.1016/0002-9394(68)93882-8 [CrossRef]
  2. Yoshizumi MO, Thomas JV, Smith TR. Glaucoma-inducing mechanisms in eyes with retinoblastoma. Arch Ophthalmol. 1978;96(1):105–110. doi:10.1001/archopht.1978.03910050061015 [CrossRef]
  3. Camp DA, Yadav P, Dalvin LA, Shields CL. Glaucoma secondary to intraocular tumors: mechanisms and management. Curr Opin Ophthalmol. 2019;30(2):71–81. doi:10.1097/ICU.0000000000000550 [CrossRef]
Authors

From the Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts.

The author has no financial or proprietary interest in the materials presented herein.

Correspondence: Helen H. Yeung, MD, 2 Longfellow Place Suite 201, Boston, MA 02114. E-mail: helen.h.yeung.md@gmail.com

10.3928/01913913-20191203-01

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