Journal of Pediatric Ophthalmology and Strabismus

Whats Your Diagnosis 

Girl With Eye Pain and Iris Heterochromia

Helen H. Yeung, MD

Abstract

A 3-year-old girl presented with eye pain, ocular injection, and a history of a recent diagnosis of acute lymphoblastic leukemia. Her symptoms began 1 day before evaluation and were associated with photophobia, epiphora, and suspected decreased vision in the affected left eye. On examination, her vision was worse in her left eye than her right eye using Allen card figures. The conjunctiva in the left eye was injected. Slit-lamp examination revealed a cloudy cornea associated with fine endothelial keratic precipitates. The anterior chamber of the left eye possessed many cells associated with a significant hypopyon (Figure 1). Examination of the left iris found it to be grayer than the right eye. Inspection of the iris stroma found the normal crypts filled with a grayish-yellow gelatinous-appearing material. The pupillary reactivity was less brisk in the left eye than the right eye. The lenses were clear bilaterally. The intraocular pressure was 12 mm Hg in the right eye and 40 mm Hg in the left eye. Funduscopy was normal in the right eye and could not be performed in the left eye. B-scan ultra-sonography in the left eye was unremarkable. Treatment was initiated with topical steroids four times a day and the hypopyon decreased rapidly over a period of 4 days, accompanied by significantly reduced intraocular pressure and improved vision. Radiation treatment was considered but not performed. Diagnostic anterior chamber paracentesis was also contemplated but believed to be unnecessary.

For the correct answer, see page 263.

The answer for What's Your Diagnosis? is hypopyon associated with acute lymphoblastic leukemia.…

A 3-year-old girl presented with eye pain, ocular injection, and a history of a recent diagnosis of acute lymphoblastic leukemia. Her symptoms began 1 day before evaluation and were associated with photophobia, epiphora, and suspected decreased vision in the affected left eye. On examination, her vision was worse in her left eye than her right eye using Allen card figures. The conjunctiva in the left eye was injected. Slit-lamp examination revealed a cloudy cornea associated with fine endothelial keratic precipitates. The anterior chamber of the left eye possessed many cells associated with a significant hypopyon (Figure 1). Examination of the left iris found it to be grayer than the right eye. Inspection of the iris stroma found the normal crypts filled with a grayish-yellow gelatinous-appearing material. The pupillary reactivity was less brisk in the left eye than the right eye. The lenses were clear bilaterally. The intraocular pressure was 12 mm Hg in the right eye and 40 mm Hg in the left eye. Funduscopy was normal in the right eye and could not be performed in the left eye. B-scan ultra-sonography in the left eye was unremarkable. Treatment was initiated with topical steroids four times a day and the hypopyon decreased rapidly over a period of 4 days, accompanied by significantly reduced intraocular pressure and improved vision. Radiation treatment was considered but not performed. Diagnostic anterior chamber paracentesis was also contemplated but believed to be unnecessary.

What's Your Diagnosis?

For the correct answer, see page 263.

The answer for What's Your Diagnosis? is hypopyon associated with acute lymphoblastic leukemia.

References

  1. Ridgway EW, Jaffe N, Walton DS. Leukemic ophthalmopathy in children. Cancer. 1976;38(4):1744–1749.
  2. Schachat AP, Jabs DA, Graham ML, Ambinder RF, Green WR, Saral R. Leukemic iris infiltration. J Pediatr Ophthalmol Strabismus. 1988;25(3):135–138.
  3. Fonken HA, Ellis PP. Leukemic infiltrates in the iris. Successful treatment of secondary glaucoma with x-irradiation. Arch Ophthalmol. 1966;76(1):32–36.
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. Email: helen.h.yeung.md@gmail.com

10.3928/01913913-20200529-01

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