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