Case Presentation

Dr. Amreen H. Deshmukh

Chief Complaints

A 2 year old female child was brought

by parents to OPD with chief

complaints of

White opacity in both eyes since birth

Poor vision in both eyes since birth

Forward protrusion, redness and

watering from right eye since 15 days

History of Present Illness

History narrated by parents

Parents had noticed white opacity in both

eyes since birth.

It increased in size progressively.

No medical advice was sought for the

same

Child did not look at her mother or smile

She did not reach for objects held in front

of her

H/o repeated falls

Contd.

15 days back she developed forward bulging of right eye associated with pain, redness and watering

It increased progressively to reach present state.

Associated with malaise, lethargic behaviour

No h/o fever No h/o squinting in either eye No h/o previous attacks of pain, redness

and watering No h/o NICU admission, Oxygen therapy

Contd.

No h/o maternal infection during

pregnancy

Not a/w mental retardation

No h/o pets like dogs or cats

No h/o recurrent attacks of cold,

sinusitis

No h/o convulsions.

Past History

No h/o hospital admissions in past

No h/o major surgeries in past

No h/o TB, bronchial asthma

Family History

No h/o consanguinity

No h/o similar illness in siblings

No h/o eye loss in other family

members

Father

16 yrs Female

11 yrs

Female

Mother

6 yrs Male

2 yrs

Female

Birth History

FTND

At home

Baby cried at birth

Birth weight- 2.5 kg

No h/o NICU admission, Oxygen

therapy

No vaccination given at birth

Immunization History

Well immunized till date

Status of BCG vaccination- uncertain

Developmental History

Milestones delayed

Verbal and motor both

Personal History

Sleep- disturbed

Appetite- Reduced, breast fed,

Weaning started

Bowel/ bladder habbits- altered

General Examination

Patient is conscious, irritable

Child appears malnourished

GC- fair

Pulse- 102/min

B. P. – 100/60 mm of Hg

R. R. – 18/min

e/o Pallor +

Contd

No e/o icterus, cyanosis, clubbing

No e/o lymphadenopathy, cervical or

pre-auricular

No e/o pedal oedema

Systemic Examination

CVS- S1, S2 heard

RS- AEEBS

P/A- soft, non-tender

CNS- Patient is conscious

Ophthalmic Examination

Patient is highly uncooperative for

examination

Head Posture- Normal

Facial Symmetry- altered d/t Proptosis

RE

Eye alignment- cannot be judged

EOM- Right eye- Restricted

Left Eye- Full and free in all

directions of gaze

Proptosis Evaluation

RE Axial Proptosis

Rest measurements not possible

Palpation

◦ Non- reducible

◦ Firm to hard consistency

Right Eye Left Eye

Eyebrows Normal Normal

Eyelids Edema+ Normal

Eyelashes Matted Normal

IPF Increased Normal

Conjunctiva Conjunctival Congestion

severe Chemosis

Circumcorneal

Congestion

Right Eye Left Eye

Cornea Hazy d/t Exposure

Keartopathy

Clear

Anterior Chamber Leucocoria

Rest details not

appreciated

Shallow, Whitish

membrane in ant

chamber, Blood

stained

Iris CPA, Whitish

membrane over iris

Pupil Details not seen

Pupillary Aperture Leucocoria blood tinge

seen over surface

Lens

Right Eye Left Eye

Fundus No glow No glow

Vision Patient doesn’t follow

light

Patient doesn’t follow

light

IOP Cannot be judged DF increased

Sac NROP NROP

Clinical Photographs

Provisional Diagnosis

Both Eyes Leucocoria with Right Eye

Axial Proptosis with Exposure

Keratopathy with Left eye

Differential Diagnosis

Retinoblastoma

Orbital Cellulitis

Congenital Cataract

Persistent Hyperplastic Primary

Vitreous

Retinopathy of Prematurity

Ocular Toxocariasis

Investigations

Routine Haematological Investigations

Biochemical Investigations

USG-B scan

CT Brain with Orbit with axial and

coronal sections 2mm slice thickness

MRI Brain with orbit

Chest X-ray

USG- Abdomen pelvis

CSF cytology

Bone marrow biopsy

Technetium-99 bone scan

PET- CT

Aqueous LDH,

Phosphoglucoisomerase

THANK YOU !!!