An otherwise healthy patient without past ocular history presented with left eye irregular pupils since birth and no associated symptoms. The birth history was unremarkable. The examination under anesthesia was notable for visual acuity based on Teller Acuity Cards was approximately 20/70 in the right eye and 20/100 in the left eye and intraocular pressure was 18 in both eyes. The remainder of the examination showed posterior embryotoxon in the right eye and posterior embryotoxon with an eccentric pupil nasally and a nasal white avascular band of tissue from the iris to the cornea and an open angle on gonioscopy and ultrasound biomicroscopy. The axial length of both eyes were in the high normal range for the patient’s age and B-scan ultrasonography showed a flat retina and no masses in both eyes. Dilated fundus exam revealed bilateral findings of a normal posterior pole with a cup-to-disc ratio of 0.35 to 0.40. The patient was referred for genetics evaluation including genetic testing for Axenfeld-Rieger Syndrome which is currently pending. The patient was started on pharmacologic dilation in the left eye to maximize the visual axis and was referred to pediatric optometry specialists to consider neutralizing his anisometropia with corrective spectacles and patching therapy. The patient will be followed regularly to promote visual development and prevent ocular complications.
Presentation Date: 10/20/2022
Issue Date: 12/09/2022