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Juvenile Myasthenia Gravis A child previously healthy, presented to the ED with his mother for new onset right upper eyelid ptosis of few weeks duration. History was significant for variability in eye alignment over the past few months. Exam was notable for right upper eyelid ptosis with MRD1 of -2…

Juvenile X-linked Retinoschisis A pediatric patient with a past medical history of Kawasaki disease presents for retinal evaluation of reported vitreous hemorrhage in the right eye and retinal detachment in the left eye. The visual acuity was 20/200 in the right eye and 20/800 in the left eye. The …

Knobloch Syndrome An infant presented to the eye clinic with nystagmus. The patient underwent examination. Initial eye examination revealed horizontal nystagmus, a midline occipital scalp lesion, hypoplastic macula in both eyes, and high myopia (greater than -15.0 D in both eyes). Given a family hi…

Marfan Syndrome with Ectopia Lentis A young child presented to the ophthalmology clinic with blurry vision. Slit lamp examination was notable for superotemporally subluxed lenses in both eyes, along with a tall slender body frame. Due to these findings, the patient was referred to a geneticist and …

Ocular Neuromyotonia A child with a history of left exotropia secondary to a congenital third nerve palsy treated with strabismus surgery and ptosis repair presented with sudden onset intermittent left upper lid twitching and involuntary eye movements. Patient had no previous history of intracrania…

Oculocutaneous Albinism A 12-year-old female with a history of OCA was referred to the retina clinic for evaluation. She had no significant family history. Best corrected visual acuity was 20/80 in the right eye and 20/70 in the left eye. On exam she was noted to have nystagmus and a small angle in…

Optic Disc Drusen with Structural and Functional Changes A young child presented with crossing of the eyes without headaches or associated neurologic symptoms. Visual acuity was OD 20/30 and OS 20/40. Motility examination demonstrated moderate angle esotropia with full versions. Intraocular pressur…

Optic nerve cyst (first image) that over time revealed an optic nerve coloboma (second image).

In this module, we will look at:




Extraocular Muscle


Introduction to Pediatric Ophthalmology

Persistent Fetal Vasculature This patient with past ocular history of leukocoria was referred forretinal evaluation. Ophthalmological evaluation under anesthesia was notable for a cataractous lens with spherical appearance,anterior segment dysplasia andpersistence of the iridohyaloid vessels and tu…

Pulled-in-Two Syndrome A 61-year-old female with longstanding left sixth nerve palsy secondary to meningioma that was resected. Her visual acuity OD was 20/20, OS 20/40. Her traction testing OS revealed severe restriction to abduction. She had visual confusion with superimposition of the images tha…

Restrictive Strabismus and Brown Syndrome Secondary to Graves’ Disease A 68-year-old male with restrictive strabismus and Brown syndrome with extraocular movement restriction secondary to TED. He was on clinical trial for Teprotumumab 302 and had prior RAI ablation. His visual acuity OD is 20/20,…

Retinal Cavernous Hemangioma with Vitreous Hemorrhage A five-week-old full-term male with a history of seizures and birth trauma underwent ophthalmology screening. Initial eye examination revealed vitreous hemorrhage. Subsequent examination under anesthesia with multi-modal imaging revealed vitreou…

Retinopathy of Prematurity An 19-year-old woman presented with decreased vision in the right eye and was found to have a retinal detachment. She had a history of retinopathy of prematurity as an infant and had been treated with laser photocoagulation. Treatment for retinopathy of prematurity in the…

Simple Corectopia 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 approximate…

Slipped Medial Rectus Muscle A patient with history of childhood esotropia presented to our clinic. She reported experiencing binocular visual confusion/jumping images and eye pain in the right eye. The patient was previously treated with prism glasses. Her exam was notable for a comitant esotropia…

A patient with slipped right medial rectus 5 days after recession of medial rectus muscle in both eyes, intraoperative images showing slipped muscle.

Strabismus Secondary to a Glaucoma Drainage Implant A 10-year-old female was referred to the clinic for strabismus evaluation. She had a complex past ocular history including a congenital cataract OD s/p CE/IOL OD at 8 weeks old, RXT s/p RLR recession and RMR resection, IOL dislocation s/p PPV/lens…

Sturge Weber Syndrome An infant presented to clinic as a referral due to a cloudy right cornea and port wine birthmark. The parents did not notice any abnormal behavior from the infant. The patient’s intraocular pressure was 28 and 14, but limited exam was possible in the office setting. An exam …

Sturge-Weber Syndrome A child was born with an extensive, bilateral, flat, red facial skin lesion that was initially flat and barely noticeable but over time has grown and become thicker and a deeper red color. He was born at term to a healthy mother, had no other lesions on his body, no other symp…