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This is congenital retinal dystrophy is caused by a mutation in the retinoschisin (RS1) gene, which encodes for a protein that functions in cellular adhesion. The fundus photo shows a macular stellate pattern caused by schisis or splitting of the retinal layers at the level of the outer plexiform l…

Fundus photo with retinal arteriovenous malformation emanating from the nerve. FA shows filling of the vessels without leakage. MRI is needed to assess for intracranial AVMs.

Fundus photo with central and peripheral retinal atrophy as well and bone spicule RPE changes. This patient also had characteristic hearing loss.

Traumatic Transection of a Lateral Rectus Muscle by a Zygomatic Implant Zygomatic implants can be used to support dental prostheses in patients with inadequate maxillary bone volume. While maxillary sinusitis is the most common reported complication of ZI placement, rarely, intraorbital penetration…

The temporal toxocara lesion led to sub retinal exudation, macular fold and tractional retinal detachment. Surgery was performed with pars plana vitrectomy.

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…

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…

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…

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…

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,…

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…

In this module, we will look at:




Extraocular Muscle


Introduction to Pediatric Ophthalmology

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

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…

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…

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…

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…

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…

Iatrogenic Medial Rectus Transection Patient presented with acute onset binocular horizontal diplopia and an incomitant left exotropia with severe, but not complete adduction deficit. On orbital imaging, the medial rectus appeared to be completely transected, however the patient maintained some add…

Hermansky-Pudlak Syndrome An infant was brought to the emergency department by his mother referred from his pediatrician after a routine well-child visit. Parents had noticed severe light sensitivity, but patient was otherwise developing well. Patient grimaced to light in both eyes but had poor fix…