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Chronic External Progressive Ophthalmoplegia A 36-years-old female patient presents to pediatric ophthalmology clinic at BPEI for a second opinion regarding progressive bilateral ptosis and exotropia. The patient has a history of progressive bilateral ptosis OS>OD and limitation of ocular moveme…

RetCam photo with a bullous exudative retinal detachment. Angiography shows area of engorged vessels, telangiectasias and neovascularization. Ultrasound with moderate dense vitreous opacities and no calcifications. Surgery with external drainage was required for treatment.

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…

In this module, we will look at:




Extraocular Muscle


Introduction to Pediatric Ophthalmology

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,…

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…

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…

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

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…

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

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.

Coats Disease An infant presented with suspected retinoblastoma after undergoing an exam under anesthesia (EUA) with an outside provider. On repeat exam under anesthesia, there were no mass lesions identified on indirect exam or ultrasound. Indirect exam revealed powdery yellow exudative changes an…

Coats' Disease with Secondary Pseudoangiomatous Acquired Retinal Gliosis A healthy 6-year-old female was referred after she failed her school vision screening in the right eye. Exam revealed a visual acuity of count fingers (CF) at 1 foot in the right eye. Slit lamp examination was unremarkable. Fu…

Coats' Plus Disease An infant born prematurely via emergency cesarean section at 27-weeks due to IUGR and fetal distress weighting 650 g was referred for the evaluation of incomplete vascularization of the retina. After birth, the patient spent 117 days in the neonatal intensive care unit (NICU), w…

Combined Hamartoma of the Retina and Retinal Pigment Epithelium A 19-month-old girl with an unremarkable prenatal and infantile history presented with esotropia of the left eye and was found to have a vascularized mass concerning for retinoblastoma. Examination under anesthesia revealed a charcoal …

Familial Exudative Vitreoretinopathy A child with a history of full-term birth complicated by arrest of descent and resolved neonatal seizure with normal MRI and EEG was referred for evaluation of nystagmus. An examination under anesthesia was required, during which an electroretinogram demonstrate…

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…

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…

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…