Thursday, October 27, 2011
Pediatric Retinal Detachment
A previously full-term, 2-month-old male came to clinic for his health supervision visit. His parents reported that he was doing well including no concerns about his vision or hearing.
The pertinent physical exam showed an infant with growth parameters in the 75-90%. On his visual examination he showed some turning of his head with the cover test when his right eye was occluded.
His ophthalmologic examination showed a white/gray pupillary reflex in the left eye. The anterior chamber and lens appeared normal. Posteriorly, no normal landmarks could be seen and the white/gray coloration had a “bubbly” quality to the heterogeneity.
The right eye showed a normal red reflex and normal retinal vessels and part of the optic disk. The rest of his examination was normal.
The parents continued to say that they and no other family members or friends had noticed any abnormalities and he was otherwise well. They also denied trauma.
The work-up was an immediate consultation with a pediatric ophthalmologist and the diagnosis of unilateral retinal detachment was made. He was taken to the operating room and had the detachment surgically corrected.
At follow-up two months later, the surgical correction was intact and he had a myopia which was being treated with glasses. Although he had no obvious physical abnormalities associated with a congenital syndrome, he was referred to genetics for consultation.
Retinal detachment is not common in infants and children and usually is caused by trauma or retinopathy of prematurity. There are 3 types:
Rhegmatogenous (most common) – where a hole or tear in the retina develops with build up of fluid underneath the retina and subsequent lifting of the retina away from the underlying tissues
Traction (second most common) – where the retina is pulled away from the underlying tissues
Exudative – where subretinal fluid accumulates between the retina and the underlying tissues
Leukocoria can be caused by congenital or acquired eye diseases. This is an ophthalmologic emergency particularly because of the need to promptly diagnose and treat conditions such as retinoblastoma, glaucoma, retinal detachment and infections.
The differential diagnosis of leukocoria includes:
Anterior chamber or lens abnormalities
Hypopyon (i.e. white blood cells accumulating in the anterior chamber)
Coloboma of retina, choroid or optic nerve
Myelinated nerve fibers
Persistent hyperplastic primary vitreous
Vitreous hemorrhage that is organizing
von Hippel disease
Posted by Venkataramanan Ramasethu