R Venkataramanan

R Venkataramanan

R Venkat's Blog

R Venkat's Blog
"To be an Inspiring Teacher,one should be a Disciplined Student throughout Life" - Venkataramanan Ramasethu

SNK

SNK

Thursday, October 27, 2011

Pediatric Retinal Detachment


Patient Presentation

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.

Discussion

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

Learning Point

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

Cataract

Corneal opacity

Glaucoma

Hypopyon (i.e. white blood cells accumulating in the anterior chamber)

Congenital abnormalities

Coloboma of retina, choroid or optic nerve

Incontinentia pigmenti

Myelinated nerve fibers

Myopia, high

Norrie disease

Persistent hyperplastic primary vitreous

Retinal detachment

Retinal fold

X-linked retinoschisis

Infection

Toxocara

Inflammation

Endophthalmitis

Uveitis

Neoplasia

Retinoblastoma

Medulloepithelioma

Trauma

Foreign body

Retinal detachment

Retinal fibrosis

Vitreous hemorrhage that is organizing

Vascular abnormalities

Choroidal hemangioma

Coats’ disease

von Hippel disease