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Answers: 2006 Series -  October 24, 2006 Lecture 10 of 52  NEXT»

To see views enlarged, click on the individual pictures...

This 5-year-old girl was said to have crossed eyes since shortly after birth.  The family reports that the right eye is the one that is crossed.  Visual acuity is: OD 20/200 and OS 20/20. Refraction is: OD +0.50 , OS +0.75.  The girl looks as seen in the photo above.

1.  The most likely diagnosis is:    
 

d -- congenital esotropia and amblyopia

The most likely cause for this clinical picture is congenital esotropia with amblyopia, but more needs to be done to confirm the diagnosis and plan the treatment.


 

2.  The appropriate initial treatment would be:   
 

c -- amblyopia therapy

Given the most likely diagnosis is congenital esotropia with amblyopia, the initial treatment should be aimed at the amblyopia.  The esotropia should be treated with surgery after the amblyopia treatment has achieved the maximum visual improvement possible.


 

3.  Before taking the next step with this patient the doctor should: 
 

e -- all of the above

It is important to rule out an organic lesion in the right eye as a cause of the reduced vision, but it is necessary also to take a careful look at the preferred left eye.  It is always good practice to ask about a positive family history.  If there is any doubt about the vision loss being functional it can be confirmed by demonstrating a greater relative loss of vision in the better seeing eye under scotopic conditions.

With regard to having a good look at the left eye, click here to see the disc and macular of the left eye.

 


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