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Answers: 2009 Series -  May 12, 2009 Lecture 34 of 52  NEXT»

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This child is now 2 years old. He was brought in for examination by his parents who reported that, except for the obvious problem with the right eye, the child is healthy. There was a normal pregnancy and delivery and normal development except for the mass in the right orbit that is slowly enlarging. There is no family history for this type of problem and two older siblings are normal. Examination of the left eye was normal.

1. The most likely diagnosis is:

c -- microphthalmos (colobomatous) with cyst

This is an example of microphthalmos with a colobomatous cyst protruding from the inferior aspect of the small globe with the mass protruding in the lower lid area. These cysts can enlarge with time.

Above is the clinical picture of a 1-year-old girl with an enlarging mass in the right lower lid. The CT images show the large cyst with a smaller shadow most likely representing the small eye. The fellow eye is normal. The colobomatous cyst arises from a failure of normal closure of the fetal fissure. Microphthalmos with cyst is rare, usually unilateral, has no sex predilection, and is usually sporadic. However other forms of coloboma can be inherited.

2. Regarding the left eye:

d -- both (a) and (c) are correct

This lesion will not affect the left eye, but as the child matures, it would be advisable to wear safety glasses.

3. The best treatment would be:

a -- enucleation and placement of an orbital implant followed by a cosmetic prostheses

This condition is treated with enucleation, placement of an orbital implant and fitting of a cosmetic prosthesis.


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