Aaron McCoy, MD, PGY3

5 mo previously healthy male presents because mom is worried his eyes just dont look right. He is able to follow objects with both of his eyes most of the time. His left eye does seem to wander sometimes.

PMH/SH: Born at 39.1 weeks, elective induction, vaginal delivery, APGARS 8 and 9, weighed 7 pounds 13 ounces. Maternal labs: Rubella imm, Hep B neg, VDRL neg, GBS neg. IMMS: UTD Meds: None Allergies: NKDA FH: Twin-sibling passed early in gestation. No other childhood illnesses in the family SH: Lives with mom, dad, 2 healthy sibs ROS: Otherwise healthy

Exam: Eyes: Able to fix and follow, corneal reflex normal, pupillary reflex normal bilaterally, Rest of exam unremarkable

Cataract Retinoblastoma Strabismus Anisometropia (unequal focus) Intraocular infections (Toxoplasmosis, Toxocariasis) Endstage ROP Retinal vascular disorders Coats disease (exudative retinitis) Ie. These are ALL vision or life threatening

A major cause of unilateral amblyopia Urgent surgery, optical rehabilitation and occlusion therapy is necessary in neonates and infants for any hope of good vision Diagnosis must be made prior to 6 weeks of age for best vision outcomes Unilateral cataract acquired after 2 years of age require prompt treatment to prevent loss of vision

Only rarely associated with systemic disease (80% are idopathic) A systemic work up is not needed in almost all cases 80% are idiopathic and 10% associated with trauma (must think about child abuse)

Much higher likelihood of being associated with systemic disease and a genetic basis 60% are idiopathic, 30% are hereditary (vast majority AD), 5% genetic and metabolic disease, 5% maternal infections and ocular abnormalities A systemic work up is needed in most cases