Pediatric Eye Exam Case Study

Study Notes

Patient Information

Emma Watson, a 6-year-old female, presented for an eye exam on March 15, 2024
Her mother reported that Emma's right eye has been turning inward for the past year, especially when tired or focusing on distance objects.
Emma's eye misalignment has become more noticeable in recent months.

History

Emma's eye misalignment began 12 months ago, initially subtle and intermittent, but now increasing in frequency.
Emma complains of occasional double vision and difficulty focusing at school, especially while reading.
Emma sometimes tilts her head slightly to the right to improve her focus.
Emma has no history of past eye surgeries or trauma.

Examination

Visual acuity: Right eye: 20/40, Left eye: 20/20
Ocular Examination:
- Hirschberg Test: Light reflex deviation in the right eye, indicating esotropia (inward deviation)
- Cover Test: Upon covering the left eye, the right eye moves outward to take up fixation, confirming right esotropia.
Extraocular Movements (EOM): Full range of motion, no restrictions observed
Pupils: Equal, round, reactive to light and accommodation
Fundoscopy: Normal findings, no evidence of retinal abnormalities or optic nerve issues.

Diagnosis

Right eye intermittent esotropia (squint)
Amblyopia (reduced vision) in the affected eye

Differential Diagnosis

Concomitant Esotropia: Likely, given age of onset and absence of neurological signs.
Accommodative Esotropia: To be confirmed by refractive error evaluation
Paretic Strabismus: Unlikely, as no limitation in extraocular movements or history of trauma.

Management Plan

Refractive Error Correction: A cycloplegic refraction test will be conducted to assess for refractive error, specifically hyperopia (farsightedness). Prescription glasses may help control the esotropia if accommodation is a contributing factor.
Amblyopia Treatment: Occlusion therapy (patching) of the left eye (dominant eye) for several hours a day to encourage visual development in the right eye.
Follow-up: Every 3-4 months to assess improvement in alignment and vision. Adjustments to glasses or therapy may be needed based on progress.
Surgical Consultation: Referral for possible strabismus surgery (to align the eyes) will be considered if the strabismus doesn't improve with glasses and amblyopia treatment.

Patient Education

Mother was educated on the importance of adhering to patching therapy to treat amblyopia and prevent long-term vision loss.
Discussed the possibility of needing glasses or surgery, depending on the severity and persistence of the squint.
Advised to return to the clinic immediately if Emma develops any new symptoms, such as worsening vision, pain, or significant changes in eye alignment.

Conclusion

Emma is a 6-year-old girl diagnosed with intermittent esotropia and amblyopia of the right eye.
Initial management will focus on correcting any refractive error and treating the amblyopia.
Follow-up is essential to monitor progress and consider additional interventions if necessary.

Next Appointment

June 25, 2024

Description

This quiz examines a detailed case of a 6-year-old girl, Emma, who presents with eye misalignment and related symptoms. It covers her clinical history, examination findings, and diagnostic tests, highlighting conditions such as esotropia. Test your understanding of pediatric ophthalmology and eye examination techniques.