As the worm turns: An infant with exotropia

Area of Science:

• Ophthalmology
• Pediatric Ophthalmology
• Parasitology

Background:

• A two-year-old boy presented with intermittent exotropia.
• Funduscopic examination revealed a new retinal lesion with subretinal exudates.

Purpose of the Study:

• To describe the clinical presentation and management of a pediatric retinal granuloma.
• To evaluate the efficacy of topical steroids in treating subretinal and intraretinal fluid associated with a presumed Toxocara granuloma.

Main Methods:

• Clinical examination including funduscopy and examination under anesthesia (EUA).
• Fluorescein angiography to characterize the retinal lesion.
• Treatment with topical 1% prednisolone.
• Serial examinations under anesthesia to monitor fluid resolution.

Main Results:

• Examination under anesthesia revealed a subretinal posterior pole granuloma with hyperfluorescence and late leakage.
• A repeat EUA showed increased subretinal and intraretinal fluid.
• Following treatment with topical steroids, resolution of subretinal and intraretinal fluid was observed.
• The patient's condition improved with steroid tapering.

Conclusions:

• Topical steroids appear effective in managing inflammatory fluid associated with pediatric retinal granulomas.
• Close monitoring is essential for patients with presumed Toxocara granuloma.
• Further research may be warranted to explore long-term outcomes and alternative treatments.