As the worm turns: An infant with exotropia
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Published on: March 24, 2020
Lauren Hennein1, Alejandra G de Alba Campomanes1, Armin R Afshar1
1Department of Ophthalmology, University of California San Francisco, San Francisco, California, USA.
Insights
A pediatric ophthalmology case details a two-year-old boy with a retinal granuloma. Topical steroids effectively resolved subretinal and intraretinal fluid, indicating successful treatment for this pediatric eye condition.
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.
Abstract:
A two-year-old full-term boy with a history of an intermittent exotropia presented to the pediatric ophthalmology clinic for routine follow-up. He was found to have a stable sensorimotor examination however dilated funduscopic examination of the right eye was significant for a dim foveal reflex with a new discrete, white, elevated retinal lesion superotemporal to the fovea with surrounding subretinal exudates. An examination under anesthesia (EUA) was performed two days later that revealed a subretinal posterior pole granuloma with hyperfluorescence and late leakage from the lesion without telangiectatic vessels on fluorescein angiography. A repeat EUA one month later demonstrated an increase in surrounding subretinal and overlying intraretinal fluid. The patient was started on topical 1% prednisolone with a presumed diagnosis of Toxocara granuloma. At EUA, three months later, the subretinal and intraretinal fluid had resolved. The topical steroids were tapered, and the patient continues to be followed closely.
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