This case study highlights the importance of a comprehensive eye examination with pupil dilation early in life, regardless of the presence or absence of signs and/or symptoms of pathology.
Recently, a 4-year-old African American male presented for his first eye examination. As per the child’s mother and father, the chief complaint was that he had failed a vision screening at his pediatrician’s office for the reasons of hyperopia and astigmatism in the right eye.
Observation the child walking back to the examination room showed a normal gait and overtly good attention to his surroundings. Medical history was unremarkable, and he was taking no medications. He also had no known medication or environmental allergies. Family history was remarkable for cataracts, high blood pressure, and glaucoma.
Entering uncorrected distance visual acuities by means of Allen pictures were 20/400 and 20/25 for the right eye and left eye, respectively. Near visual acuity was 20/20 with both eyes open. Color vision was normal for the left eye and was unable to be tested for the right eye. There was no frank stereopsis present.
The patient was not fully cooperative for cover test assessment, but Hirschberg testing showed no overt strabismus. Pupil testing, extraocular muscle function, and visual field assessment by means of quadrant screening were all unremarkable as well.
Anterior segment examination showed clear corneas, intact irides, open angles, and quiet lids, lashes, and conjunctivae. Anterior chambers were deep and quiet. Intraocular pressure measurements by means of rebound tonometry were 9 mm Hg in the right eye and 10 mm Hg in the left eye.
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