An Infant With Esotropia and Nystagmus
A 9-month-old, full-term healthy girl was referred to the pediatric ophthalmology service for evaluation of eye crossing. The crossing was noticed shortly after birth. It first occurred intermittently and then gradually became constant. Her parents felt that mostly the left eye was involved. They also noticed constant shaking of the eyes from the time the child was about 1-2 months of age. They reported that the child was otherwise completely healthy and developing normally. The pregnancy was unremarkable, and there is no family history of eye diseases. The review of systems was negative.
On examination, visual acuity in both eyes was uncentral, unsteady, and maintained. Motility was full. However, an esotropia of 30 prism diopters was measured with the right eye fixating, using the Krimsky technique. A pendular, large-amplitude nystagmus was also noted. Both pupils were reactive and showed no relative afferent pupillary defect. Anterior segment examination was unremarkable. Cycloplegic refraction was +0.50 diopters of sphere in both eyes.
Retinal photographs were taken of both eyes (Figures 1 and 2).
Figure 1. Retinal photograph of the right eye.
Figure 2. Retinal photograph of the left eye.
Clinical Presentation
A 9-month-old, full-term healthy girl was referred to the pediatric ophthalmology service for evaluation of eye crossing. The crossing was noticed shortly after birth. It first occurred intermittently and then gradually became constant. Her parents felt that mostly the left eye was involved. They also noticed constant shaking of the eyes from the time the child was about 1-2 months of age. They reported that the child was otherwise completely healthy and developing normally. The pregnancy was unremarkable, and there is no family history of eye diseases. The review of systems was negative.
On examination, visual acuity in both eyes was uncentral, unsteady, and maintained. Motility was full. However, an esotropia of 30 prism diopters was measured with the right eye fixating, using the Krimsky technique. A pendular, large-amplitude nystagmus was also noted. Both pupils were reactive and showed no relative afferent pupillary defect. Anterior segment examination was unremarkable. Cycloplegic refraction was +0.50 diopters of sphere in both eyes.
Retinal photographs were taken of both eyes (Figures 1 and 2).
Figure 1. Retinal photograph of the right eye.
Figure 2. Retinal photograph of the left eye.