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An 11-month-old girl with a retinal detachment
Digital Journal of Ophthalmology 2019
Volume 25, Number 2
May 11, 2019
DOI: 10.5693/djo.03.2019.02.004
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Vinay Badhwar, MBBS, BSc | Barts and The London, School of Medicine and Dentistry, London, United Kingdom Damien Yeo, MBBS, FRCOphth | Royal London Hospital, Barts Health Trust; Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom Samruddhi Joshi, BSc | Barts and The London, School of Medicine and Dentistry, London, United Kingdom Sui Chien Wong, MBBS, FRCSEdOphth, MRCOphth, PGC | Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom; Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom; Royal Free Hospital, London, United Kingdom Ashwin Reddy, MD, MBBChir, FRCOphth | Royal London Hospital, Barts Health Trust; Moorfields Eye Hospital NHS Foundation Trust,London, United Kingdom
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| Differential Diagnosis | In this case, the asymmetry of the red reflexes between the eyes identified the presence of pathology, which warranted an urgent diagnosis. The findings in this patient suggested Coats disease (stage 3B) as the most likely diagnosis. However, other conditions that produce retinal detachment or an abnormal red reflex in children are important to consider as differential diagnoses.
Retinoblastoma is an important differential consideration for leukocoria with a mass, because it is the most common primary ocular tumor in children. Other pediatric ocular tumors, such as choroidal melanoma, choroidal hemangioma, and medulloepithelioma are also important diagnoses. Leukocoria is also commonly seen in congenital cataracts.
The etiologies for retinal detachment in children differ from those in adults. A large proportion of pediatric retinal detachments are congenital in nature and include rare hereditary vitreoretinal conditions, such as familial exudative vitreoretinopathy, incontinentia pigmenti, Stickler syndrome, X-linked retinoschisis, Marfan syndrome, and Norrie disease.
In infants, developmental pathologies, such as persistent fetal vasculature and colobomas may be associated with retinal detachment, and retinopathy of prematurity is an important cause of retinal detachment in premature babies.
Retinal detachment may also occur because of trauma, inflammation, and infection; however, these usually present with more clues in the presenting history and have other signs of systemic involvement. | |
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