History
An 8-year-old white male presented to the office with a chief complaint of occasional double vision, most noticeable when he looked up to the left. He explained that the double vision had been there since last year and that it had not been getting better or worse.
He also complained about his vision being blurry while looking at the blackboard. He described his vision at near as fine with no double vision.
There was no history of childhood illnesses or trauma. There was also no history of current ocular or systemic disease, no use of medication, and no history of allergies.
Diagnostic Data
Uncorrected entering acuity was 20/50 at distance and 20/20 at near in each eye. Uncorrected cover test revealed 9 prism diopters of exophoria at near and 5 prism diopters of exophoria at distance. Confrontation fields were full O.U. Pupils were normal with no afferent pupillary defect. Stereopsis revealed normal depth perception. Versions demonstrated right eye restriction on elevation in the left gaze with the right eye restriction persisting on ductions. There was no restriction on elevation in the right gaze.
Refraction revealed myopia of -1.00D sphere O.U., correctable to 20/20 at distance and near. Corrected cover test revealed 5 prism diopters of exophoria in primary gaze at near. Base-in and base-out ranges at near were normal at blur/break/recovery of 12/19/13 and 18/22/19, respectively. Accommodative amplitudes and facility were normal. Accommodative convergence/accommodation (AC/A) ratio was 4/1, and vergence facility was normal at 11 cycles per minute (cpm).
The patient in this casean 8-year-old white malehad an external apprearance similar to the patient pictured above.
Biomicroscopy revealed normal anterior segment structures O.U. Intraocular pressure measured 19mm Hg in both eyes. Dilated fundus examination was unremarkable, with cup-to-disc ratio of 0.25 x 0.25 O.U. and no peripheral pathologies.
Your Diagnosis
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Thanks to Josephine Ibironke, O.D., for contributing this case.
