![]() While you consider your differential, you rule out congenital cataracts on the basis of normal visual acuity and lack of pupillary cloudiness on exam. Visual acuity remains at 20/20 in both eyes, and color vision is normal. The optic disc, macula, and retinal vessels appear to be normal. Both pupils are equal, round, and reactive to bright light in a darkened room, and you note that red reflex is present bilaterally on direct ophthalmic exam.ĭirect ophthalmoscopy further reveals that the visual axis is clear without any obstructing mass or cataract. Extraocular muscle function is normal bilaterally (without manifest or latent strabismus). External examination of the eyes and adnexae reveals no abnormalities. The patient’s outward appearance and behavior are unremarkable. You consult several reliable references for additional causes of unilateral leukocoria (Table). You concur with the mother that this is also your most serious diagnosis. The child’s mother tells you that she performed an Internet search and that her biggest concern is the possibility of a malignant tumor in her child’s eye. You also see that there is no family history of ocular problems or cancers, and you confirm that this remains true. On review of the patient’s chart, you see that at her recent well-child checkup, her visual acuity was 20/20 in both eyes, and color vision was normal bilaterally. The patient denies having any pets, and she has not had any recent contact with animals. The child has not been taking any prescribed or over-the-counter medications. The patient and her mother deny ocular complaints such as visual disturbance, eye pain, proptosis, strabismus, or signs of intracranial dysfunction. The patient’s mother denies infections during pregnancy, and the patient has not had any serious illnesses or hospitalizations. On careful history, you learn that the mother delivered a healthy baby without any neonatal problems.
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