A four-week-old Caucasian female (born at 39 weeks via C-section, no complications during pregnancy or delivery) with past medical history only significant for bilateral club feet was brought in by her mother for “drifting of the right eye” and “cloudy” appearance of the pupil noted since birth. No significant family ocular history is reported by the mother. The patient did not react to a light stimulus shining on the right eye but did on the left eye. There was a notable right exotropia, but motility was full by doll’s head maneuver. Slit lamp exam of the right eye is demonstrated in the photo; the left eye appeared normal.

15 comments

  1. I think that DDX is a list of conditions that can not be differentiated unless we run some investigations.
    I hope If the list of DDX is revised.

    1. A differential diagnosis is the list of diagnostic possibilities that exist from preliminary information obtained on history or examination. Further history, examination and testing allows one to refine the broad list of possible diagnoses down to a more limited number or only one possible diagnosis.

  2. Congenital cataract and ehe deviation in the eye indicate abnormal retinal coresponde due to amblyopia

    1. With a significant cataract, there is no retinal correspondence as the image is too obscurred. In a case like this, the exotropia would best be described as “sensory deprivation strabismus” which can be either esotropic (more common of congenital conditions) or extropic (more common of aquired conditions… but these rules are not definite).

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