A 18-year-old female with unilateral extensive myelinated nerve fibers, high axial myopia(-17 D), and deep amblyopia. Straatsma syndrome is a rare disease entity characterized by the traditional triad of unilateral myelinated retinal nerve fibers (MNRF), axial myopia, and am…

The figure shows an incidental finding of bilateral juvenile retinoschisis with a partial macula-off retinal detachment found in a non-verbal, developmentally delayed, 5-year-old male during a baseline exam under anesthesia.

Bilateral nonspecific orbital inflammation (orbital pseudotumor) in an 11-year old boy with a 1-week history of eye pain. Ocular rotation was markedly limited in all directions. CT confirmed proptosis and showed enlargement of all extraocular muscles. Laboratory workup was…

Dystopia canthorum in a patient with Waardenburg syndrome. Notice that the vertical lines drawn through the puncta intersect the cornea.

Recognition visual acuity testing. A, LEA optotypes; screenshot of an American Association for Pediatric Ophthalmology and Strabismus iPad application for visual acuity screening. B, Crowding bars around a single-letter optotype displayed on a clinic monitor for distance vis…

Newborn with congenital glaucoma (right eye), buphthalmose.

Atropine penalization of right eye for strabismic amblyopia of the left eye. Upper photo demonstrates fixation at near. Lower photo demonstrates fixation at distance.

Congenital double lower lacrimal puncta are rarely reported.

Groups of fetal nuclear fibers (N = 40 secondary fiber cells); imaginary pole is included to facilitate perception of lens shape. (A) Neither secondary fibers with opposite end curvature nor those without opposite end curvature extend from pole to pole. (B) Arrangement of se…

Strabismus is the most common underlying cause of amblyopia.

Mechanical or surgical procedures are often indicated. For example, congenital cataracts, if significant, must be removed at the earliest possible age. Good visual acuity can be obtained if the cataract is removed before the patient reaches 1 to 2 months of age, although the…

There is no simple test to quantify an infant’s visual acuity that is available for use in an office setting. The ophthalmologist may use preferential looking tests or more involved testing methods for such quantification, but these are fairly time-consuming and are not inte…

If both eyes are amblyopic, an infant may present with such features of poor vision as a failure to fix and follow an object, wandering eye movements, rhythmic shaking of the eyes (nystagmus), or unusual habits such as eye-poking or hand- waving.

Parental concern may initiate the evaluation for amblyopia. Parents may note that their child’s eyes “look different”. Careful examination may reveal such serous concerns as a white pupillary light reflect (leukocoria, top) or an abnormally large cornea, indicating possible…

In a child with an abnormal head turn or tilt, it is important to place the head in a normal position to check for strabismus, since the child’s preferred head position may hide certain forms of strabismus. Conversely, an ocular misalignment may exist only in one direction o…

Focusing the Image. Infants and children with high refractive errors require glasses. or contact lenses to achieve good vision and avoid amblyopia. The ophthalmologist can objectively quantify an abnormal refractive error by altering the quality of the red reflex obtained…

Patching, or occlusion, therapy is the mainstay of amblyopia treatment. Patching the unaffected or better-seeing eye provides monocular stimulation to the amblyopic eye, promoting more normal visual development. Occlusion therapy is prescribed to improve visual acuity and, a…

Sixth nerve palsy, left eye. A, Right gaze. B. Esotropia in primary position. C, Limited abduction, left eye. D, Still incomplete but further abduction of left eye when fixating, a finding important in the plan for surgical correction.

Posterior capsulotomy creation via pars plana approach after pediatric lensectomy and IOL insertion.

Cortical regrowth and capsular phimosis after IOL implantation with primary posterior capsulotomy.

Slit lamp (a) and red-reflex illumination (b) of visual axis opacifications after IOL implantation

The Bruckner Test is an extremely useful test in the diagnosis for esotropia using a bright coaxial light source.

Corneal trauma with a bottle in a one year-old child causing pupillary displacement.

Mixed staphyloma anterior plus ciliary which is cosmetic blemish on a 4-year-old young boy.

Iris retroillumination in ocular albinism.