Sunday, February 27, 2011

Paediatric Optometry Case 9: 18months old/M/F

·         Parents noticed her RE looks deviates in especially from photo taken
·         She has twin and their development normal
·         Has Chinese bloodline
·         Generally healthy
General Observation
Broad nose bridge
Small PAS on RE compared to LE
VA (unaided) at 57cm using Lea Grating Test
BE: 8.00cpd
Retinoscopy (estimated)
<10° to temporal
Hirschberg after pull the epicanthal fold
Centre and symmetry
SAFE (no V pattern)


Diagnosis: ??
Management: ?

Please think of;
1)      The Exact diagnosis.
2)      Proper management.
3)      The prevalence in paediatric.

prepared by Group 2 :)


  1. how about his cover test??
    any finding?

  2. 1. I think the diagnosis would be pseudoesotropia.

    2. Management would be spectacle correction since patient is antimetropia. However before spectacle prescription can be prescribe we have to monitor the stability of the refractive error. 3X follow up with interval of 3 months are encourage before any correction is given.

    3. Pseudoesotropia is common among Orientals origin.

  3. the information given is inadequate. it's difficult to diagnose this patient.

    Supposingly, if we were to diagnose patient with pseudoesotropia, the corneal reflex should be center and symmetry with both pulling the epichantal fold or not. The clinical findings seemed to be not convincing enough.

    was the doctor using forcep during delivery?

  4. i was once encountered this type of patient once. the presence of epichantal fold cause the eyes look as if tropia was there but it is not.

    i agree with is pseudotropia.

    looking at the age, the emmetropization is still going on. At this age, her RX was suppose to be hyperopic right?? ermm...pls enlighten me..

    since emmetropization is still going on, stability of the RX need to be monitored first by 3X follow up before any prescription given.

    this type of case is more prevalent among chinese with wide nose bridge

  5. 1. i think it was RE pseudoesotropia due to epichantal is common among chinese population

    2. at this age, the Rx suppossed to be, we need to monitor this patient in 3 visit n focus on Rx n visual acuity...

  6. i wonder if this is pseudoesotropia case due to epichantal fold, the Hirshberg should be central and symmetry right? but for this patient it isn't. so im a bit confused here.someone help me please?



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