The Baby With an Oval-Shaped Pupil

Nabeel Umer Moon; Kimberly G. Yen, MD


June 05, 2017

A 10-month-old child presents to the eye clinic with an abnormal spot in the left eye. The parents had noticed this abnormality since birth, stating that the child's pupil looked like it was oval.

The child was healthy, developing appropriately, and had no other known medical conditions. The parents felt that he could see well at home, and there was no evidence of eye misalignment. The child was not photophobic.

On exam, the child was able to fix and follow with each eye separately (Figure).

Figure. The patient's left eye on visual inspection.

There was no preference with base down prism testing. The patient was orthophoric, and the external exam was normal.

The anterior segment exam showed the right eye to have a round, reactive pupil and the left eye to have a teardrop-shaped pupil. No afferent pupillary defect was present. The rest of the anterior segment exam was otherwise normal.

The fundus exam showed no abnormalities, and the patient was +2.00 in both eyes, with cycloplegic refraction.


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