Brother with larger pupil since infancy and associated poor acuity

摘要

A 10-year-old boy with suspected ocular allergies recently described poor vision in one eye and was then referred by his pediatrician for further evaluation of confirmed poor acuity in the left eye. His parents reported him always seeing well and with no history of epiphora, photophobia, or corneal cloudiness. His mother had been reassured that his larger left pupil was an insignificant anomaly. Review of facial photographs from infancy confirmed the constant presence of an anisocoria and the larger diameter of the left cornea since 1 year of age. On eye examination, he appeared healthy with good fixation and following without nystagmus. Snellen visual acuity testing found an uncorrected acuity of 20/25 in the right eye and 20/60 in the left eye. Refraction measured minimal defect in the right eye and two diopters of myopia and astigmatism in the left eye. With correction, his acuity improved to 20/30 in the left eye. The left pupil reacted poorly to light and a definite relative afferent defect was present. The eye movements were full with no deviations. The anterior segment examination revealed clear corneas without breaks in Descemet's membrane and with estimated diameters of 12.5 mm in the right eye and 13.5 mm in the left eye.