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   Table of Contents      
PHOTO ESSAY
Year : 2019  |  Volume : 67  |  Issue : 4  |  Page : 551-552

Pediatric keratoconus misdiagnosed as meridional amblyopia


Department of Ophthalmology, Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, India

Date of Submission22-Oct-2018
Date of Acceptance05-Jan-2019
Date of Web Publication22-Mar-2019

Correspondence Address:
Monica Lohchab
B-448 Sector-1, Rohini, New Delhi - 110 085
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_1496_18

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  Abstract 


Keywords: Corneal collagen cross linking, meridional amblyopia, pediatric keratoconus


How to cite this article:
Arora R, Lohchab M. Pediatric keratoconus misdiagnosed as meridional amblyopia. Indian J Ophthalmol 2019;67:551-2

How to cite this URL:
Arora R, Lohchab M. Pediatric keratoconus misdiagnosed as meridional amblyopia. Indian J Ophthalmol [serial online] 2019 [cited 2019 Apr 23];67:551-2. Available from: http://www.ijo.in/text.asp?2019/67/4/551/254715




  Case Report Top


A series of five children in the age group of 9–14 years were referred to our outpatient department from different primary centers with a diagnosis of anisometropic meridional amblyopia.

According to the past records [Table 1], corrected distance visual acuity (CDVA) with glasses in the affected eye ranged from 6/24–6/12 with myopic astigmatism of −2 to −3.5D. With a diagnosis of meridional amblyopia, occlusion of normal eye with patching was initiated. Contact lens trial or tomography was not done. Referral was done after a period of 6–8 months, as vision worsened despite the occlusion therapy.
Table 1: Summary of data of five cases of pediatric keratoconus misdiagnosed as meridional amblyopia

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At presentation to our center, progression from −3D to −5D (mean) of myopic astigmatism in 4 out of 5 (80%) patients, raised the suspicion of keratoconus [Table 1]. Two patients gave a history of allergic eye disease. Biomicroscopic signs (Vogt's striae and ectasia) were evident in two cases. Orbscan confirmed keratoconus [Figure 1] and [Figure 2] and CDVA improved to 6/6 with contact lens in all five children. A diagnosis of keratoconus without underlying amblyopia was made. Collagen cross linking followed by contact lens prescription was done for visual rehabilitation.
Figure 1: Case 1: Orbscan quad map of a right eye forme fruste keratoconus (KC) (OD) and the left eye with KC (OS). The left eye was misdiagnosed with meridional amblyopia

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Figure 2: Case 2: Orbscan quad map of a normal right eye (OD) and the left eye with keratoconus (OS). The left eye was misdiagnosed with meridional amblyopia

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  Discussion Top


Despite the reported high incidence of pediatric keratoconus in South-East Asia,[1],[2] it was misdiagnosed as amblyopia. Pediatric keratoconus is more likely to have rapid progression and may present at advanced stage with marked diminution of vision, even hydrops.[3],[4],[5]

This report highlights the issue of difficult diagnosis and rapidly progressive nature of pediatric keratoconus. Corneal tomography is recommended in children with myopic astigmatism and steep keratometry. Eye rubbing should be discouraged with proper management of allergic eye disease. Early diagnosis is crucial in this subgroup of patients to arrest the progression by early collagen cross linking.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Georgiou T, Funnell CL, Cassels-Brown A, O'Connor R. Influence of ethnic origin on the incidence of keratoconus and associated atopic diseases in Asian and white patients. Eye (Lond) 2004;18:379-83.  Back to cited text no. 1
    
2.
Saini JS, Saroha V, Singh P, Sukhija JS, Jain AK. Keratoconus in Asian eyes at a tertiary eye care facility. Clin Exp Optom 2004;87:97-101.  Back to cited text no. 2
    
3.
Léoni-Mesplié S, Mortemousque B, Touboul D, Malet F, Praud D, Mesplié N, et al. Scalability and severity of keratoconus in children. Am J Ophthalmol 2012;154:56-62.e1.  Back to cited text no. 3
    
4.
McMahon TT, Edrington TB, Szczotka-Flynn L, Olafsson HE, Davis LJ, Schechtman KB, et al. Longitudinal changes in corneal curvature in keratoconus. Cornea 2006;25:296-305.  Back to cited text no. 4
    
5.
Jonas JB, Nangia V, Matin A, Kulkarni M, Bhojwani K. Prevalence and associations of keratoconus in rural Maharashtra in central India: The central India Eye Medical Study. Am J Ophthalmol 2009;148:760-5.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1]



 

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