A 3-year-old child with alternate convergent squint and abnormal movements of eyes since 1 year

ONE MINUTE OPHTHALMOLOGY

Year : 2019  |  Volume : 67  |  Issue : 1  |  Page : 7

Hypopigmented fundus in a young male

Nawazish Fatma Shaikh, Vinod Kumar
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India

Date of Web Publication

21-Dec-2018

Correspondence Address:
Dr. Vinod Kumar
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi - 110 029 
India

Source of Support: None, Conflict of Interest: None

Check

DOI: 10.4103/ijo.IJO_1834_18

 

How to cite this article: Shaikh NF, Kumar V. Hypopigmented fundus in a young male. Indian J Ophthalmol 2019;67:7

How to cite this URL: Shaikh NF, Kumar V. Hypopigmented fundus in a young male. Indian J Ophthalmol [serial online] 2019 [cited 2018 Dec 22];67:7. Available from: http://www.ijo.in/text.asp?2019/67/1/7/248137

Case

A 3-year-old boy presented with alternate convergent squint and abnormal movements of eyes since 1 year. Family and systemic history was unremarkable. The child had a best-corrected visual acuity of 20/100 in both eyes (OU). Ocular examination revealed pendular nystagmus and normal anterior segments in OU. Iris OU was brown-colored. Dilated fundus examination revealed a hypopigmented fundus with prominent choroidal vessels [Figure 1]a, [Figure 1]b. Macular pigments and foveal avascular zone (FAZ) were lacking in OU.

Figure 1: Dilated fundus examination revealed a hypopigmented fundus with prominent choroidal vessels (a and b). Macular pigments and foveal avascular zone (FAZ) were lacking in OU. Swept-source optical coherence tomography revealed an absent foveal contour and preservation of retinal layers in the foveal area (c and d) Click here to view

What is Your Next Step?

1. Refraction and optical coherence tomography (OCT)
2. Magnetic resonance imaging
3. Genetic analysis
4. Visual evoked potentials and electroretinogram

Findings

The child had a refractive error of + 3D in OU. Color vision was found to be normal for the child. Swept-source OCT revealed an absent foveal contour and preservation of retinal layers in the foveal area [Figure 1]c, [Figure 1]d. A diagnosis of ocular albinism and foveal hypoplasia was made, and the parents were explained about the prognosis. The child was prescribed glasses and was advised regular follow-up in addition to a strabismic evaluation.

Diagnosis

Ocular albinism with foveal hypoplasia

Correct Answer: A.

Discussion

Ocular albinism is an X-linked disorder in contrast to oculocutaneous albinism, which is inherited in a autosomal recessive manner.^[1],[2] Patients usually present with a variable decrease in visual acuity (visual acuity ranging from 20/60 to 20/400), nystagmus, strabismus, and photophobia. While oculocutaneous albinism is an easy diagnosis, ocular albinism may pose a diagnostic challenge as iris may not be hypopigmented.^[1],[2] The patients are frequently mistaken as having myopia as the fundus is lightly pigmented. Foveal hypoplasia is a frequent association and can be easily missed. Absent foveal reflex, FAZ, and macular pigments indicate foveal hypoplasia, which can be confirmed on OCT (preservation of retinal layers at fovea) or fundus fluorescein angiography (absent FAZ).

Ocular albinism is characterized by mutation in the GPR143 gene leading to dysfunctional melanosome ultimately resulting in macromelanosomes.^[1],[2] Melanin acts as an inducer and organizer of the formation of the fovea, optic nerves, optic tracts, and visual cortex. Absence or deficiency of melanin leads to ocular structure malformation and optic tract misrouting.

To conclude, high index of suspicion is required to diagnose ocular albinism as the fundus in these cases is easily confused with myopia.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 

References

1.	Federico JR, Krishnamurthy K. Albinism. [Updated 2018 Jul 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2018.
2.	De Filippo E, Schiedel AC, Manga P. Interaction between G protein-coupled receptor 143 and tyrosinase: Implications for understanding ocular albinism type 1.J InvestDermatol2017;137:457-65.