| | Features |
| Disorders of the visual pathway |
| Retinal lesions |
| Chorioretinitis | - Inflammatory changes in choroid and retina
- Associated with congenital TORCH infections, especially toxoplasmosis and cytomegalovirus
|
| Retinoblastoma | - Typically presents as leukocoria*
- Strabismus, nystagmus, and a red eye also present
|
| Retinopathy of prematurity | - Abnormal retinal vascular proliferation
- Occurs in preterm infants (most commonly in infants born at <30 weeks gestation or birth weight ≤1500 grams)
|
| Traumatic retinal injury | - A clear history of preceding trauma may not be given in cases of nonaccidental trauma
- Patients may complain of flashes and floaters
- Retinal hemorrhages or tears may be seen on funduscopic exam
|
| Macular scarring | - Can result from congenital infections (especially toxoplasmosis and cytomegalovirus), retinal injury, or retinal dystrophies
|
| Stargardt disease | - Inherited disorder that causes macular degeneration in childhood
- Onset is typically at age 7 to 12 years
|
| Coats disease | - Exudative retinal vascular disorder characterized by retinal telangiectasias and subretinal exudation leading to serous retinal detachment
- Occurs mainly in boys and is almost always unilateral
- Presents with leukocoria that is yellowish in color
|
| Retinal dystrophies (eg, achromatopsia, cone-rod dystrophy, albinism) | - In addition to reduced visual acuity, patients may have photophobia and abnormal color vision
|
| Optic nerve lesions | The optic nerve lesions are generally associated with: - Afferent pupillary defect
- Abnormal color vision (dyschromatopsia)
|
| Optic nerve hypoplasia | - Optic disc is small and pale and often surrounded by a yellowish halo bordered by a ring of pigmentation
- Bilateral involvement is more common than is unilateral
- Associated with a variety of CNS and endocrine abnormalities (eg, septo-optic dysplasia)
|
| Optic neuropathy/atrophy | - Optic disc is pale or whitish
- Some causes are associated with eye pain
- Can be caused by injury to the optic disc (eg, from ischemia, compression, inflammation, or increased intracranial pressure) or it may be hereditary
|
| Optic neuritis | - Optic disc appears swollen with blurring of disc margins
- Usually unilateral
- Eye pain is common
|
| Myelinated nerve fibers | - Characteristic finding is a white optic disc with feathery borders
- May be inherited in an autosomal dominant fashion or a component of the Gorlin syndrome
|
| Optic disc coloboma | - Appears as a sharply defined, white, inferiorly decentered excavation of the optic disc
- Occur unilaterally or bilaterally with equal frequency
|
| Brain lesions |
| Craniopharyngioma | - Often associated with headaches and endocrine abnormalities
|
| Psychogenic causes |
| Conversion disorder | - May occur in children with underlying mental health disorders
- Often associated with other somatic complaints including headache, photophobia, or diplopia
|
| Malingering |
