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JAMA Ophthalmology Clinical Challenge
October 2016

Unusual Photophobia in a Child

Author Affiliations
  • 1Bascom Palmer Eye Institute, Miami, Florida
JAMA Ophthalmol. 2016;134(10):1195-1196. doi:10.1001/jamaophthalmol.2016.1825

A 7-year-old boy with a history of Klinefelter syndrome presented to the pediatric glaucoma service with a 4-year history of intense intermittent photophobia. During the office evaluation, the patient had an uncorrected visual acuity of 20/30 OD and 20/25 OS but was extremely photophobic and would not cooperate with any additional examination. An examination under anesthesia was performed. Intraocular pressures by Tono-Pen XL (Reichert) under light sedation were 13 mm Hg OD and 12 mm Hg OS. Axial lengths by echography were 23.7 mm OD and 23.9 mm OS. Retinoscopy showed bright reflexes in both eyes. Anterior segment examination of each eye showed normal eyelids and lashes, conjunctiva, anterior chamber, iris, and lens. The examination of the cornea of each eye was significant for punctate keratitis in the epithelial and subepithelial layers that stained lightly with fluorescein (Figure). The corneal diameters were normal, and there was no evidence of Haab striae or stromal scarring. The ophthalmoscopic examination was unremarkable.