Urgent ophthalmology referral and childhood vision loss: Case

This ten-month-old boy has the classic presentation of the leukocoria detected by the parent and confirmed by the red reflex test, and the case is built to probe the framing, the red reflex test, the principle of the time-critical vision loss, the red-flag presentations and the changed approach for the painful red eye, the sudden painless loss of vision and the papilloedema. ^[4][5]

Framing the problem

The clinician frames this child in a single sentence: the leukocoria, the white pupillary reflex, is retinoblastoma or a congenital cataract until proven otherwise, and the first step is the same-day referral to the ophthalmology service. The cream-white reflex on the left, replacing the warm orange-red, is the abnormal red reflex, and the delay of the weeks can convert the curable intraocular tumour into the lethal extraocular disease or saddle the child with the irreversible amblyopia. The generalist refers the same day without the pre-referral imaging, because the ocular ultrasound and the magnetic resonance imaging are the tools of the ophthalmology service. ^[4][6]