Leucocoria in a boy with Kawasaki disease: a diagnostic challenge

Retinoblastoma, the most common primary intraocular malignancy of childhood, usually presents in the first three years of life. Atypical presentation of retinoblastoma can masquerade as virtually any ocular or orbital pathology, which may lead to diagnostic dilemmas especially in the presence of other systemic diseases. We report a 20-month-old boy who was diagnosed with coronary aneurysm as a complication of Kawasaki disease, and presented with sudden left eye redness. His mother noticed the presence of white pupillary reflex three months earlier. Atypical acute ocular presentation secondary to Kawasaki disease was initially suspected, but the presence of multiple calcification and mild proptosis on imaging suggested characteristics of advanced retinoblastoma. Histopathological examination of the enucleated eye, which revealed a classical rosette pattern appearance, confirmed the diagnosis. Atypical presentations of retinoblastoma are usually associated with advanced disease. The presence of other systemic conditions further complicates the diagnosis. Early diagnosis is important to reduce the mortality and morbidity.

Orbital abscess secondary to ethmoidal sinusitis in neonates / 国际眼科杂志(Guoji Yanke Zazhi)

A subperiosteal abscess is a form of orbital cellulitis characterized by a collection of fluid and pus confined by the periosteal lining of the orbit. In neonates, orbital abscesses are extremely rare. We present a case of a 26-day-old baby girl with severe orbital cellulitis in the right eye. A computed tomography (CT) scan of the orbits and paranasal sinuses revealed right orbital cellulitis with medial subperiosteal and retro-orbital abscess. The growth of Staphylococcus aureus was found in eye discharges. The patient was started on intravenous ceftriaxone and intravenous metronidazole. Urgent drainage of the abscess was performed via functional endoscopic sinus surgery (FESS). She recovered well after intravenous antibiotics and surgical drainage. Surgical drainage via endoscopic technique is the preferred treatment to prevent further complications.