Unilateral Myelinated Retinal Nerve Fiber Layer Associated with Axial Myopia,Amblyopia and Strabismus

A 4-year-old girl with normal development presented with progressive ocular deviation of 3 years’ duration; past medical and ocular history was unremarkable. Upon presentation, cycloplegic refraction revealed refractive error of +1.00 -0.50×180 and -14.00 in the right and left eyes. Visual acuity was 20/20 and 20/400 in the right and left eyes with optical correction of plano and -14.00, respectively. Relative afferent pupillary defect was negative and cover test revealed 40 prism diopters of constant left esotropia (Fig. 1). Slitlamp examination was normal and dilated fundus examination was unremarkable in the right eye, but revealed extensive Myelinated retinal nerve fibers in the left (Fig. 2). A-scan ultrasound biometry showed axial length of 20.75 and 25.57 mm in the right and left eyes, respectively (Fig. 3). The patient was diagnosed with extensive unilateral myelinated retinal nerve fibers associated with axial myopia, deep anisometropic amblyopia and esotropia in her left eye. She received spectacle correction together with part time patching of the right eye six hours every day. The patient was scheduled for a three month follow-up visit to monitor improvement in visual acuity.