Unilateral Myelinated Retinal Nerve Fibers.

PRESENTATION

A 5-year-old boy presented to our clinic for a routine check-up. Best corrected visual acuity was 20/20 and 20/60 in the right and left eyes, respectively. Cycloplegic refraction revealed +0.50 −0.50 × 179° in the right eye and −6.50 −0.75 × 171° in the left eye. The left eye had an exotropia of 14 prism diopters. Anterior segment examination was normal in both eyes. On dilated funduscopy, the right eye was normal [Figure 1a]; while in the left eye, there was an extensive myelination of the retinal nerve fibers [Figure 1b]. Full correction of the refractive error in the left eye was prescribed and patching of the right eye for 2 hours daily was recommended. The usage of contact lens was suggested for maximal results and in order to reduce the aniseikonia. One year later, visual acuity of the left eye improved to 20/40.

Figure 1

(a) Right eye: normal fundus, (b) left eye: extensive myelination of the retinal nerve fibers extending from disc along the superotemporal and inferotemporal arcades up to the retinal periphery, sparing the macula.

DISCUSSION

Unilateral extensive myelinated retinal nerve fibers are known to be associated with high myopia and consequent amblyopia.[123] Refractive amblyopia can be treated by correcting the refractive error early with glasses or contact lenses.[45] In some cases, patching of the fellow eye is necessary.[5] Complete eye examination including funduscopy and cycloplegic refraction at 6 months and then at 3 years of age is crucial for the timely diagnosis and treatment of amblyopia.

Financial Support and Sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.