Differential Diagnosis for a 28-month-old with Left Eye Shifting Inwards
Single Most Likely Diagnosis
- Esotropia: This is a common condition in children where one eye turns inward due to imbalance in the muscles controlling eye movement. It's often noticed in early childhood and can be congenital or acquired.
Other Likely Diagnoses
- Accommodative Esotropia: This condition occurs when the eye turns inward due to excessive focusing effort, often associated with refractive errors like hyperopia (farsightedness). It's common in children around the age of 2-3 years.
- Acquired Non-Accommodative Esotropia: This type of esotropia is not related to focusing effort and can be caused by various factors, including neurological conditions or trauma.
- Convergence Excess: A condition where the eyes have a tendency to turn inward more than necessary during near vision tasks, which can be a sign of an underlying issue with the convergence mechanism.
Do Not Miss Diagnoses
- Retinoblastoma: Although rare, this is a critical diagnosis to consider because it's a malignant tumor of the retina that can present with strabismus (eye misalignment) among other symptoms. Early detection is crucial for treatment and prognosis.
- Medullary Thyroid Carcinoma with MEN 2B: This rare genetic condition can cause mucosal neuromas and other systemic features, including ocular abnormalities like esotropia.
- Third Cranial Nerve Palsy: This can cause inward deviation of the eye due to weakness or paralysis of the oculomotor nerve, which controls several eye muscles. It can be a sign of a serious underlying condition, such as a brain tumor or aneurysm.
Rare Diagnoses
- Duane Syndrome: A rare congenital disorder characterized by limited horizontal eye movement, which can cause the eye to appear as if it's turning inward.
- Moebius Syndrome: A rare neurological disorder that can cause facial paralysis and abnormal eye movements, including esotropia, due to underdevelopment of the cranial nerves.
- Graves' Disease: Although more common in adults, Graves' disease can occur in children and cause exophthalmos (bulging eyes) and other eye movement abnormalities, including esotropia in some cases.