Differential Diagnosis for a 2-year-old boy with intermittent cross-eyed appearance
- Single most likely diagnosis
- Esotropia: This is a common condition in children where one eye turns inward, often due to a refractive error or muscle imbalance. The patient's mildly deviated right eye toward the nose and asymmetric pupillary red reflexes support this diagnosis.
- Other Likely diagnoses
- Exotropia: Although less common than esotropia, exotropia (outward turning of the eye) can also present with intermittent crossing of the eyes. However, the patient's eye is deviated toward the nose, making esotropia more likely.
- Accommodative esotropia: This condition occurs when a child's eyes turn inward due to focusing effort, often caused by uncorrected hyperopia (farsightedness). The family history of glaucoma in the father increases the likelihood of a refractive error.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Retinoblastoma: Although rare, retinoblastoma is a life-threatening condition that can cause leukocoria (white pupillary reflex) and strabismus (crossed eyes). The asymmetric pupillary red reflexes in this patient warrant further investigation to rule out this condition.
- Coats disease: This rare condition causes retinal detachment and can lead to vision loss if left untreated. It may present with leukocoria or strabismus, making it essential to consider in the differential diagnosis.
- Rare diagnoses
- Duane syndrome: A rare congenital condition characterized by limited horizontal eye movement, often associated with esotropia or exotropia. The patient's intact extraocular movements make this diagnosis less likely.
- Moebius syndrome: A rare neurological disorder that affects the muscles controlling eye movement, often causing esotropia or exotropia. However, this condition typically presents with other systemic features, such as facial weakness, which are not mentioned in the patient's history.