Amblyopia or Pathology? Diffuse Unilateral Subacute Neuroretinitis in a Pediatric Patient

Abstract

Background: Diffuse unilateral subacute neuroretinitis (DUSN) is a retinal disorder cause by a subretinal nematode. The disorder tends to affect children and young adults. It is characterized by unilateral retinal pigment epithelium changes, vitritis, retinal vessel narrowing and, in advanced stages, optic atrophy. Patients are generally asymptomatic or report a painless loss of vision. It has been described in the United States as well as Latin America, Asia and Europe. Case Report: A 9 year old female, recently adopted from the Ukraine, presented for an eye exam after failing a vision screening. Uncorrected visual acuity was 20/20 OD, 20/30 OS with hyperopia OS>OD. A dilated examination revealed pigment epithelial changes in the macula OS only. Examination by a retinal specialist included ocular coherence topography and a fluorescein angiography. Blood work and stool samples were normal. A diagnosis of DUSN was made and laser photocoagulation was performed around the suspected worm. The patient tolerated the procedure well. After treatment, and with her eyeglasses, visual acuity was 20/25 OS. Conclusion: Diffuse unilateral subacute neuroretinitis (DUSN) is a condition that can be detected on a routine exam in asymptomatic patients. Recognition of the condition and prompt treatment is important to help delay disease progression and preserve visual acuity.