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An 11-year-old boy presented to the Eye Casualty in March 2012 with a 2-day history of bilateral blurring of vision, preceded by some mild discomfort several days prior to that. He had no previous ocular history. On examination, his Snellen Best Corrected Visual Acuity (BCVA) was 6/9 in his right eye (RE) and 6/6-3 in his left eye (LE). Slit-lamp examination revealed bilateral corneal microopacities. There was no conjunctival injection, and the rest of his ocular examination was unremarkable. Of note, he also had an asymptomatic erythematous rash on his cheeks.
What other history would be of relevance in this case?
Figure 1A,B shows the appearance of these tiny whitish opacities on slit-lamp examination. What are these opacities? What is the differential diagnosis?
What is the management?
His medical and drug history is important. In his case, he had acute lymphoblastic leukaemia (ALL), and as part of his chemotherapy regimen (week 9) for his relapsed ALL, he had just completed a cycle of high-dose systemic cytosine arabinoside (Ara-C)/cytarabine (>1 g/m2) (Hospira UK Limited, Warwickshire, UK) when his symptoms started.
Any history of old or recent ocular trauma and any family history of ocular problems may also be relevant; important clues in considering corneal dystrophies or the spectrum of …