• J Emerg Med · Jun 2014

    Review Case Reports

    Ophthalmic Presentation in the Emergency Department: A Case Report of a Girl With "Shimmering Eyes"

    • Roman Krivochenitser, Yonatan Lemma, Barbara Wynn, and Jeffrey S Jones.
    • Michigan State University College of Human Medicine, Grand Rapids, Michigan.
    • J Emerg Med. 2014 Jun 1;46(6):e163-5.

    BackgroundOphthalmic complaints are commonplace in the emergency department (ED) and are often initial presentations of a systemic illness. We present a 2-year-old girl presenting to the ED with ataxia and "shimmering" eyes.Case ReportThe patient was diagnosed with opsoclonus-myoclonus syndrome (OMS) involving involuntary, multi-vectorial (mostly horizontal), conjugate fast eye movements without intersaccadic intervals. The ophthalmic presentation led to a paraneoplastic work-up, which revealed an abdominal mass measuring 5.3 × 3.3 × 4.3 cm, suggestive of neuroblastoma. The patient's opsoclonus improved after a 5-day course of dexamethasone and intravenous immunoglobulin. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case illustrates the importance of recognizing pathognomonic ophthalmic complaints in the ED. We present an overview of classic ophthalmic presentations associated with systemic illnesses.Copyright © 2014 Elsevier Inc. All rights reserved.

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