Paediatric photophobia: The pressure of a timely diagnosis

A girl aged eight months was brought to see her family's general practitioner (GP) with a four-month history of persistent bilateral epiphora (overflow of tears onto the face) and light sensitivity. There were no other symptoms such as decreased appetite or vomiting. Medical history included an uncomplicated vaginal delivery at 41 weeks' gestation, with no significant history other than mild pre-eclampsia. Clinically, the infant was afebrile and hemodynamically stable. On examination, the infant appeared to have poor ability to fixate and follow a near target. The eyes appeared prominent, and the corneas appeared mildly cloudy. However, the eyes were not obviously red, and there were no periorbital rashes or inflammation of the periocular skin. There was no obvious head and neck lymphadenopathy. There were no rashes or focal neurological signs. Systemic examination was otherwise unremarkable. The GP referred the infant immediately to an ophthalmologist for review.