Description

A 10-year-old boy presented for evaluation of a squint and low vision in his left eye. He had undergone cataract surgery (lens aspiration and anterior vitrectomy) in the same eye at the age of 1 year. He also had sensorineural hearing loss. On examination, microphthalmos of the left eye was present along with exotropia with normal range of extraocular movements (figure 1). Best-corrected visual acuity in the right eye was 6/6 and 6/60 in the left eye. Anterior segment of the left eye revealed aphakia. Right eye anterior segment was unremarkable. Fundus examination of both eyes revealed classical ‘salt and pepper’-like pigmentary retinal changes suggestive of rubella retinopathy (figure 2). Cardiovascular examination revealed asymptomatic patent ductus arteriosus. All the above features contributed to the diagnosis of congenital rubella syndrome (CRS).

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Figure 1

Left eye with evidence of micro-ophthalmia.

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Figure 2

Fundus photo of the right eye showing characteristic ‘salt and pepper’ retinopathy.

CRS is a catastrophic complication of rubella infection in pregnant women.1 The risk of fetal infection is greater in the first and third trimester.2 The common systemic manifestations associated with CRS are deafness, mental retardation, and cardiovascular and ocular defects.3 Eye findings such as cataract, microphthalmia and retinopathy are frequent findings, as in our patient. The patient was advised to wear contact lenses along with undergoing occlusion therapy to treat his amblyopia. Secondary intraocular lens implantation could also be considered as an option for later visual rehabilitation.