Ophthalmic presentation in the emergency department: a case report of a girl with "shimmering eyes".
BACKGROUND
Ophthalmic 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.


METHODS
The 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.
Michigan State University College of Human Medicine, Grand Rapids, Michigan.
Roman
R
Krivochenitser
Michigan State University Program in Emergency Medicine, Spectrum Health Hospital-Butterworth Campus, Grand Rapids, Michigan.
Yonatan
Y
Lemma
Michigan State University Program in Emergency Medicine, Spectrum Health Hospital-Butterworth Campus, Grand Rapids, Michigan.
Barbara
B
Wynn
Michigan State University Program in Emergency Medicine, Spectrum Health Hospital-Butterworth Campus, Grand Rapids, Michigan.
Jeffrey S
JS
Jones
D000008:Abdominal Neoplasms / Q000150:complications / Q000175:diagnosis*; D001259:Ataxia / Q000209:etiology; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D009447:Neuroblastoma / Q000150:complications / Q000175:diagnosis*; D053578:Opsoclonus-Myoclonus Syndrome / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology
emergency department; eye complaints; neuroblastoma; opsoclonus-myoclonus; paraneoplastic