A Child With Severe Autism Spectrum Disorder With Bilateral Corneal Ulcers

Abstract

A 6-year-old boy with severe autism spectrum disorder (ASD) was brought to the hospital by his mother for whitening in the right eye. The patient was nonverbal at baseline and exhibited restrictive and repetitive behaviors. His diet consisted exclusively of cookies, apples, potato chips, and Gatorade. His mother noticed him frequently rubbing his eyes for several weeks, which she initially attributed to new-onset allergies. She did not describe any reduction in visual function or ability to perform low-luminance tasks.The patient was admitted and ophthalmology was consulted. He required an examination under sedation. His visual acuity could not be determined. There was no relative afferent pupillary defect in either eye. The eyelids were mildly erythematous with bilateral eyelash hypertrichosis. The conjunctiva and cornea appeared dry and leathery bilaterally. The right cornea was diffusely hazy with a 3-mm paracentral epithelial defect with 60% stromal thinning and a 1-mm infiltrate. There was a small crescentic fibrin deposit nasally in the right anterior chamber. The left cornea was diffusely hazy with a 1-mm epithelial defect without stromal thinning (Figure). Dilated examination showed bilateral grade 3 optic nerve head edema and otherwise normal retinal findings. Fortified vancomycin eye drops, 25 mg/mL, and tobramycin eye drops, 15 mg/mL, were initiated. Results of magnetic resonance imaging of the brain were normal.