“…57,58 The pupils react sluggishly to light and, although the fundus appearance is often normal, abnormal retinal changes including peripheral white dots at the RPE level, macular atrophy, retinal pigmentation, and vascular attenuation may be seen. Other findings include the oculodigital sign, microphthalmos, enophthalmos, strabismus, keratoconus, 59 high refractive error, 60 cataract, and optic disc swelling.…”