An 8-year-old girl was referred to the vitreoretinal service for evaluation of bilateral macular lesions noted by her pediatric ophthalmologist. Bilateral lateral rectus muscle recession for exotropia was performed 4 years before this presentation. Medical history was otherwise unremarkable. The patient was born full term after a normal pregnancy and delivery, with normal growth assessments. The patient was performing well in school.On examination, her best-corrected visual acuity was 20/40 OD and 20/40 OS, which was stable from previous visits. Her pupils were round and reactive. There was a residual intermittent exotropia of 4 prism diopters bilaterally. Findings on slitlamp examination of the anterior segment were unremarkable. A single, 1-cm, oval, lightly pigmented macule with irregular borders was noted on her right upper arm. Dilated fundus examination revealed eccentric, yellow-clear, preretinal lesions in the maculas of both eyes. Optical coherence tomography revealed hyperreflective areas on the surface of the macula with a spiculated appearance, projecting anteriorly into the vitreous. There was an increase in retinal thickness and loss of the foveal contour in both eyes (Figure).