Can you diagnose this corneal lesion in an 8-year-old girl?

Welcome to this Contemporary Pediatrics poll. Take a look at the following case below. After reading through the description, choose a multiple-choice answer and try to guess the correct patient diagnosis.

Then visit our website on Wednesday, November 26, at 12:00 PM ET or later for the full case presentation, differential diagnosis, and correct patient diagnosis.

This case was presented by Jenna Scanlon, DO; Melissa Mondello, MD; and Jennifer Haile, MD.

The case

An 8-year-old previously healthy female presents to the pediatrician’s office to establish care after recently moving to the United States from Peru 3 months ago. Past medical history is significant for mild intermittent asthma. Past surgical history is significant for removal of left-sided preaxial polydactyly as well as removal of right-sided preauricular appendage while living in Peru. Patient is not currently taking medications and is otherwise healthy. Immunizations are up to date. Physical exam is notable for a tan colored lesion on the left eye that Mom states has been present since birth. Mom reports that they saw an eye doctor in Peru who would not remove the lesion due to its proximity to the pupil. Mom reports no significant change in the size of the lesion since onset. The child is not bothered by the lesion and can close eyelids without difficulty. 

Examination and studies

Physical exam shows pupils are equal and reactive, and extraocular eye movements are intact. Cranial nerves II-XII are intact, and there are no visual field deficits. Physical exam is also pertinent for facial and chest asymmetry, with noted hypoplasia of the left side of the face. Small hypopigmented scars are noted on the lateral aspect of the left first digit as well as the preauricular area of the right ear. The patient is referred to Ophthalmology and Genetics for further evaluation. Ophthalmology exam consisted of visual acuity (R: 20/20 L: 20/20), tonometry (R: 24 L: 23), and visual field testing (R: Full L: Full).

Below, take your best guess at diagnosing this patient.

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