Introduction Refractive disorders are a common condition found in the children. Fulton et al., [1] described a rate of 19% astigmatism of normal infants, at least twice the incidence in adults. Female sex, higher grade level and using computers regularly were signifcantly associated with refractive error according to Sewunet et al., [2]. For undiagnosed patients, who compensated during childhood, it can be made manifest in an acute way during adolescence. Accuracy of accommodation is reduced in uncorrected children with high astigmatism and high hyperopia [3]. Ten the complaints can be very large and it becomes tricky for the clinician to make the diagnosis. Case Report In our center, a 14-year-old girl described decrease of visual acuity in the right eye since 3 weeks, without any pain or redness. She did a major depressive disorder leading to hospitalization 2 months before, and was under citalopram for a short period. Except that, she had no other past medical or ocular history. On examination, best-corrected visual acuity was 0.3 decimal Snellen units in the right eye (+0.25/0/0) and 0.8 decimal Snellen units *Corresponding author: Georgios Panos, Department of Ophthalmology, Geneva University Hospitals, Alcide-Jentzer 22, CH 1211, Geneva, Switzerland, Tel: +41 767459028; Fax: +41 223828382; E-mail: gdpanos@gmail.com Citation: Roquelaure D, Panos GD (2015) A Tricky Case of Refractive Disorder in a Female Teenager. J Ophthalmic Clin Res 2: 010. Received: November 25, 2014; Accepted: April 13, 2015; Published: April 27, 2015 in the lef eye (+0.25/+0.25/65). Pupils were isocore, normoreactive, with no relative aferent pupillary defect. Anterior segment examination was unremarkable in both eyes. Fundus examination was also normal, without any optic nerve abnormality. Te Lang stereo test II score was 2/4 (200moa). Te Hardy-Rand-Rittler color vision test score was 21/24 in the right eye, 24/24 in the lef eye. Visual feld (Octopus System) revealed numerous peripheral absolute defects in every quadrant of the right eye (Figure 1), with a relative good respect of the macular area; no defect was found in the lef eye. Answers of visual evoked potentials were normal and symmetrical, for monocular and binocular vision. An optical coherence tomography (Heidelberg Engineering) was also normal both eyes. Considering the possible diagnosis of right optic nerve lesion, like retrobulbar neuritis, brain tumour, or multiple sclerosis, we organized an urgent cerebral and orbit MRI with contrast product Gadolinium. It didn’t show any abnormality at last. Ten days later, we found a better best-corrected visual acuity at 0.8 decimal Snellen units both eyes, with a diferent refraction (OD -1), and Lang stereotest I was 3/3 (1200 moa). Te rest of the examination was without any particularity. Tese last results tend to conclude to a refractive and accommodative disorder. Consequently, we organized a cycloplegia, according to the protocol following: one drop of oxybuprocaïne, and then three drops of cyclopentolate 0.5% every 10 minutes. Afer that, we did an Roquelaure D and Panos GD, J Ophthalmic Clin Res 2015, 2: 010 DOI: 10.24966/OCR-8887/100010 HSOA Journal of Ophthalmology and Clinical Research Research Article Abstract We present a tricky case of a teenage female patient who has been initially misdiagnosed as a case of optic neuropathy. A detailed examination including cycloplegic refraction revealed that the patient presented accommodative disorders because of latent hyperopia and previous stressful situation. Every young patient coming in Ophthalmology service complaining for blurred vision, regardless of his age, or ocular past, need to have a cycloplegic objective refraction. Keywords: Accommodative disorders, Cycloplegia, Optic neuropathy, Refractive errors Daniel Roquelaure and Georgios D Panos* Department of Ophthalmology, Geneva University Hospitals, Geneva, Switzerland A Tricky Case of Refractive Disorder in a Female Teenager Figure 1: The frst visual feld examination revealed numerous peripheral absolute defects in every quadrant of the right eye.