Journal of Pediatric Ophthalmology and Strabismus

Whats Your Diagnosis 

“My Son Will Not Play Outside”

Helen H. Yeung, MD

Abstract

This 14-month-old boy (Figure 1) presented for an initial eye examination because his mother described an “intolerance to light outdoors” since infancy, with a preference for playing indoors. At times, epiphora occured with intense photophobia. Medical history included forceps-assisted delivery at term. His development had been normal, with all growth milestones reached. There was no family history of childhood eye disease. On further examination, the child was easily upset and possessed no systemic abnormalities. Eye examination showed that he had brief fixation and followed toys for both eyes. The conjunctiva of both eyes were slightly injected. Both corneal diameters were estimated to be approximately 14 mm. The right cornea appeared clear but with multiple horizontal Haab's striae. The left cornea was diffusely hazy, also with multiple horizontal Haab's striae. The irides were moderately well pigmented bilaterally with concentric stromal collarettes present bilaterally. The lenses appeared clear on portable slit-lamp examination. Axial lengths were measured to be 21 and 23 mm in the right and left eyes, respectively, and B-scan ultrasonography was otherwise normal bilaterally. Retinoscopy found no refractive error in the right eye and 4.00 diopters of myopia in the left eye. On gonioscopy, both angles were widely open. In the right eye, the scleral spur and ciliary body band were well defined. In the left eye, the ciliary body band was poorly differentiated from the trabecular meshwork and the scleral spur could only be seen temporally. Funduscopy revealed a well-vascularized right disc with a cup-to-disc ratio of 0.1. The left disc showed near complete cupping with a poorly vascularized narrow residual rim. Goniosurgery was recommended for the left eye.

What's Your Diagnosis?

The correct answer for What's Your Diagnosis? is bilateral late-recognized primary congenital glaucoma associated with spontaneous resolution of primary congenital glaucoma in the right eye.…

This 14-month-old boy (Figure 1) presented for an initial eye examination because his mother described an “intolerance to light outdoors” since infancy, with a preference for playing indoors. At times, epiphora occured with intense photophobia. Medical history included forceps-assisted delivery at term. His development had been normal, with all growth milestones reached. There was no family history of childhood eye disease. On further examination, the child was easily upset and possessed no systemic abnormalities. Eye examination showed that he had brief fixation and followed toys for both eyes. The conjunctiva of both eyes were slightly injected. Both corneal diameters were estimated to be approximately 14 mm. The right cornea appeared clear but with multiple horizontal Haab's striae. The left cornea was diffusely hazy, also with multiple horizontal Haab's striae. The irides were moderately well pigmented bilaterally with concentric stromal collarettes present bilaterally. The lenses appeared clear on portable slit-lamp examination. Axial lengths were measured to be 21 and 23 mm in the right and left eyes, respectively, and B-scan ultrasonography was otherwise normal bilaterally. Retinoscopy found no refractive error in the right eye and 4.00 diopters of myopia in the left eye. On gonioscopy, both angles were widely open. In the right eye, the scleral spur and ciliary body band were well defined. In the left eye, the ciliary body band was poorly differentiated from the trabecular meshwork and the scleral spur could only be seen temporally. Funduscopy revealed a well-vascularized right disc with a cup-to-disc ratio of 0.1. The left disc showed near complete cupping with a poorly vascularized narrow residual rim. Goniosurgery was recommended for the left eye.

What's Your Diagnosis?

The correct answer for What's Your Diagnosis? is bilateral late-recognized primary congenital glaucoma associated with spontaneous resolution of primary congenital glaucoma in the right eye.

References

  1. Yeung HH, Walton DS. Clinical classification of childhood glaucomas. Arch Ophthalmol. 2010;128:680–684. doi:10.1001/archophthalmol.2010.96 [CrossRef]
  2. Walton DS, Nagao K, Yeung HH, Kane SA. Late-recognized primary congenital glaucoma. J Pediatr Ophthalmol Strabismus. 2013;50:234–238. doi:10.3928/01913913-20130423-02 [CrossRef]
  3. Nagao K, Noël LP, Noël ME, Walton DS. The spontaneous resolution of primary congenital glaucoma. J Pediatr Ophthalmol Strabismus. 2009;46:139–143. doi:10.3928/01913913-20090505-04 [CrossRef]
Authors

From the Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.

The author has no financial or proprietary interest in the materials presented herein.

Correspondence: Helen H. Yeung, MD, 2 Longfellow Place, Suite 201, Boston, MA 02114. E-mail: helen.h.yeung.md@gmail.com

10.3928/01913913-20171019-02

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