Journal of Pediatric Ophthalmology and Strabismus

Whats Your Diagnosis 

“My Baby's Eyes Are Cloudy”

Helen H. Yeung, MD

Abstract

A 2-month-old male infant was referred for glaucoma goniosurgery with a history of cloudy corneas since birth and poor therapeutic response to topical glaucoma medications and acetazolamide. On examination, this male infant was found to be healthy, with good head control and moderate avoidance of bright light. On eye examination, diffuse corneal clouding was present with moderate corneal enlargement and estimated horizontal corneal diameters of 12.5 mm in both eyes. The intraocular pressures by Perkins applanation tonometry were 32 mm Hg in both eyes. The anterior chambers were abnormally deep in both eyes. The iris stroma in each eye was uniform and smooth, with no circumferential folds and with the suggestion of a pupillary ectropion in both eyes. The iris leaf in both eyes appeared to be attached anteriorly and with no convexity. Gonioscopy using a Koeppe lens (Figure 1) revealed high iris insertion with minimal visible trabecular meshwork circumferentially and no visible ciliary body and scleral spur in both eyes. The indication for alternative glaucoma surgery was considered based on the gonioscopic findings to be confirmed during a planned examination under anesthesia.

What's Your Diagnosis?

For the correct answer, see page 106.

The correct answer for What's Your Diagnosis? is newborn primary congenital glaucoma.…

A 2-month-old male infant was referred for glaucoma goniosurgery with a history of cloudy corneas since birth and poor therapeutic response to topical glaucoma medications and acetazolamide. On examination, this male infant was found to be healthy, with good head control and moderate avoidance of bright light. On eye examination, diffuse corneal clouding was present with moderate corneal enlargement and estimated horizontal corneal diameters of 12.5 mm in both eyes. The intraocular pressures by Perkins applanation tonometry were 32 mm Hg in both eyes. The anterior chambers were abnormally deep in both eyes. The iris stroma in each eye was uniform and smooth, with no circumferential folds and with the suggestion of a pupillary ectropion in both eyes. The iris leaf in both eyes appeared to be attached anteriorly and with no convexity. Gonioscopy using a Koeppe lens (Figure 1) revealed high iris insertion with minimal visible trabecular meshwork circumferentially and no visible ciliary body and scleral spur in both eyes. The indication for alternative glaucoma surgery was considered based on the gonioscopic findings to be confirmed during a planned examination under anesthesia.

What's Your Diagnosis?

For the correct answer, see page 106.

The correct answer for What's Your Diagnosis? is newborn primary congenital glaucoma.

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, Katsavounidou G. Newborn primary congenital glaucoma: 2005 update. J Pediatr Ophthalmol Strabismus. 2005;42:333–341.
  3. Khan AO, Aldahmesh MA, Mohamed JY, Alkuraya FS. Congenital glaucoma with acquired peripheral circumferential iris degeneration. J AAPOS. 2013;17:105–107. doi:10.1016/j.jaapos.2012.09.011 [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

10.3928/01913913-20180222-01

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