|Title||BUPHTHALMOS: MANAGEMENT & TREATMENT|
|Author, Co-Author||Noushin Ahmed|
Buphthalmos describes enlargement of the eyeball with age of onset from birth to 3 years. This case demonstrates the importance of early diagnosis and complications that may occur from this potentially visually devastating disease process.
A 5 year-old white male presented as a referral to assess congenital glaucoma. Ocular history was unremarkable. Health history was remarkable for sleep apnea. No medications were reported. He had normal birth, weight, and development.
VA was CF at 3 ft OD, 20/400 OS. Pupils were equal, round and reactive to light with an APD OS. Biomicroscopy was remarkable for non-edematous, 14 mm megalocornea with Haab’s striae OU. The anterior chamber was open with apigmented Schwalbe’s line OU. IOP was 40mm Hg OU. DFE revealed nerves with CD ratio of 1.0 OU. Otherwise, unremarkable findings OU.
Differential diagnoses include anterior chamber dysgenesis, sclerocornea, trauma, and endothelial dystrophy.
The clinical findings of buphthalmos, high IOP, large corneas, Haab’s striae, deep anterior chambers, and glaucotamous nerves led to the diagnosis of congenital glaucoma. He did not have the classic triad of symptoms: epiphora, photophobia, and blepharospasm1. Since he was developing normally, the parents and pediatrician overlooked any ocular issues. The trabecular meshwork abnormally developed as immature, thick, and compressed, increasing resistance to aqueous outflow2.
He was promptly referred to a glaucoma specialist who performed a trabeculotomy with temporary success. He was treated with multiple IOP-lowering medications and surgeries over 10 years. Later, retinal detachment occurred OS and was treated with retinal pneumopexy & laser photocoagulation. Subsequent neovascular glaucoma formed. Medication treated it unsuccessfully. Currently, another procedure involving an Ahmed/Baerveldt tube or laser diode is under consideration.
Although incidence of buphthalmos is 1 in 30,000 births2, early pediatric eye exams are critical to prevent further blindness due to the early age of onset1. Additionally, the complexity of management stems from the disease process's risks, including congenital glaucoma and retinal detachment.
|Affiliation of Co-Authors|