A CASE OF PRIMARY INFANTILE GLAUCOMA: A DIAGNOSTIC DILEMMA

Title A CASE OF PRIMARY INFANTILE GLAUCOMA: A DIAGNOSTIC DILEMMA
Author, Co-Author Nadine Girgis, Kelly Frantz
Topic
Year
2004
Day
Program Number
Poster 2
Room
Affiliation
Illinois College of Optometry
Abstract BACKGROUND: Infantile glaucoma is a primary pediatric glaucoma and is typically bilateral. It generally presents as the classic clinical triad of photophobia, blepharospasm, and epiphora, due to the corneal changes that occur secondary to increased intraocular pressure (IOP). Uncontrolled IOP also leads to optic nerve damage. Onset is from age 2 months to 2-3 years. Atypical cases make diagnosis challenging.

CASE REPORT(S): A 2-year, 5-month old Hispanic boy presented to our clinic with a right eye that looked larger than the left for at least one year and an intermittent right eye turn outward, without tearing or photophobia. Examination revealed a larger corneal diameter in the right eye than the left, intermittent exotropia OD at distance only, highly myopic refractive error OD only (-5.00 diopters), and larger cup-to-disc ratio OD. IOP measurements were unreliable. Spectacles were prescribed for full-time wear and referral to a pediatric ophthalmologist was made. On first examination under anesthesia (EUA), the child was diagnosed with unilateral megalocornea due to normal IOP and absence of other typical signs of infantile glaucoma. Upon follow-up at our clinic three months later, aided visual acuity was reduced OD, anisometropia was unchanged, the exotropia had increased in frequency, and Haab’s striae were noted in the cornea OD. An amblyopia therapy plan was initiated to address the anisometropic amblyopia component and he was referred back to the ophthalmologist due to the new corneal findings. Subsequent EUA led to a diagnosis of primary infantile glaucoma based on appearance of Haab’s striae, additional enlargement of the corneas, and elevated IOP at this time. Because IOP was not greatly elevated, medical management was instituted rather than surgery. The child was subsequently lost to follow-up.

CONCLUSIONS: This case demonstrates the importance of recognizing infantile glaucoma, despite lack of classic signs. It is vital that comanagement between an optometrist and ophthalmologist begin as soon as possible to provide the best visual outcome for the child.
Affiliation of Co-Authors Illinois College of Optometry
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