2020–2021 BCSC Basic and Clinical Science Course™
10 Glaucoma
Chapter 11: Glaucoma in Children and Adolescents
Primary Congenital Glaucoma
Clinical Features
In infants, PCG presents with the classic triad of epiphora, photophobia, and blepharospasm. Until about 4 years of age, elevated IOP causes the cornea to stretch, leading to increased corneal diameter and enlargement of the globe (buphthalmos; Fig 11-2A), along with stretching of the scleral canal housing the optic nerve. The corneal stretching produces Haab striae, or breaks in Descemet membrane, and may lead to corneal edema and corneal opacification (Fig 11-2B; also see Figs 22-2 and 22-3 in BCSC Section 6, Pediatric Ophthalmology and Strabismus). As the cornea swells, the child may become irritable and photophobic. After age 3–4 years, the cornea ceases to enlarge further. Scleral stretching also ceases around this age. However, persistently elevated IOP may result in continued optic nerve damage.
Table 11-8 Differential Diagnosis for Symptoms and Signs of Primary Congenital Glaucoma
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.