Posted by firstname.lastname@example.org - Posted on 04/23/2015 10:59:42 Glaucoma
A new born baby was referred with bilateral bluish appearance of the cornea. What do you think is the diagnosis and how do you proceed with this child?
This 7 day old baby with bluish discoloration of the corneas has bilateral corneal edema. The main differential here will be congenital glaucoma. The intraocular pressure could be measured in infants at the bedside using the Tonopen. If elevated, one has to examine the baby under general anesthesia. Typically in babies with Congenital Glaucoma, the IOP will be high (30 mm hg or higher, the cornea may be enlarged (diameter > 11 mm) , edematous (secondary to elevated IOP), may have Descemet breaks and enlarged optic nerve cupping. Remember the differential diagnosis for childhood corneal opacities include (STUMPED) S for sclerocornea, T for tears (Forceps injury),U for ulcers (Infections), M for metabolic (Mucopolysaccharidosis and lipidosis), P for Peters anomaly, E for edema ( Infantile glaucoma, Posterior corneal opacity, Posterior corneal stromal (CHSD) or endothelial (CHED)dystrophy), and D for Dermoid