Week 11 Q&A

The triad of epiphora, blepharospasm, and photophobia with corneal clouding on exam is consistent with what pediatric ophthalmologic emergency?

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A. Congenital nasolacrimal duct obstruction

B. Orbital cellulitis

C. Primary congenital glaucoma

D. Endemic keratoconjunctivitis

E. Congenital Horner syndrome

The correct answer is C. Primary congenital glaucoma. 

Primary Glaucoma
  • Primary infantile glaucoma (congenital glaucoma): 1:10,000–1:15,000; 90% sporadic

  • Caused by developmental defect in the structure of the anterior chamber

  • Associated systemic syndromes include Sturge–Weber, neurofibromatosis type 1, Marfan, Stickler, Lowe, Rubinstein–Taybi, Wolf–Hirschhorn

  • Also associated with ocular syndromes such as aniridia, Peters anomaly

Congenital glaucoma, right eye. Note that the right eye and cornea are much larger (buphthalmos) than the left.

Sources: (Question) Peterson AR, Wood KE. Pediatrics Examination and Board Review. New York, NY: McGraw-Hill Education; 2017

(Explanation) Shah SS et al. The Philadelphia Guide, 2nd ed. New York, NY: McGraw-Hill Education; 2016.

(Photo) Lueder GT. Pediatric Practice Ophthalmology. New York, NY: McGraw-Hill Education; 2011.