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A one month old baby presents with watering and increased corneal size. What is the diagnosis?
A one month old baby presents with watering and increased corneal size. What is the diagnosis?
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In infants, elevated IOP causes the entire elastic globe to enlarge, giving an ox-eye appearance.
Updated On: Jun 23, 2026
- Buphthalmos
- Hurler's Syndrome
- Galactosemia
- Cataract
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The Correct Option is A
Solution and Explanation
Clinical picture: 1-month-old infant + epiphora (watering) + enlarged corneal diameter = Buphthalmos due to Primary Congenital Glaucoma (PCG).
Why does the eye enlarge?
In infants, the sclera is thin and elastic. Elevated IOP distends the entire globe outward. The cornea enlarges beyond normal limits (>12 mm at birth is abnormal; >13 mm is diagnostic of PCG). Horizontal breaks in Descemet's membrane (Haab's striae) appear due to stretching.
Classic triad of PCG:
- Epiphora (watering)
- Photophobia
- Blepharospasm
PCG age variants:
- Newborn onset (0-1 month)
- Infantile onset (1-24 months) -- most common presentation (3-9 months)
- Late onset (>24 months)
Cause: maldevelopment of the trabecular meshwork and anterior chamber angle impairing aqueous outflow (trabeculodysgenesis).
Hurler syndrome causes corneal clouding; galactosemia causes cataract; neither produces buphthalmos. \[\boxed{\text{Buphthalmos (Primary Congenital Glaucoma)}}\]
Why does the eye enlarge?
In infants, the sclera is thin and elastic. Elevated IOP distends the entire globe outward. The cornea enlarges beyond normal limits (>12 mm at birth is abnormal; >13 mm is diagnostic of PCG). Horizontal breaks in Descemet's membrane (Haab's striae) appear due to stretching.
Classic triad of PCG:
- Epiphora (watering)
- Photophobia
- Blepharospasm
PCG age variants:
- Newborn onset (0-1 month)
- Infantile onset (1-24 months) -- most common presentation (3-9 months)
- Late onset (>24 months)
Cause: maldevelopment of the trabecular meshwork and anterior chamber angle impairing aqueous outflow (trabeculodysgenesis).
Hurler syndrome causes corneal clouding; galactosemia causes cataract; neither produces buphthalmos. \[\boxed{\text{Buphthalmos (Primary Congenital Glaucoma)}}\]
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