A nine month old boy presents to the clinic with tearing and light sensitivity in the left eye. His mother also complains that he is constantly rubbing his eye. The boy is poorly cooperative with the examination. External examination findings are shown below:
What is the most appropriate next step?
A. Antibiotics ointment
B. NLD probing & irrigation
C. Examination under anesthesia
D. Uveitis work-up
Correct Answer: C
Examination under anesthesia demonstrates Haab straie. This patient presents as a classical case of congenital glaucoma due to the larger cornea diameter present in the left eye. When examining pediatric patients with congenital glaucoma, initial examination under anesthesia is recommended to measure IOP, corneal diameter, central cornea thickness, and conduct proper optic nerve imaging. Congenital glaucoma is also often associated with anterior segment dysgenesis and cataracts in pediatric patients. Further genetic testing can be recommended upon diagnosis.
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