Authors
Alexander D M Withrow, Jeffrey Schuch, Michael Frick, David W M Withrow
Published in
South Dakota medicine : the journal of the South Dakota State Medical Association. Volume 79. Issue suppl 5. Pages s28-s29.
Abstract
Primary congenital glaucoma (PCG) is a rare and vision-threatening condition caused by abnormal development of the anterior chamber angle, leading to impaired aqueous humor outflow and subsequent elevated intraocular pressure. Although uncommon, PCG remains an important cause of irreversible visual impairment in the pediatric population. Early recognition is critical, as delayed diagnosis may result in optic nerve damage, amblyopia, and permanent vision loss. Classic clinical findings include epiphora, photophobia, blepharospasm, corneal clouding, and increased corneal diameter. This report describes an early presentation of PCG in a previously healthy infant and emphasizes the importance of prompt referral and surgical management.
A three-month-old male with no significant past medical history presented to pediatric clinic with a one-day history of progressive eye swelling, cloudy pupils, and fussiness. Patient's mother denied respiratory symptoms, fever, or ocular discharge. Patient was born at term via uncomplicated vaginal delivery. Prior examinations documented normal pupillary responses and bilateral red reflex. On examination, the right eye appeared cloudy with an absent red reflex, prompting same-day referral to pediatric ophthalmology. Evaluation revealed right corneal clouding and elevated intraocular pressures of 26 and 24 mmHg. The patient was started on topical brinzolamide. At follow-up two days later, the corneal clouding had improved; however, intraocular pressures increased to 37 and 45 mmHg. The patient was diagnosed with primary congenital glaucoma and referred to a tertiary pediatric glaucoma center for surgical management. He subsequently underwent bilateral canaloplasty and trabeculotomy with additional revisions and continued ophthalmologic follow-up.
This case highlights the importance of rapid identification of primary congenital glaucoma in early infancy. Subtle findings, including corneal clouding and abnormal red reflex, should prompt urgent ophthalmologic evaluation. Early diagnosis and surgical intervention are essential to reduce intraocular pressure, prevent optic nerve damage, and preserve visual function.
PMID:
42525993
Bibliographic data and abstract were imported from PubMed on 30 Jul 2026.
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