In congenital glaucoma, Haab's striae are pathognomic horizontal linear opacities in the cornea. The underlying mechanism is:

• A Disruption of Bowman's layer from raised IOP causing corneal scarring
• B Breaks in Descemet's membrane due to stretching from elevated IOP in the context of a distensible infant cornea ✓
• C Corneal oedema from limbal stem cell failure secondary to glaucoma
• D Fibrotic changes in stroma following recurrent corneal hydrops

Explanation

Haab's striae are curvilinear, horizontal breaks in Descemet's membrane (the basement membrane of the corneal endothelium) caused by the circumferential stretching of the infant eye (buphthalmos) due to chronically elevated IOP. The distensible infant sclera allows globe enlargement; the inelastic Descemet's membrane tears in the direction of stretch (horizontal/concentric to limbus). Subsequent fibrotic repair of the breaks creates the characteristic opaque lines. They are not seen in adult glaucoma because the sclera is not distensible.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.