In congenital glaucoma (buphthalmos), Haab's striae are seen on the cornea. What do Haab's striae represent, and why do they run horizontally?

• A Iron deposition lines in the corneal stroma from chronic corneal oedema
• B Scarring of the trabecular meshwork seen on gonioscopy
• C Ruptures in Descemet's membrane running horizontally due to expansion of the infant globe from elevated IOP ✓
• D Corneal endothelial folds due to acute angle-closure attack

Explanation

Haab's striae are breaks (ruptures) in Descemet's membrane caused by the stretching of the infant's elastic cornea and globe under the force of chronically elevated IOP (buphthalmos). They run horizontally or obliquely in the cornea because circumferential expansion causes horizontal tensile stress. In contrast, birth trauma forceps injuries cause Descemet's ruptures that run vertically. Haab's striae cause corneal oedema, scarring, and irregular astigmatism.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.