A 2-month-old infant has bilateral watering, photophobia, and blepharospasm. Both corneas are enlarged and hazy, measuring 13 mm horizontally. Intraocular pressure is 28 mmHg in each eye. On examination of the corneal endothelium behind the limbus, which finding would be MOST confirmatory of the diagnosis?

• A Posterior embryotoxon
• B Krukenberg spindle
• C Kayser-Fleischer ring
• D Haab striae ✓

Explanation

The triad of epiphora, photophobia and blepharospasm with raised pressure, corneal oedema and enlargement (buphthalmos, cornea over 12 mm) indicates primary congenital glaucoma. Stretching of the cornea ruptures Descemet membrane, producing horizontal endothelial breaks known as Haab striae, a hallmark confirming chronic stretching. Posterior embryotoxon belongs to Axenfeld-Rieger anomaly, Krukenberg spindle to pigment dispersion, and Kayser-Fleischer ring to Wilson disease.

Reference: Nelson Textbook of Pediatrics, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.