A 6-week-old infant presents with bilateral corneal edema, increased corneal diameter, and Haab striae. Intraocular pressure is elevated at 32 mmHg in both eyes. The most likely diagnosis is:

• A Congenital nasolacrimal duct obstruction
• B Birth trauma from forceps delivery
• C Megalocornea
• D Primary congenital glaucoma ✓

Explanation

The triad of epiphora, photophobia, and blepharospasm with corneal edema, increased corneal diameter, Haab striae (breaks in Descemet membrane), and elevated IOP is classic for primary congenital glaucoma. Megalcornea is non-progressive with normal IOP. Forceps trauma causes corneal edema without Haab striae or buphthalmos. CNLDO causes tearing but not corneal haze or elevated IOP.

Reference: Kanski's Clinical Ophthalmology, 9th ed.

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Written and medically reviewed by the StethoPrep medical team.