Recognising congenital glaucoma

To the Editor: Rudkin and colleagues1 remind readers of the importance of detecting congenital glaucoma early to reduce the risks of permanent eye damage, including blindness. The first clinical signs of congenital glaucoma are reported to be blepharospasm, photophobia and excessive tears, all difficult to discriminate in an infant. If the condition is untreated, the cornea progressively loses clarity, and diagnosis becomes more obvious. In giving this account of my personal experience, I remind general practitioners, paediatricians and ophthalmologists that early oedema of the cornea may be detectable before other signs.

Our daughter was born uneventfully and without medical problems. Four weeks after the birth, my wife, while gazing into her newborn’s eyes, commented, “Do you think her right eye is . . . more “shiny” than the left?” Looking at all angles, the anxious medical parents were convinced it was. Various medical friends were consulted. “Maybe, possibly”, they indulged us. A call to the senior paediatric ophthalmology registrar at our local children’s hospital was made along the lines of, “Is there such a thing as loss or increase in shine to the eye of a newborn?” In the absence of any other signs, such as inflammation, misery or excessive tears, we were told not to worry. Not reassured, we prevailed upon another ophthalmology registrar who, in a fit-in appointment, confirmed subtle corneal oedema caused by bilateral glaucoma, worse in the left eye.

In retrospect, the diagnosis was obvious. “Couldn’t have been anything else”, except the presenting sign was not a cloudy cornea, blepharospasm or misery — it was simply light reflecting off one eye less brilliantly than the other. “It ain’t fine, if it don’t shine.”