As congenital glaucoma progresses, which finding is most characteristic?

• A. Increased corneal diameter greater than 12 mm
• B. Decreased intraocular pressure
• C. Cloudy cornea with preserved corneal clarity
• D. Normal vision

Answer: (A)

Elevated intraocular pressure in congenital glaucoma causes the eye to stretch and enlarge over time. The most characteristic progression sign is corneal enlargement, or buphthalmos, seen as a corneal diameter greater than about 12 mm in infants. This reflects chronic IOP elevation stretching ocular tissues and is the hallmark of advancing disease. In contrast, pressure is not decreased in this condition, so a finding of low IOP isn’t fitting. Cloudy or edematous cornea can occur with glaucoma, but the defining progressive change is the enlarged corneal diameter, and vision is unlikely to remain normal as the disease progresses.