Epiphora with photophobia in a newborn most strongly suggests which diagnosis?

• A. Congenital glaucoma
• B. Conjunctivitis
• C. Corneal abrasion
• D. Retinopathy

Answer: (A)

Tearing with sensitivity to light in a newborn points most strongly to congenital glaucoma because high intraocular pressure from an abnormal aqueous outflow causes corneal edema and light sensitivity. This leads to photophobia and tearing early in life, often with a hazy cornea or an enlarged eye as features. Conjunctivitis usually brings discharge and redness with milder or no photophobia; a corneal abrasion would require trauma and presents with focal eye pain rather than the typical newborn glare and tearing pattern; retinopathy presents with abnormal red reflex or leukocoria rather than prominent photophobia. So the combination described is most characteristic of congenital glaucoma.