Signs and symptoms in the presentation of primary infantile glaucoma.

Delayed initiation of proper therapy for infants with primary infantile glaucoma results in an unnecessarily poor outcome. In an effort to understand why some infants and children had more advanced disease than others, researchers reviewed the records of 24 consecutive infants and children with this problem. The presenting signs and symptoms were studied in particular. As noted by the parents, only 32% had the full classic symptom complex of epiphora and photophobia/blepharospasm. Twenty-one percent of infants and children presented with parents having noted signs of infantile glaucoma without ever noting symptoms. More than 90% of infants and children had signs of glaucoma at their initial presentation to a physician. Signs of glaucoma are apparently more difficult to appreciate in bilateral cases. In each of the three cases in which physicians repeatedly failed to make the diagnosis or refer the patient to an ophthalmologist bilateral disease was present. Recognition of the signs and symptoms of primary infantile glaucoma will allow physicians to refer infants and children at a time when good vision may be maintained in the majority of cases.