Obstetric forceps injury mimicking unilateral congenital glaucoma

摘要

A healthy child was brought to our emergency department 2 h after birth with a diagnosis of suspected unilateral congenital glaucoma of the left eye. There was a history of forceps assisted delivery. Examination showed conjunctival chemosis, congestion and corneal oedema, more prominent centrally and paracentral vertical fold across the diameter of the cornea (figure 1). The right eye was normal and intraocular pressure was 12 mm Hg in both eyes. The cornea of the left eye showed vertical rupture in Decemet's membrane, typical of obstetric forceps injury, as opposed to the more horizontal or curvilinear breaks of 'Haab's striae' found in congenital glaucoma patients. Based on these findings, corneal birth trauma secondary to obstetric forceps injury in the left eye was established. Six weeks following conservative treatment corneal oedema cleared leaving a vertical scar just nasal to the visual axis (figure 2). The corneal scar may result in astigmatism and vision loss if anisometropia and ambly-opia is left untreated. The paediatrician and the obstetrician should be aware that obstetric forceps-related corneal birth trauma may mimic unilateral congenital glaucoma and refer promptly to the ophthalmologist for management and continued amblyopia treatment.