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This 5-year-old boy presented to an eye clinic in Africa with the appearance shown in the pictures.  He is in no distress.  There is no previous family history of eye problems like this.  The boy does not appear to be in distress, but his vision is severely reduced and is measured at only “hand motions”.  His corneas look large and are cloudy as you can see.

1.	What is the most likely diagnosis?
	a. xerophthalmia b. onchocerciasis c. trachoma d.  congenital glaucoma e. none of the above
2.	Other characteristics about this boy are likely to include:
	a. myopia b. increased axial length c. increased intraocular pressure d.  Haab’s striae e. all of the above
3.	How would you treat this boy?
	a. There is really nothing to do; just use lubricating drops. b. Start steroid therapy, topically and systemically. c. Start with pilocarpine drops and adjust treatment depending on results. d.  Do a trabeculectomy/trabeculotomy now and consider a filtering implant later, if needed. e. Do a goniotomy.

For answers to the above, click here on or after December 11, 2007.