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This 8-year-old boy presents with what his parents describe as large “eyes”. As you look at the boy in the clinic you see that the child appears to have large corneas. Before doing anything beyond looking at the boy:

1.	What is your first thought about a possible diagnosis?
	e -- congenital glaucoma The first thing to think about when you see a child with enlarged corneas is congenital or pediatric glaucoma. If there were a refractive error, it would be myopic. Doing nothing is not an option here. A skin lesion would be present with Sturge-Weber.
2.	What would you do next?
	e -- all of the above You would do all of the above. If the child had congenital glaucoma, you would be likely to see some or all of the following: reduced visual acuity, myopia (increased axial length), a cloudy cornea with linear opacities called Haab’s stria, and cupping of the optic nerve.
3.	If all of the above were normal, which of the following would you be most likely to find?
	c -- iris transillumination If all of the tests were normal, the boy would be likely to have X-linked megalocornea, and would therefore not have an affected sister or father. The axial length would be normal in megalocornea. Lisch nodules are seen in slightly older children with neurofibromatosis.