Online Photo Diagnosis

By Gregory W. DeNaeyer, OD

This is a picture of posterior embryotoxon of a patient who has Axenfeld's anomaly. Posterior embryotoxon is a prominent Schwalbe's line that may be a partial or complete bilateral ring and is usually visible on gross external examination. It is an indication of either Axenfeld's anomaly/syndrome or Rieger's anomaly/syndrome, both of which are anterior chamber syndromes that put patients at risk for glaucoma.

Axenfeld's Anomaly

• Autosomal dominant
• Posterior embryotoxon
• Iris processes
• Normal IOP
• Glaucoma risk: 25 to 50 percent

Axenfeld's Syndrome

• Includes all findings of Axenfeld's anomaly except the patient will have an elevated IOP.

Rieger's Anomaly

• Includes all findings of Axenfeld's anomaly plus includes significant iris hypoplasia.
• Glaucoma risk: 50 to 75 percent

Rieger's Syndrome

• Includes all findings of Rieger's anomaly plus includes facial, dental, and systemic manifestations.

The patient featured in the photograph maintains normal IOP with no indications of glaucoma. She will be monitored yearly.

Reference

Catania, LJ. Primary Care of the Anterior Segment 2nd Ed. Appleton & Lange 1995. p. 242-243.