Fig. 1. This 4-month-old girl came to the University of California, Davis, eye clinic with her older sister, who was returning for a strabismus examination. The child's mother had noted no symptoms of photophobia or tearing. The resident on the strabismus service noted her asymmetric eye size and initiated an evaluation. The intraocular pressure was 30 mmHg in the larger right eye. An axial length disparity of 3.01 mm was found at presentation (right eye, 22.58 mm; left eye, 19.57 mm). Trabeculotomy ab externo was performed 2 days after diagnosis and intraocular pressure was normalized. The axial length disparity had decreased to 0.2 mm 18 months after surgery.