To the Editor: Picascia and Esterly described the occurrence of glaucoma in 2 of 22 patients with cutis marmo-rata telangiectatica congenita and commented on one previously reported infant who was similarly affected (J AM ACAD DERMATOL 1989; 20: 1098-104). We have seen two additional infants with both conditions, I which suggests that this may be a relatively frequent association. In all fivecases the glaucoma occurred when an eye was overlaid by a vascular abnormality. The vascular abnormality was a nevus f1ammeus in four cases and cutis marmorata telangiectatica in the fifth. However, study of the published photographs demonstrates an unusual degree of mottling or reticulation in these facial lesions, thereby making difficult the clinical distinction between nevus f1ammeus and the usual vascular lesions of cutis marrno-rata telangiectatica.

The association between glaucoma and an overlying nevus f1ammeus (at least in the setting of the Sturge-Weber syndrome) is well known, suggesting, as Picascia and Esterly noted, that an overlap exists between the two types of skin lesions. However, because our patients had an abnormal filtration angle rather than the increased episcleral venous pressure usually seen with nevus flammeus, perhaps the pathophysiology in the two settings is different. In any case one can conclude that there isa need to investigate underlying glaucoma in any patient who presents with cutaneous vascular abnormalities in the distribution of the first branch of the trigeminal nerve.