Childhood Glaucoma

By Eyecare NG

Overview   |  Types   |   Risk Factors   |  Signs & Symptoms   |   Diagnosis   |   Treatment   |   Prognosis

Overview

Glaucoma is a group of eye diseases that cause progressive damage to the optic nerve. It is usually associated with high pressure in the eye and if left untreated can lead to blindness.

In childhood glaucoma, the progressive damage to the optic nerve occurs in children, mostly in the early years of life and is usually associated with increased pressure in the eye.

Compared to glaucoma in adults, childhood glaucoma is rare. However, due to its potential to cause permanent vision loss, it is an important condition to watch out for, particularly if your child has conditions that put him or her at risk for the disease.

Types

There are different types of childhood glaucoma which are classified based on the cause or age of onset.

Types of childhood glaucoma by cause

  • Primary glaucoma: This is glaucoma that is not linked to any specific cause. It is hereditary and is thought to be due to an abnormal development of the drainage system of the eye before birth.
  • Secondary glaucoma: This is glaucoma that has a specific identifiable cause. This could be a genetic condition or an inflammatory eye disease. It could also occur as a complication of long term use of steroids, trauma or an eye surgery (like cataract surgery).

Types of childhood glaucoma by age of onset

  • Congenital glaucoma: This is glaucoma that is present at birth. It is inherited and occurs due to a defect in the structures responsible for the drainage of fluid in the eye
  • Infantile glaucoma: This is glaucoma that develops within the first two years of life. It may be inherited.
  • Juvenile glaucoma: This is glaucoma that develops in children aged 3 years and above.

Risk Factors

Some conditions that may increase a child’s risk of developing childhood glaucoma include:

  • History of childhood glaucoma in one or more siblings
  • Eye surgery
  • Eye injury
  • Prolonged use of steroids

Signs and Symptoms 

  • Excessive tearing: This is caused by the irritation of the eye by high pressure and glare.
  • Cloudy cornea: This is one of the earliest signs of glaucoma. It is a result of the swelling of corneal tissues due to excess fluid in the eye
  • Light sensitivity: Cloudy and water-filled cornea may cause glare and inflammation resulting in abnormal sensitivity to light.
  • Excessive blinking or spasm of the eyelid (blepharospasm): This is the response of the eyelids to irritations that arise due to the cloudy cornea and enlargement of the eyeball.
  • Enlarged cornea or eyeballs (buphthalmos): This is caused by increased pressure in the eye. It is often a major sign of glaucoma in children.

Diagnosis

Diagnosis of childhood glaucoma requires a comprehensive eye examination.

Examination in young children, particularly infants may be performed under anaesthesia to enable the doctor effectively carry out the exam.

Note that children can react badly to anaesthesia. Therefore any examination involving anaesthesia should be done in a hospital in the presence of a trained pediatric anesthesiologist. It is also recommended that the doctor be prepared to perform surgery immediately should in case his/her diagnosis indicates a need for that. This helps to prevent a situation whereby the child is anaesthetized again for surgery at a later date.

During the examination, the doctor measures the eye pressure and other parameters such as corneal diameter and the length of the eyeball (from front to back). He assesses all the parts of the eye including the optic nerve for abnormality.

Examination for older children is similar to that of adults comprising eye pressure measurement, visual field assessment and a dilated eye exam.

After performing the standard tests, supplemental tests like Optical Coherence Tomography (OCT) may be required to make a definite diagnosis.

Treatment

The primary goal for the treatment of glaucoma in children is to preserve vision. Treatment is targeted at lowering the intraocular pressure surgically and medically.

Surgery

This is usually the first choice of treatment for young children. It is done to open up the drainage system in the eye or create a new one so that fluid can drain from the eye properly.

For older children, surgery is considered if medications fail.

Medical treatment

This involves the use of eye drops and tablets to lower eye pressures. Medical treatment is usually given as an adjunct to surgical treatment in young children. However, medications may be started on a diagnosis of childhood glaucoma to lower the pressure while surgery is being planned.

For older children, medical treatment is usually the first line of treatment.

There are different types of anti-glaucoma drops that may be prescribed for the lowering of pressure. A combination of these medications may be prescribed depending on the stage of glaucoma and how high the pressure in the eye is.

Prognosis

The visual outcome of the eye after glaucoma treatment depends on the stage of the disease and age of onset. The earlier the diagnosis and treatment, the better the outcome. Surgeries tend to be more successful with good control of the pressure and little or no permanent damage to the structures of the eye if glaucoma is diagnosed early.

Children with glaucoma may also have refractive errors such as shortsightedness (due to the enlarged eyeball) and astigmatism (due to the corneal scars or irregularities). For better outcomes, these errors are usually corrected with lenses.  Also, if a squint or amblyopia is present, they are also be treated.

Childhood glaucoma is challenging to treat and there may be complications. To ensure better visual outcomes, it is important that the child is closely follow-up to enable prompt detection and management of post-surgery complications that may arise.