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Childhood Glaucoma

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Updated October 31, 2012

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Internal/External Eye Anatomy
A.D.A.M.
When most people hear the word glaucoma, they immediately think of older adults. Surprisingly, however, infants and young children can also develop glaucoma. Glaucoma is a group of diseases characterized by higher than normal pressure in the eye. This pressure can cause damage to the optic nerve, severe vision loss, and sometimes even blindness. Glaucoma is more common in people over forty but it can occur at any age.

Childhood glaucoma is usually classified based on age of onset. Glaucoma that is present at birth is referred to as congenital glaucoma while glaucoma present between the ages 1-2 is considered infantile glaucoma. After the age of 3, the condition is referred to as juvenile glaucoma.

Why Some Children Develop Glaucoma

In most cases of glaucoma in children, the canal in the eye that drains the fluid fails to develop properly. This leads to an increase in the pressure inside the eye and eventually damage to the optic nerve. When a child is otherwise healthy, doctors refer to the glaucoma as primary pediatric glaucoma. If the child has identifiable syndromes or systemic conditions such as Axenfeld-Rieger syndrome, Sturge-Weber syndrome, or neurofibromatosis, then doctors consider it to be secondary pediatric glaucoma. In some of these systemic conditions, the canal that drains the eye’s fluid does not develop properly or is malformed which limits the amount of fluid to drain. Some children can develop secondary glaucoma from treatment of other problems such as juvenile rheumatoid arthritis or cataracts.

Signs and Symptoms of Childhood Glaucoma

  • Excessive tearing
  • Light sensitivity
  • Enlarged, cloudy cornea
  • Enlarged eye
  • Eye redness
Unlike glaucoma that develops in an adult, very young children often develop a condition called buphthalmos. Because the tissue of the globe of the eye is more elastic, as the pressure increases inside the eye it actually expands the size of the eye and the cornea. The pressure also creates swelling and clouding of the cornea.

Diagnosis of Childhood Glaucoma

Most eye doctors, pediatricians and neonatal hospital health professionals are aware of physical changes or symptoms of glaucoma and recognize it early. A pediatric optometrist or ophthalmologist will often be called to examine the child under anesthesia. The eye pressure will be measured, as well as the corneal diameter, length of the eyeball, the inside of the eye and the optic nerve. If the child is older, some of these measurements can be conducted in the physician’s office. The pediatric eye doctor will usually then refer that patient to a pediatric glaucoma specialist whom is often affiliated with children's clinics or hospitals.

Treatment of Childhood Glaucoma

Childhood glaucoma treatment is a lot different than that of adults. In adults, the first line of treatment for glaucoma is usually medicational eye drops given to lower the eye pressure to a safer level. Although medicated eye drops are a part of the treatment in children, surgery is usually chosen first to correct the physical abnormalities that prevent the proper drainage of fluid.

Surgeries for pediatric glaucoma are usually either a trabeculectomy or a goniotomy. In these types of procedures, surgeons surgically alter the anatomy to create a route for the fluid to escape. If these procedures do not work, the surgeon will install a tube or a shunt to drain the fluid. Other times, surgeons will use a device to "freeze" the ciliary body, the part of the eye that manufactures the fluid that fills the front part of the eye. This freezing technique renders the ciliary body inactive so that very little fluid is produced.

Once the pressure is lowered, the pediatric specialist will then use a procedure to treat problems that sometimes occur in children with pediatric glaucoma. These children are often nearsighted and require eyeglasses and may have a lazy eye (amblyopia) or a crossed eye (strabismus). Early diagnosis is important because secondary problems can cause vision loss as well.

Source:

Beck, A D. Diagnosis and management of pediatric glaucoma. Ophthalmology Clinic North America, 14 Sept 2001, pp 501-12.

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