08/03/2022
Childhood Glaucoma
*** A condition of childhood in which the optic nerve (nerve that goes from the eye to the brain) is damaged from high pressure in the eye. It can be present at birth or be diagnosed throughout childhood. Childhood glaucoma can cause permanent vision loss if left untreated.
*** Glaucoma is diagnosed based on certain eye
examination findings: ***
•Increased eye pressure.
•Optic nerve damage diagnosed based on the appearance of the nerve.
•Lines in the cornea (called Haab striae), which are stretch marks from the increased pressure.
•Increase in the length of the eye measured by ultrasound and glasses prescription (nearsightedness).
•Peripheral vision loss. This may be impossible to measure until a child is old enough (usually after 5 years of age) to cooperate with a formal side vision test (visual field).
•Abnormal appearance to the drainage system of the eye which can diagnosed only by (gonioscopy).
*** Symptoms of childhood glaucoma ***
• Excessive tearing
• Light sensitivity (photophobia)
• Closure of one or both eyes in the light
• Cloudy, enlarged cornea (large eye)
• One eye may be larger than the other Vision loss
*** Different Types of Childhood Glaucoma ***
•Primary Congenital Glaucoma (PCG).
Children with PCG have enlarged eyes and frequently have corneal clouding. it consists of three subtypes based on the age of the child at onset.
1.Neonatal onset develops before 1 month of age;
2. infantile onset develops between 1 month and 24
months of age;
3.Late onset develops after 24 months of age.
•Juvenile Open Angle Glaucoma (JOAG).
This type of glaucoma develops after age 3 years, and is associated with normal sized eyes and the absence of corneal clouding.
• Secondary Childhood Glaucoma
Glaucoma is classified as secondary if it results from an ocular birth defect or a syndrome, an eye injury, or other disease such as juvenile inflammatory arthritis. There are four categories of secondary childhood glaucoma:
•Glaucoma following Cataract Surgery.
Also called aphakic glaucoma, this refers to the type of
glaucoma that can occur in children who’ve had cataract surgery.
•Glaucoma Associated with Acquired Conditions.
This type of glaucoma occurs as a result of conditions such as
ocular injury, inflammation or infection of the eye, or medication
use (corticosteroids).
•Glaucoma Associated with Non-Acquired Systemic Disease or
Syndrome.
This type of glaucoma is associated with systemic conditions that
are present at birth, such as Down syndrome, Marfan syndrome,
and Sturge-Weber syndrome.
•Glaucoma Associated with Non-Acquired Ocular Anomalies.
This type of glaucoma is associated with certain ocular conditions
present at birth such as aniridia, Axenfeld-Rieger anomaly or
Peters anomaly, among others.
***Treatment for glaucoma:***
Specific treatment for glaucoma will be determined by your child's physician based on:
• Your child's age, overall health, and medical history
• Extent of the disease
• Child's tolerance for specific medications, procedures, or therapies
Expectations for the course of the disease.
Your opinion or preference
It is important for treatment of childhood glaucoma to start as early as possible. Treatment may include:
*** Medications ***
Some medications cause the eye to produce less fluid, while others lower pressure by helping fluid drain from the eye.
*** Conventional surgery ***
The purpose of conventional surgery is to create a new opening for fluid to leave the eye.
*** Surgery***
Surgical procedures are performed by using microsurgery or lasers. The purpose of surgery is to create an opening for fluid to leave the eye. Surgical procedures used to treat glaucoma in children include the following:
•Trabeculotomy and goniotomy
A surgical opening is made into the drainage area of the eye (known as the trabecular meshwork drainage system), therefore establishing a more normal anterior chamber angle that allows the fluid to drain more freely, lowering the intraocular pressure (IOP). A goniotomy is an internal trabeculotomy procedure that is used in congenital glaucoma.
•Trabeculectomy
A surgical procedure that involves the removal of part of the trabecular meshwork drainage system, allowing the fluid to drain from the eye.
•Iridotomy
In this procedure, a small hole is made through the iris - the colored part of the eye - to allow fluid to flow more freely in the eye. The surgeon may use a laser to create this hole (laser iridotomy).
•Cyclophotocoagulation
A procedure that uses a laser beam to freeze selected areas of the ciliary body - the part of the eye that produces aqueous humor - to reduce the production of fluid. This type of surgery may be performed with severe cases of childhood glaucoma.
