What is it?

Childhood glaucoma is a disease associated with increased eye pressure resulting in optic nerve damage. From the name itself, this condition occurs in babies and young children and are usually categorized into different types depending on the age of onset.

Know more about the different types of childhood glaucoma, its associated risk factors, diagnostic procedures and available treatment options in the following sections.

Types of Childhood Glaucoma

Oftentimes, the type of childhood glaucoma can be based on the child’s age. These types include:

  • Primary Congenital Glaucoma – manifested at birth
  • Infantile Glaucoma – developed at age 1-24 months
  • Juvenile Glaucoma – onset 2 years after birth

In addition to age, the abnormality of eye structure and related medical conditions provide a more appropriate way to determine the type of glaucoma.

Glaucoma illustration

Symptoms of Childhood Glaucoma

The three most common symptoms of childhood glaucoma are abnormally enlarged eyes, increased sensitivity to light and corneal cloudiness. In some cases, secondary glaucoma can develop and can be influenced by numerous factors.

What is Secondary Glaucoma?

Secondary glaucoma is a medical condition where the glaucoma is associated with a secondary cause like certain types of disease and disorders.

Causes of Secondary Glaucoma

Eye Disorders during Childhood

Certain eye disorders that occurred during childhood can cause secondary glaucoma. For instance, children who have had the following conditions are at higher risk to developing glaucoma as they age:

  • prolonged use of steroidal eye drops to treat associated eye inflammations like juvenile rheumatoid arthritis
  • their genetic cataracts removed early in their life

Systemic Diseases

Systemic diseases are diseases that affect the whole body, this can be a cause for secondary glaucoma. The following systemic diseases are usually associated with secondary glaucoma:

  • Neurofibromatosis- a genetic disorder that mainly affects the nerve cells
  • Aniridia-characterized by partial or complete absence of the iris
  • Axenfeld-Rieger syndrome- a disorder that primarily affects the frontal area of the eye and in some cases, other parts of the body
  • Sturge-Weber syndrome- a rare condition caused by brain abnormalities and usually affecting one side of the face

History of Eye Trauma

A child with a history of eye trauma can also develop glaucoma during his/her childhood. However, in some cases, glaucoma does not manifest until the child reaches a certain age. This is why doctors recommend regular eye screening for children who have experienced eye trauma in their childhood for early detection of secondary glaucoma.

Early Detection is Key

Even though glaucoma is widely known as a disease occurring in adults, children at a very young age can be very vulnerable to developing this condition. To prevent irreparable damage later in life, early detection of childhood glaucoma is key.

In this light, for the remaining sections, this article will focus on the type of glaucoma present at birth which is medically known as primary congenital glaucoma.

What is Primary Congenital Glaucoma?

Baby rubbing its eyes

Primary congenital glaucoma is a relatively rare disease (1 in 10,000) manifested at birth. When the paediatrician or the parents observe eye abnormalities on newborn babies, these affected infants are promptly referred to be screened by an ophthalmologist.

Prominent eye abnormalities may include:

  • Abnormally enlarged eyes
  • The round, dark part of the infant’s eye is larger than usual
  • Corneas appear cloudy or opaque
  • Increased photosensitivity (light sensitivity)
  • Excessive blinking
  • Having excessive tears

It is important to note that not all excessive tearing is a sign of congenital glaucoma. This is because excessive tearing associated with the obstruction of tear ducts is generally more common than primary congenital glaucoma in infants.

To avoid confusion of the symptoms, excessive tearing caused by tear duct obstruction is often accompanied by discharge and crusting. Therefore, without discharge and crusting, the excessive tears can be an indication of congenital glaucoma.

Diagnostic Procedures

In the case where there is a chance of primary congenital glaucoma, an examination under anaesthesia is done along with relevant surgeries. Unlike adult glaucoma where eye drops or laser treatments are considered for first-line treatments, primary congenital glaucoma is generally considered a disease and requires early surgery. As the baby is undergoing the examination, surgery is also performed to avoid having the baby endure the anaesthesia twice.

For the diagnosis of primary congenital glaucoma, the ophthalmologist does the following:

  • Measures the eye pressure of the baby
  • Inspects the whole eye of the baby, which includes the optic nerves and drainage angle
  • Checks if the baby’s cornea is clear or cloudy
  • Measures the cornea size of the baby
  • Measures the baby’s eye size (as the eyeball is larger than normal in the case of congenital glaucoma)

When the child gets older, these examinations are done in the clinic instead of the operating room and are done similarly to adult examinations. At this stage, diagnostic procedures include the use of visual field tests and optic nerve imaging.

Treatment Options

Several types of surgeries may be performed for primary congenital glaucoma. Those include:

  1. Goniotomy

Goniotomy is a surgical procedure done to open an eye’s drainage systems. This is done via the use of a special lens called a goniolens to be able to see the structures on the front of the eye or anterior chamber. A small hole is then made in the trabecular meshwork, which is the group of small canals located in the drainage angle. This then allows fluid to leave the eye.

  1. Trabeculotomy or Trabeculectomy

A trabeculectomy is a surgical procedure done to lower the eye pressure by making a small hole in the eye. A trabeculectomy is the same procedure except that the hole is made with the removal of tissue.

  1. Tube Shunt Surgery

Tube-shunt surgery is performed to help lower eye pressure and is done by inserting a tube in the front of the eye.

Both goniotomy and trabeculectomy surgeries are done to open the eye’s drainage systems and have shown success in the treatment of primary congenital glaucoma. Trabeculectomy and Tube-shunt surgery are also performed on adults with glaucoma and are performed to lower eye pressure.

Although surgeries for primary congenital glaucoma have shown to be very successful, the child will need routine checkups as the eye pressure may start to increase over time. To get the eye pressure under control, multiple examinations and procedures are needed to be done.

Doctor pouring eye drops in eye patient

Eye drops are still prescribed even for highly successful surgeries to keep the eye pressure optimal. There is also a chance for the child to develop nearsightedness due to the larger eyeball size and will need glasses. Some children also develop amblyopia (lazy eye) or strabismus (crossed eyes)  which will impair their vision and require further treatment from a pediatric ophthalmologist.

Important Things to Know

Based on numerous reports and studies, children who developed glaucoma can lead healthy and fulfilling lives. However, because glaucoma can start to manifest early in life, significant (sometimes permanent) vision damage can be expected as the child grows older.

This is why early diagnosis and treatment of childhood glaucoma is very important as it can have a great impact on the child’s life. Proper monitoring and dedication to treatment are important keys to achieve better outcomes and improve the management of childhood glaucoma.

While lost vision cannot be regained, the remaining vision of each child can be optimized and maximized with the help of the child’s doctor and the support of the parents and the child’s community.

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