PAEDIATRIC GLAUCOMA

Paediatric Glaucoma

Glaucoma is a condition in which the optic nerve that connects the eye to the brain gets damaged, mainly due to the increased eye pressure. Although it most commonly affects the elderly, childhood glaucoma (from birth to 18 years of age) affects about 1 in every 3300 children in India.  In these children, the fluid inside their eyes (which controls the intraocular pressure or IOP) does not drain properly. Normally, fluid flows in and out of the eye. When it builds up to high levels, however, it creates too much pressure inside the eye. This condition damages the optic nerve, the structure that delivers visual information from the eyes to the brain. Left untreated, glaucoma leads to irreversible blindness.

Because paediatric glaucoma is uncommon and harder to detect, it is important to seek specialized care.

Identifying Paediatric Glaucoma at an earlier stage is the best way to defy irreversible blindness in children. Usually, Paediatric Glaucoma exhibits between birth to 18 months of age, however, many children are born with this problem. Some children may also suffer from secondary glaucoma which could be caused by injury, some other eye surgery or as a result of using certain medication for a long time.

Identifying Paediatric Glaucoma

Children having big eyes (cornea, the black portion usually is enlarged) or having a whitish or bluish appearance of the cornea may have glaucoma, and should immediately be taken to the Paediatric Ophthalmologist; specifically, to a Paediatric Glaucoma Specialist.

Your child’s eye examination will include microscopic examination of the eyes’ structure, followed by Intraocular pressure (IOP), also known as eye pressure, using a special equipment. Most children may require an eye examination under anaesthesia as they may not co-operate for the routine clinical testing.

The signs and symptoms of childhood glaucoma include:

• Enlarged eyes – one or both (often subtle and mistaken for normal)
• Excessive tearing
• Cloudy corneas and a dull iris
• Sensitivity to light in one or both eyes
• Myopia (near-sightedness) in one or both eyes

Childhood glaucoma can sometimes be missed – the signs are not always obvious; the disorder mimics other conditions and children cannot always explain their symptoms. For this reason, your paediatrician should examine your baby’s eyes during the first year of life. If vision appears to be developing normally, your child needs a comprehensive eye exam by their fourth birthday, and every two years after that. 

Tests

Comprehensive Eye Examinations – Our paediatric ophthalmologists use child-appropriate exam techniques to diagnose childhood glaucoma.

Imaging Tests – Optical coherence tomography (OCT) gives your child’s physician a 3-D view of the retina, optic nerve and other structures inside the eye. Other imaging tests may include photography and ultrasounds.

Causes of Glaucoma in Children

As a parent, you naturally wonder what caused your child’s glaucoma. While some glaucoma can run in families, most primary childhood glaucoma have no identifiable causes. Secondary paediatric glaucoma occurs more often in children who have any of the following conditions:

• Axenfeld-Rieger Syndrome
• Aniridia
• Sturge-Weber Syndrome
• Neurofibromatosis
• Chronic steroid use
• History of retinopathy of prematurity and laser treatment
• Trauma or previous eye surgery such as childhood cataract removal

Treatment of Paediatric Glaucoma

Paediatric Glaucoma is usually treated with both, surgically as well as with medicines. The surgery requires a well-trained Paediatric Glaucoma Specialist. After the surgery, many children recover completely. However, a few may require medical treatment for a long time, in some cases, the entire life.

Surgery – Most children, especially babies with primary congenital glaucoma, have better vision results from surgery than medication. Options may include goniotomy, trabeculotomy, or a glaucoma drainage device. Some children need surgery more than once to control the eye pressure. In infants younger than 2 months of age or who were premature, sometimes an overnight stay is required after surgery. Otherwise, most children go home the same day after glaucoma surgery. 

Approximately 80-90% of babies who receive prompt surgical treatment will do well, and may have normal or nearly normal vision for their lifetime. Most babies who have glaucoma and do not obtain appropriate care quickly will lose their vision. Early detection and treatment can mean the difference between sight and blindness.

Eye Drops and Oral Medications – When glaucoma develops during childhood, in addition to surgery, your child’s physician may prescribe eye drops or oral medications to control intraocular pressure (IOP)

Glasses and Patching Therapy – Many children with paediatric glaucoma develop myopia (near-sightedness) and amblyopia (lazy eye), and will need glasses and patching therapy.