Pediatric Glaucoma

What is Glaucoma?

Glaucoma is a group of diseases characterized by damage to the optic nerve that often occurs when the eye pressure is too high. This optic nerve damage can eventually result in severe vision loss. Most often, the pressure is too high because the eye is able to make the fluid it needs but is unable to sufficiently drain the fluid out. Glaucoma is more common in the elderly, but can develop at any age. Infants and children with glaucoma typically have different signs and symptoms than adults.

Is Pediatric Glaucoma common?

Childhood Glaucoma is not rare in the Middle Eastern and Asian population. Children who undergo Cataract surgery have a higher incidence of Glaucoma. For example, 50% of patients with Aniridia [an eye disorder characterized by a complete or partial absence of colored part of the eye—iris] will develop Glaucoma during their lifetime.

What are the symptoms of Congenital Glaucoma?

The most common symptoms of Congenital Glaucoma are excessive tearing, light sensitivity and a large, cloudy cornea which can cause the iris [colored part of the eye] to appear dull.

One has to be careful as excessive tearing accompanied by mattering/discharge in a child is usually not caused by Glaucoma but instead is the result of Congenital Nasolacrimal Duct Obstruction [blocked tear duct].

How is Pediatric Glaucoma evaluated and diagnosed?

There are several areas to be examined that help the ophthalmologist determine the type and severity of Glaucoma. Depending on the age and cooperation of the child, some or all of these components may be better evaluated while the child is under anesthesia.

Specifically, the ophthalmologist will evaluate the intraocular pressure, corneal diameter, corneal clarity, corneal thickness, the drainage angle of the eye, the axial length, refractive error and the optic nerve.

Older children may also be able to participate in a diagnostic visual field test to evaluate peripheral vision.

This can help determine if there has been any significant optic nerve damage. Additional imaging tests [looks for thinning of the actual nerve fibers]—such as Optical Coherence Tomography (OCT)—can be useful for detecting more subtle changes in the progression of the disease.

How is Pediatric Glaucoma treated?

Pediatric Glaucoma is treated by lowering the Intraocular Pressure (IOP) via medical and/or surgical means. Most cases of primary Pediatric Glaucoma are treated with surgery. There are various types of surgery depending on the area of the eye affected. Below are the commonly performed procedures which differ in different individual patients:

1. Trabeculotomy and Goniotomy, which open the drainage canals, are the most common surgical interventions. Other procedures create a bypass route for the aqueous [fluid made by the eye] to drain out of the eye. A Trabeculectomy creates a guarded opening from the front of the eye to a space underneath the conjunctiva- which is the clear membrane that covers the sclera [the white part of the eye].

2. A tube shunt is a device which is inserted into the front of the eye or into the vitreous cavity [back part of the eye]. Fluid from the eye then drains to a reservoir that is located underneath the conjunctiva.

3. Laser procedures can also be beneficial in some cases.

4. Deep Sclerectomy is a procedure of choice for adults and is gaining popularity in neonates in certain parts of the world.

Control of the glaucoma often requires multiple procedures and examinations under anesthesia. Eye drops, and oral medications are the primary treatments for secondary and juvenile glaucoma and are often used as adjuvant therapy after surgery in primary pediatric glaucoma.

One or more medications may be necessary to control the Intraocular Pressure (IOP), even after surgery. Achieving the best vision in patients with Pediatric Glaucoma is not solely dependent on successful reduction of IOP. Many children with Pediatric Glaucoma develop Myopia [nearsightedness] and require glasses. Also, Amblyopia [Lazy Vision] and Strabismus [misalignment of the eyes] occur more frequently and may require treatment with patching or surgery.

Despite timely and aggressive treatment, Pediatric Glaucoma can still cause significant and permanent vision loss. Early diagnosis and treatment, as well as close monitoring, are crucial for obtaining a long-term successful outcome.

Associated information site: Pediatric Glaucoma and Cataract Family Association (PGCFA)

Measurement of the cornea- corneal diameters

BELOW ARE SOME OF THE COMMON EXAMINATION PROCESSES INVOLVED IN A PATIENT WITH GLAUCOMA       

Intra ocular pressure check

Assessment of angle structures – Gonioscopy

Documentation of the angle and optic nerve