Glaucoma is an eye disease that affects children as well. It is a group of diseases where increased eye pressure damages the optic nerve. If not treated, glaucoma can lead to severe loss of vision and even blindness. Although glaucoma mainly affects adults, it can occur in children of any age. The disease, however, presents differently in children and adults. It is also rare as it occurs in only one out of 1000 children.
Glaucoma can be classified according to when it began.
- Congenital glaucoma - A child is born with it.
- Infantile glaucoma - It begins in children aged one month to two years.
- Juvenile glaucoma - It develops in children from age three and above.
Glaucoma can also be classified according to structural abnormalities and systemic conditions involved and include:
When there is no specific justifiable cause. For instance, primary congenital or primary infantile glaucoma
Caused by or associated with other conditions/situations such as aniridia, Sturge-Weber, previous eye surgery, neurofibromatosis, Aexnfeld-Reiger syndrome, trauma, chronic steroid use, etc.
Causes & Risk Factors
Literature indicates that hereditary factors are involved in approximately 10% of primary infantile/congenital glaucoma. Some conditions like aniridia and neurofibromatosis are hereditary, and sometimes transferred to children. They in turn, may lead to glaucoma.
Risk factors may include:
- High eye pressure
- Race where the disease affects more African-Americans
- Certain eye diseases associated with glaucoma such as aniridia
- Family history where individuals with a history of glaucoma have an increased likelihood of developing glaucoma
Signs & Symptoms
Typical signs seen in congenital glaucoma include:
- Sensitive to bright lights
- Unusual, excessive tearing
- The eyes grow bigger with higher eye pressure
- The cornea becomes cloudy such that it’s difficult to see the iris
There are no obvious symptoms of juvenile glaucoma. These children have a positive family history of glaucoma. Signs and symptoms for juvenile glaucoma resemble those of adults and include:
- Blurry vision
- Severe eye pain
- Nausea or vomiting
- Halos around lights
- Increased eye pressure
- Optic nerve cupping where the optic nerve’s center is enlarged
Early diagnosis is necessary, and diagnosis can be made through:
- Taking complete medical and family history
- Checking corneal thickness
- Measuring eye pressure using a tonometer
- Pupil dilation to examine the eye’s inner structures
- Checking if the cornea is clear and free of cloudiness
- Assessing the eye’s drainage angle using a gonioscopy
- Evaluation of the optic nerve head using an ophthalmoscope
- Visual acuity test to see how well a child can see at various distances
- Evaluation of eye pressure by checking if the corneal diameter has increased
- Imaging tests such as optical coherence tomography can detect any subtle changes
- Examination of the axial length to check if the eye is elongated on account of raised pressure
- Checking for refractive error, which may be caused by eye elongation and optic nerve damage
- For older children, a visual field test may be performed to assess peripheral vision. This test reveals the extent of the damage on the optic nerve
Treatment for glaucoma in children is aimed at lowering eye pressure. Glaucoma associated with other conditions such as juvenile rheumatoid arthritis needs an interdisciplinary approach to treatment between the ophthalmologist and arthritis specialist. Children born with retinopathy of prematurity require frequent treatment. Some children may require repeated surgical or medical treatment to achieve the desired outcomes.
Medications in the form of eye drops and oral drugs are available to treat glaucoma. They are the primary means of secondary and juvenile glaucoma treatment. These medications can manage eye pressure after a surgical procedure. They help fluid drain from the eyes, while some cause the eye to create less fluid.
Surgery is considered the best option for children, mainly because the chances of success are very high. Surgery is also preferred because children do not have to spend the rest of their lives on daily eye drops. Primary pediatric glaucoma is primarily treated with surgery such as goniotomy and trabeculotomy. These procedures help open the drainage canals and normalize pressure. Other types of glaucoma surgery make an alternative route for the fluid to flow out of the eye and lower the pressure.
Sometimes eye pressure can be lowered by a tube shunt placed into the eye. The shunt allows fluid to drain from the eye to a reservoir below the conjunctiva. Laser surgery can help to lower eye pressure.
Prognosis & Long-Term Outlook
Pediatric glaucoma patients often develop nearsightedness, amblyopia, and strabismus. These require treatment such as eyeglasses, patching of the eye, and surgery. Pediatric glaucoma is a serious disease that can still cause extensive damage or permanent loss of vision, even when diagnosed and treated aggressively. Thus, the patient must follow the ophthalmologist's instructions faithfully. Patients who have already lost their vision can make do with low vision devices to lead a comfortable life.
Prevention & Follow Up
Close monitoring of children with glaucoma can help them achieve successful long-term outcomes.