A Basic Guide to Understanding Childhood Glaucoma

Childhood glaucoma is also called congenital glaucoma, infantile glaucoma, and pediatric glaucoma. It occurs in infants and young children. 

How common is childhood glaucoma? Congenital glaucoma is a rare eye disorder that may be inherited. It occurs in approximately 1 in 10,000 live births worldwide.

What causes childhood glaucoma?

It is caused by the malformation of the eye’s drainage system in intrauterine (before birth), which leads to the accumulation of aqueous humor. The accumulation of aqueous humor cause increases intraocular pressure, which leads to damage of the optic nerve and loss of vision eventually. 

What are the symptoms of childhood glaucoma?

Here are signs and symptoms of childhood glaucoma:

  • Photosensitivity (sensitivity to light): closure of one or both eyes to the flash of light
  • Enlarged cornea (large eyes)
  • Blurry vision
  • Severe eye pain
  • One eye may look bigger than the other
  • Excessive tearing
  • Headache (mainly complained by much older children)
  • Nausea
  • Vomiting
  • Loss of appetite (poor feeding)
  • Child becomes irritable
  • Abdominal pain
  • Cloudiness of the cornea
  • Eventually, loss of vision

Risk Factors of Childhood Glaucoma include:

  • Family history of glaucoma
  • Being born with a cornea that is thin in the center
  • Eye injuries
  • Sickle cell anemia

Types of childhood glaucoma

The classification of childhood glaucoma according to onset:

  1. Congenital glaucoma: is glaucoma that is present at birth.
  2. Infantile glaucoma: is glaucoma that begins before three years of age.
  3. Childhood glaucoma: is glaucoma that begins after three years of age.

Though they are classified according to onset, glaucoma in children is generally termed childhood glaucoma.

Classification of childhood glaucoma according to cause:

  1. Primary childhood glaucoma: is glaucoma that cannot be attributed to any other cause other than hereditary.
  2. Secondary childhood glaucoma: is glaucoma that can be attributed to an eye injury, other eye disorders, or another systemic disease that attacks the eyes.

Diagnosis of Childhood Glaucoma

Childhood glaucoma is usually diagnosed immediately after birth or within the first year of birth. If hereditary and other causes of glaucoma cause it, is diagnosed child quickly begins to complain of visual issues. Diagnostic methods used for making a confirmed diagnosis are:

  • Visual acuity examination: the ability to see things far or near is measure with the standard eye chart with letters and images.
  • Visual field test: your child’s peripheral vision is measure as well because the loss of peripheral vision is one of the earliest manifestations of glaucoma.
  • Tonometry: determines the pressure of fluid inside the eyes.
  • Pupil dilation: an eye-drop is put in your child’s eye to widen the eye so the retina and optic nerve can be examined for any damage.

Treatment of Childhood Glaucoma

Can childhood glaucoma be cured? There is no cure for glaucoma, but symptoms can be managed throughout life with surgery and medications.

Surgery:

  • Trabeculectomy and goniotomy: an opening will be made into the drainage area of the eye to allow fluid to drain out easily, thereby reducing the intraocular pressure.
  • Trabeculectomy: a part of the trabecular meshwork drainage system is removed to allow drainage of fluid.
  • Cyclo-photo-coagulation: is usually done in severe childhood glaucoma. In this procedure, a laser beam is used to freeze certain areas of the ciliary body to reduce the production of aqueous humor. The ciliary body is the part of the eye that produces aqueous humor.
  • Iridotomy: a small hole is made through the iris to allow fluid flow easily. The iris is the colored part of the eyes.

Medications

Medications that can be used to lower aqueous humor production and increase the outflow of fluid in order to reduce intraocular pressure are:

  • Beta-blockers: such as timolol and levobunolol. Timolol is the drug of choice in childhood glaucoma.
  • Dorzolamide: is the second choice for the management of childhood glaucoma. 
  • Prostaglandin analogs: such as latanoprost and bimatoprost, can be used in childhood glaucoma, but they are less effective in comparison to their effects in adults.
  • Pilocarpine: can be used in children to reduce intraocular pressure, but it is not the first choice when treating childhood glaucoma. 

Note: Combination of Timolol (taken once a day) and Dorzolamide (taken twice a day) can be used in cases where timolol is not sufficient enough to reduce intraocular pressure.  

Final word

  • The optic nerve is a collection of over a million nerve fibers that connect the retina to the brain.
  • Glaucoma is a disorder that is usually seen in adults age 60 years and above.
  • Glaucoma is the second leading cause of blindness in adults.
  • Timolol is contraindicated in children with asthma due to bronchospasm.