Glaucoma, commonly associated with older adults, can also affect children, sometimes even from birth. This group of eye diseases damages the optic nerve, which transmits visual information from the eye to the brain. Damage usually occurs when the fluid pressure inside the eye, known as intraocular pressure (IOP), rises too high. This happens when the eye’s internal fluid cannot drain properly, causing it to accumulate and compress nerve fibers. Pediatric glaucoma is rare, yet it remains a serious concern that can lead to permanent vision loss if not addressed early.
How Glaucoma Manifests in Children
Glaucoma in children is classified based on the age of onset and the underlying cause. The most common form diagnosed in infants is Primary Congenital Glaucoma, present at birth or developing within the first few years of life. This type stems from a developmental defect in the eye’s drainage system, specifically the trabecular meshwork, which obstructs the normal outflow of fluid. The problem is isolated to the eye and is not associated with other systemic disorders.
When the condition appears later in childhood or adolescence, it is often termed Juvenile Glaucoma. This form typically presents after the age of three and before adulthood, sometimes without the pronounced physical signs seen in infants. It is frequently inherited, and specific genetic factors, such as mutations in the myocilin protein, are identified in some cases.
A third category is Secondary Glaucoma, which develops as a result of another medical condition, eye trauma, or as a side effect of medication. This can occur at any age during childhood. Causes include prolonged use of steroids, previous eye surgeries such as cataract removal, or inflammation from uveitis. Secondary glaucoma can also be linked to congenital syndromes like Sturge-Weber syndrome or Axenfeld-Rieger syndrome.
Identifying Visual Symptoms in Infants and Toddlers
The symptoms of glaucoma in infants and toddlers differ significantly from those in adults because their young eye tissues are more elastic and susceptible to stretching. One of the most noticeable signs is extreme sensitivity to light (photophobia). An infant with photophobia will often squint, turn their face away from bright lights, or become irritable in normally lit environments.
Excessive tearing, or epiphora, that is not related to crying or allergies is another frequent indicator of elevated intraocular pressure. This persistent watering occurs because the raised pressure affects the cornea, leading to discomfort that triggers an overproduction of tears. Parents may observe that their child’s eyes seem to be constantly moist or running, even when they are not upset.
A characteristic sign of infantile glaucoma is buphthalmos, which describes the abnormal enlargement of the entire eyeball. Because the external layer of a baby’s eye is more pliable, the sustained high internal pressure causes the eye to expand in size. This can make the affected eye appear noticeably larger than the other.
As the pressure stretches the eye structure, the normally clear cornea can become hazy or cloudy, appearing dull or grayish. This clouding happens as the fluid is forced into the corneal layers, causing them to swell and lose transparency. The stretching can also cause microscopic breaks in the layers of the cornea, known as Haab’s striae. Behavioral changes, such as constantly rubbing the eyes or avoiding areas with normal lighting, should prompt immediate professional evaluation.
Medical Intervention and Management
The initial step in managing pediatric glaucoma involves a comprehensive assessment to confirm the diagnosis and determine the specific type of glaucoma present. For very young or uncooperative children, this often requires an examination under anesthesia (EUA), allowing the specialist to accurately measure intraocular pressure (IOP) and examine the optic nerve and drainage structures. Specialized imaging and measurement tools are used to assess the corneal diameter and look for damage to the optic nerve head.
Unlike adult glaucoma, where medication is typically the first treatment, surgery is often the primary and most effective intervention for Primary Congenital Glaucoma. This is because the condition in infants progresses rapidly and is caused by a structural defect that medication cannot resolve permanently. The goal of surgery is to physically improve the eye’s natural drainage system to permanently lower the IOP.
Common surgical procedures include goniotomy and trabeculotomy, which involve opening the blocked drainage channels within the eye. These angle surgeries are designed to reduce the resistance to fluid outflow, making them the preferred initial approach for developmental defects. If these angle procedures are unsuccessful, or if the glaucoma is secondary or more complex, the surgeon may implant a glaucoma drainage device or perform a trabeculectomy.
Medication, usually in the form of eye drops, plays a supportive role, often used temporarily to lower IOP before surgery or as a secondary treatment after a procedure. Long-term management involves regular, frequent follow-up appointments to monitor IOP, assess the optic nerve, and ensure proper visual development. Because children’s visual systems are still maturing, specialized care is necessary to prevent amblyopia (lazy eye) and other vision problems that can result from early damage or unequal vision between the two eyes.