Pediatric glaucoma involves damage to the optic nerve, which transmits visual information to the brain. This condition is typically caused by elevated pressure inside the eye, known as intraocular pressure (IOP). The eye’s natural drainage system is compromised, causing fluid to build up and exert pressure on the delicate nerve tissues. Early detection is particularly important in children because their developing visual systems are highly vulnerable to permanent damage from this increased pressure. Prompt diagnosis and treatment are necessary to preserve vision and ensure the best possible visual development.
Classifying Pediatric Glaucoma
Pediatric glaucoma is categorized by the age of onset and its underlying cause to guide treatment. Primary forms are linked to developmental abnormalities in the eye’s drainage angle, the area where fluid exits the eye. Primary congenital glaucoma occurs from birth up to one month of age, while infantile glaucoma is diagnosed between one month and two years old.
Juvenile glaucoma appears after age two and often presents with fewer physical signs than infantile forms. These primary types involve a defect in the trabecular meshwork, the tissue responsible for fluid outflow, and are not caused by other diseases. Approximately 10% of primary congenital cases are inherited, suggesting a genetic link.
Secondary glaucoma arises from underlying medical conditions, eye injuries, or previous eye surgeries. Common causes include trauma, chronic eye inflammation, or complications following congenital cataract removal. Systemic diseases, such as Axenfeld-Rieger Syndrome or Sturge-Weber Syndrome, are also associated with a higher incidence of secondary glaucoma. Identifying the underlying cause is important for developing a targeted management plan.
Recognizable Symptoms in Infants and Children
Symptoms of pediatric glaucoma often differ from those in adults, especially in infants, and serve as the first alert for parents. The classic triad of signs in infants includes photophobia (extreme sensitivity to light), epiphora (excessive tearing), and blepharospasm (forceful squeezing or blinking of the eyelids).
A physical sign unique to infants is buphthalmos, the enlargement of the eye or cornea, because the younger eye tissue stretches under elevated internal pressure. The cornea may also appear cloudy or hazy due to swelling, significantly affecting vision. These dramatic physical signs are less common in older children, whose eyes are more rigid and less likely to expand from the pressure.
In older children and adolescents with juvenile glaucoma, symptoms are often more subtle and may resemble the adult form. They may report blurry vision, worsening nearsightedness, or frequent headaches. Peripheral vision loss, the gradual inability to see objects to the side, is a common progression that can be difficult for a child to articulate.
Diagnostic Procedures and Medical Assessment
Confirming pediatric glaucoma requires a comprehensive eye examination. For infants and very young children, an accurate assessment often necessitates an Examination Under Anesthesia (EUA). The EUA allows the ophthalmologist to obtain precise, reliable measurements while the child is completely still.
Specialized tools are used during the assessment. Tonometry measures the intraocular pressure (IOP). Pachymetry measures corneal thickness, which influences IOP reading accuracy. Gonioscopy is also performed to visualize the eye’s drainage angle and assess structural defects.
Diagnosis relies on a combination of factors, not just a single high-pressure reading. The physician examines the optic nerve head for signs of damage, specifically “cupping,” which is the excavation of nerve tissue caused by sustained pressure. The overall diameter and length of the eye are also measured to check for buphthalmos and monitor future changes.
Treatment Strategies and Long-Term Care
Treatment for primary congenital and infantile glaucoma typically begins with surgical intervention, differing significantly from adult management. The goal of surgery is to correct the anatomical defect in the drainage system to allow natural fluid outflow. Goniotomy is performed when the cornea is clear, allowing the surgeon to visually incise the abnormal tissue in the drainage angle from inside the eye.
If the cornea is cloudy, obstructing the view of the angle, trabeculotomy is performed, creating an opening in the drainage pathway from the outside of the eye. Both procedures aim to restore normal fluid outflow. If angle surgeries fail, or in complex secondary cases, a trabeculectomy or the implantation of a glaucoma drainage device may be necessary to create an alternative drainage pathway.
Medical management with eye drops is often used as a secondary measure, either temporarily before surgery or when surgery is insufficient. Beta-blockers like timolol and topical carbonic anhydrase inhibitors such as dorzolamide are commonly prescribed to reduce IOP. These medications decrease fluid production or improve its outflow, though some common adult drops are avoided in young children due to potential side effects.
Long-term care involves consistent, lifelong monitoring to manage the risk of progression or recurrence. Even after successful surgery, the child’s vision must be rehabilitated, often requiring treatment for amblyopia, or “lazy eye,” which is a frequent complication. Treatment preserves remaining vision and prevents further damage, as vision lost due to optic nerve damage cannot be restored.