 Glaucoma
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Glaucoma is a condition in which the normal fluid pressure inside the eyes (intraocular pressure, or IOP) slowly rises as a result of the fluid aqueous humor - which normally flows in and out of the eye - not being able to drain properly.
Instead, the fluid collects and causes pressure damage to the optic nerve (a bundle of more than 1 million nerve fibers that connects the retina with the brain) and loss of vision.
Glaucoma is classified according to the age of onset. If it begins before the child is 3 years old, it is called infantile or congenital (present at birth) glaucoma. If it occurs in a child older than 3 years old, is called childhood glaucoma.
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Glaucoma occurs when the fluid drainage from the eye is blocked by abnormal development or injury to the drainage tissues, thus, resulting in an increase in the intraocular pressure, damage to the optic nerve, and loss of vision.
There are many causes of childhood glaucoma. It can be hereditary or it can be associated with other eye disorders. If glaucoma cannot be attributed to any other cause, it is classified as primary. If glaucoma is a result of another eye disorder, eye injury, or other disease, it is classified as secondary.
In approximately one-third of cases, congenital glaucoma is inherited by an autosomal recessive gene. Autosomal means that both males and females are equally affected, and recessive means that two genes are required to have the condition, one inherited from each parent, who are carriers. Carrier parents have a one in four, or 25 percent, chance with each pregnancy to have a child with congenital glaucoma. The remaining two-thirds of congenital glaucoma cases are sporadic (occurs by chance).
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In addition to a complete medical history and eye examination of your child, diagnostic procedures for childhood glaucoma may include:
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- visual acuity test - the common eye chart test (with letters and images), which measures vision ability at various distances.
- pupil dilation - the pupil is widened with eyedrops to allow a close-up examination of the eye's retina.
- visual field - a test to measure a child's side (peripheral) vision. Lost peripheral vision may be an indication of glaucoma.
- tonometry - a standard test to determine the fluid pressure inside the eye.
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Younger children may be examined with hand-held instruments, whereas older children are often examined with standard equipment that is used with adults. An eye examination can be difficult for a child. It is important that parents encourage cooperation. At times, the child may have to be examined under anesthesia, especially young children, in order to examine the eye and the fluid drainage system, and to determine the appropriate treatment.
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Glaucoma is rare in children, as compared to the adult. However, when it does occur, the symptoms may not be as obvious in children. More than 60 percent of children are diagnosed before they are 6 months old. Glaucoma can affect one eye or both.
The following are the most common symptoms of childhood glaucoma. However, each child may experience symptoms differently. Symptoms may include:
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- excessive tearing
- light sensitivity (photophobia)
- closure of one or both eyes in the light
- cloudy, enlarged cornea
- one eye may be larger than the other
- vision loss
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If the eye pressure increases rapidly, there may be pain and discomfort. Parents may notice that the child becomes irritable, fussy, and develops a poor appetite. Early detection and diagnosis is very important to prevent loss of vision. The symptoms of glaucoma may resemble other eye problems or medical conditions. Always consult your child's physician for a diagnosis.
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Specific treatment for glaucoma will be determined by your child's physician based on:
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- your child's age, overall health, and medical history
- extent of the disease
- your child's tolerance for specific medications, procedures, or therapies
- expectations for the course of the disease
- your opinion or preference
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It is important for treatment of childhood glaucoma to start as early as possible. Treatment may include:
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- Medications - Some medications cause the eye to produce less fluid, while others lower pressure by helping fluid drain from the eye.
- Conventional surgery - The purpose of conventional surgery is to create a new opening for fluid to leave the eye.
- Laser surgery - There are several types of laser surgery used to treat glaucoma, including the following:
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- trabeculotomy - In this, the most common type of laser surgery to treat open-angle glaucoma, a laser is used to place 'spot welds' in the drainage area of the eye (known as the trabecular meshwork) which allow fluid to drain more freely.
- iridotomy - In this procedure, the surgeon uses the laser to make a small hole in the iris - the colored part of the eye - to allow fluid to flow more freely in the eye.
- cyclophotocoagulation - A procedure that uses a laser beam to freeze selected areas of the ciliary body - the part of the eye that produces aqueous humor - to reduce the production of fluid. This type of surgery may be performed with severe cases of childhood glaucoma.
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Both medications and surgery have been successfully used to treat childhood glaucoma.
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