Childhood Glaucoma

Though the frequency of glaucoma increases with age, it can strike at any time in a person’s life. Glaucoma in children is rare, but is a significant cause of childhood blindness caused by a disease-related abnormal increase in intraocular pressure (IOP). Pediatric glaucomas usually fall into two categories. Primary congenital glaucomas result from abnormal development of the ocular drainage system and are genetic. This occurs in about 1 out of 10,000 births in the United States and is the most common form of glaucoma in infants. Secondary glaucomas result from disorders of the body or eye and may or may not be genetic. Both types may be associated with other medical diseases.

Ten percent of primary congenital glaucomas are present at birth, and 80 percent are diagnosed during the first year of life. The pediatrician or family first notice eye signs of glaucoma including clouding and/or enlargement of the cornea. The elevated IOP can cause the eyeball to enlarge and injury to the cornea. Important early symptoms of glaucoma in infants and children are poor vision, light sensitivity, tearing, and blinking.

Pediatric glaucoma is treated differently than adult glaucoma. Most patients require surgery and this is typically performed early. The aim of pediatric glaucoma surgery is to reduce IOP either by increasing the outflow of fluid from the eye or decreasing the production of fluid within the eye. One operation for pediatric glaucoma is goniotomy. Its rate of success is associated with the age of the child at the time of diagnosis, the type and severity of the glaucoma, and the surgery technique. Other surgical options are trabeculectomy and glaucoma drainage tubes.

Approximately 80 to 90 percent of babies who receive prompt surgical treatment, long-term care, and monitoring of their visual development will do well, and may have normal or nearly normal vision for their lifetime. Sadly, primary congenital glaucoma results in blindness in 2 to 15 percent of childhood patients. When childhood glaucoma is not recognized and treated promptly more permanent visual loss will result.