Childhood glaucoma

23/09/2024

Glaucoma in childhood, also known as paediatric glaucoma, is an eye disease that affects children from birth to adolescence. It is a rare condition but one of the leading causes of blindness in childhood if it is not diagnosed and treated promptly.

This rare disease can be hereditary and caused by incomplete or deficient development of the drainage system of the aqueous humour before birth. The inability of the aqueous humor to drain properly leads to increased intraocular pressure, which causes symptoms and damages the optic nerve.

It is typically diagnosed at birth or during the first year of life. If glaucoma begins before the age of 3, it is called congenital (present at birth) glaucoma. If it appears in a child over 3 years old, it is called juvenile glaucoma.

Types of childhood glaucoma

• Primary congenital glaucoma: This is the most common type of childhood glaucoma and occurs due to abnormal development of the eye’s drainage system during foetal development. It is typically diagnosed within the first few years of life, often in the first year. It can be bilateral (affecting both eyes) or unilateral (affecting only one eye).
• Secondary glaucoma: This type develops as a result of other ocular or systemic conditions, such as inflammatory diseases, tumours or trauma. It can also be caused by complications from other eye surgeries, such as those performed to treat cataracts.
• Glaucoma associated with systemic anomalies: Some genetic conditions or syndromes may be associated with glaucoma, such as Sturge-Weber syndrome, neurofibromatosis or Marfan syndrome.

Symptoms

The symptoms of childhood glaucoma are often first noticed by parents.  Children may have bulging or enlarged eyes (one eye may be larger than the other), the eye appear cloudy or whitish,and the child may exhibit intolerance to light (photophobia), excessive tearing (epiphora) and frequently close their eyes.

• Excessive tearing (epiphora): Due to eye irritation.
• Photophobia: An abnormal sensitivity to light.
• Blepharospasm: Involuntary and persistent closing of the eyelids.
• Increase in the size of the eye (buphthalmos): The eye may appear larger due to elevetad intraocular pressure.
• Corneal opacity: The cornea can become cloudy due to damage to its structure.
• Eye pain and redness: These symptoms can appear in more advanced or acute cases.

Treatment

Sometimes, medications are required to reduce eye pressure, either until surgery is performed or afterward to maintain appropriate pressure levels. Medical treatments can include topical medications (ophthalmic drops) or oral medications. Surgery may be performed using microsurgery techniques or laser treatment. It is crucial to start treatment as early as possible.

With early diagnosis and proper management, many children with glaucoma can lead relatively normal lives with functional vision. However, regular follow-up is essential to monitor disease progression and adjust treatment as needed.

Dr. Francisco Ruiz Tolosa, ophthalmologist at the Centro de Oftalmología Barraquer