Glaucoma in Children

By Nimi Patel

Image Credit: Helyx Graphic Designer: Faiza Chowdhury

Although most common in ages over 60, glaucoma is also present among youth. Glaucoma, known infamously as the “silent thief of sight,” can ultimately lead to blindness as a result of damage in the optic nerve. The reason behind this damage is relatively high eye pressure caused by excessive fluid in the back of the eye. Found in large amounts in glaucoma patients, this clear liquid, also called aqueous humor, is responsible for transporting nutrients to the lens and cornea, which lack blood supply. The cause of high pressure in the eyes of glaucoma patients is due to an inability to drain aqueous humor properly. Found in 1 in 10,000 births, pediatric glaucoma is indeed rare. So why do children suffer a disease that is considered normal in the aging process of older patients?

First off, there are three types of pediatric glaucoma: congenital glaucoma, infantile glaucoma, and juvenile glaucoma. Congenital glaucoma is detected at birth. Infantile glaucoma develops between the first two years of the child’s life, but both are characterized by excessive tearing, sensitivity to light, and enlarged, murky corneas. Juvenile glaucoma is a type of pediatric glaucoma that is discovered after the age of three, and it can develop with no apparent symptoms. A sign of juvenile glaucoma can be increased eye pressure or an enlargement in the center of the optic nerve, which can be discovered through an eye examination.

The primary cause of glaucoma is hereditary. In fact, the American Association for Pediatric Ophthalmology and Strabismus claims that about 10% of pediatric glaucoma cases are inherited, and recent research also suggests that specific genetic mutations are also connected to this disease. In addition, neurofibromatosis and aniridia are diseases that are inherited and are associated with a higher chance of glaucoma. More specifically, if a child inherits neurofibromatosis or aniridia, then he or she is at higher risk of glaucoma.

Though not currently curable, there are several ways to treat glaucoma and monitor one’s eyes. Lowering intraocular pressure is the first step in treating glaucoma, but for many pediatric cases, surgery is necessary to do so. Trabeculotomy or goniotomy may be used to open the canals in the eye that drain aqueous humor. Trabeculotomy is a procedure in which some of the tissue in the drainage angle —the point where the iris and sclera meet— is taken out to create an opening for aqueous humor to drain. Goniotomy is when a doctor uses a particular type of lens called a goniolens to see through the front of the eye. Then, the doctor makes an opening in the trabecular meshwork —a series of small canals in the drainage angle— so that aqueous humor can be drained. In some cases, a bypass route may need to be created for the liquid to drain properly. In these processes, a tube shunt is placed into the front or rear of the eye where the liquid can then drain into a reservoir. Laser treatments are common, but oral medications and eye drops are prevalent methods for treating pediatric cases.

Even after performing a surgery, glaucoma patients are at risk of myopia, strabismus, or amblyopia. Myopia, also known as nearsightedness, characterizes most patients who require eyeglasses or other corrective lenses to see properly. Strabismus is when the eyes are not aligned and may cross one another. Amblyopia, most commonly known as lazy-eye, occurs when the brain fails to recognize the sight of one eye. Therefore, glaucoma itself can lead to a variety of other eye diseases, often resulting in serious, irreversible damage to the eye, or in the worst case, loss of vision. It may be easier to diagnose glaucoma in older patients as they can express changes in their vision more clearly than children, but regardless, visiting an optometrist for routine checkups is necessary to retain healthy vision.


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