Glaucoma In Children: Types, Causes, Symptoms, And Treatment

Glaucoma is a medical condition that develops when aqueous humor, fluid in the eye that normally moves in and out of the eyes, cannot drain from the eyes. Glaucoma in children is rare, but when it occurs, the built-up pressure (intraocular pressure) in the eye can lead to optic nerve damage, causing vision loss or light sensitivity (1). Although childhood glaucoma is incurable, timely treatment can stop the progress and help prevent serious, irreversible complications, such as vision loss (2).

Read on to know about glaucoma in children, including its causes, symptoms, and treatments.

Types Of Glaucoma In Children

Glaucoma in children is rare and affects about one in 5,000 to 10,000 children below two years (3). Based on the age of onset, possible cause, and structural abnormality, glaucoma can be categorized into the following types (1) (2) (4)

1. Infantile or congenital glaucoma: Glaucoma that occurs in children between one and 24 months is called congenital or infantile glaucoma.

2. Juvenile or childhood glaucoma: When glaucoma develops in children above three years, it is called juvenile or childhood glaucoma.

3. Primary glaucoma: Primary glaucoma is the term used to classify glaucoma with an unidentifiable cause.

4. Secondary glaucoma: When glaucoma is caused or associated with a specific condition, such as Axenfeld-Reiger syndrome and aniridia, it is known as secondary glaucoma. Not all individuals with these conditions develop glaucoma. However, their risk increases, and hence, a child with any of these conditions requires regular eye check-ups.

5. Open-angle glaucoma: It is the most common type of chronic glaucoma and is seen in more than 90 percent of all glaucoma cases. It is caused by the gradual obstruction of the drainage canals, which causes the pressure inside the eye or intraocular pressure (IOP) to rise. No noticeable symptoms and damage are seen, except for the wide and open angle between the cornea and iris.

6. Low-tension or normal-tension glaucoma: It is a less common type of glaucoma in which the optic nerve is damaged although the pressure in the eye is at a normal level. The cause of the condition is unknown.

7. Angle-closure glaucoma: Also called acute glaucoma or narrow-angle glaucoma, this glaucoma type involves noticeable damage to the optic nerve. It is often a result of the closure of the angle between the iris and cornea and requires prompt medical attention.

Causes Of Glaucoma In Children

Glaucoma is often a result of the accumulation of the aqueous humor in the drainage canals of the eye. In some cases, the cause isn’t identifiable (primary glaucoma), whereas in others, glaucoma can occur due to the following factors (1) (5).

• Hereditary–specific genetic mutation
• Eye disorder, disease, or injury
• Eye surgery, such as childhood cataract removal (aphakic glaucoma)
• Intake of certain medicines, such as steroids

According to the American Association for Pediatric Ophthalmology & Strabismus (AAPOS), about ten percent of infantile or congenital glaucoma is inherited (1). Also, secondary glaucoma associated with specific conditions, such as neurofibromatosis and aniridia, is inheritable.

Symptoms Of Glaucoma In Children

Generally, the symptoms of glaucoma in children aren’t noticeable until the child loses some sight. However, you could look out for some of these common symptoms if you suspect the child has glaucoma (1) (5).

• Excessive watering of the eye
• Pain and discomfort
• Irritability and fussiness
• Appetite loss
• Sensitivity to light (photophobia)
• Cloudy, enlarged cornea
• Nearsightedness that worsens
• Difficulty seeing things off to the side
• Headaches
• One eye may be larger than the other
• Enlargement of the center portion of the optic nerve (optic nerve cupping)

Note: If a child has excessive watering with mattering/discharge, it’s more likely due to congenital nasolacrimal duct obstruction (blocked tear duct) and not glaucoma.

The severity of glaucoma symptoms varies from one child to another, and it may affect one or both eyes. Also, most of the glaucoma symptoms may appear similar to other eye problems. Hence, consult a pediatric ophthalmologist for an accurate diagnosis.

How Is Glaucoma Diagnosed In Children?

Depending on the child’s symptoms and medical and family history, an ophthalmologist will examine the child’s eyes. The examination includes evaluating the intraocular pressure, drainage angle of the eye, and abnormal cupping indicating optic nerve damage.

Here are some tests that the doctor may suggest to check the child’s eye (6).

1. Visual acuity test: It’s also known as the eye chart test and is done to measure the child’s visual ability. The doctor will ask the child to read numbers and letters of varying sizes from varying distances.

2. Pupil dilation: Pupil dilation test involves examining the eye retina and optic nerve by widening the pupil using specific types of eye drops.

3. Visual field testing: This test requires the child to observe things from side to side to determine their side vision. Loss of peripheral vision may indicate glaucoma.

4. Tonometry: It is a standard test done to measure the fluid pressure inside the eyes.

5. Optical Coherence Tomography (OCT): OCT is a test done to check the thinning and damage to the optic nerve fibers.

Examining children, especially young children, requires parental support as they may fear the examination process. Hence, the doctor may use different instruments than those used for adults to examine the child. In some cases, the doctor may perform the test under anesthesia so that the child doesn’t move during the examination.

Treating Glaucoma In Children

Effective treatment of glaucoma in children depends on timely diagnosis. The course of treatment may depend on the child’s age, overall health, medical history, and severity of glaucoma. Here’s the likely course of treatment for a child diagnosed with glaucoma (6).

1. Medications: Medications are prescribed to cause the eyes to produce less fluid and lower the pressure of the aqueous humor inside the eyes by helping the fluid drain out. Generally, medications and eye drops are the first line of treatment for treating secondary glaucoma (1).

2. Surgery: Most primary glaucoma cases are treated with surgery (1). The surgical intervention involves making a new opening in the eye to let the fluid drain out of the eye. The opening can be made using microsurgery or laser. Here’s a brief overview of the surgeries that a doctor may use to treat glaucoma in children.

• • Trabeculotomy: It’s a surgical procedure in which an opening is made into the drainage area of the eye (trabecular meshwork drainage system), which helps get a relatively normal anterior chamber angle and allows the free drainage of fluid.
  • Trabeculectomy: It’s a surgical procedure in which a part of the trabecular meshwork drainage system is removed to allow the fluid to drain from the eye.
  • Iridotomy: This surgical intervention involves making a small hole in the iris (the colored tissue at the front of the eye) to allow the aqueous humor to flow more freely in the eye. An expert may opt for a laser to perform this procedure.
  • Tube shunt: A tube shunt is a flexible drainage device placed in the eye to drain the aqueous humor (2).
  • Cyclophotocoagulation: The procedure involves using a laser beam to freeze the selected areas of the ciliary body that produce the aqueous humor to reduce fluid production. It is often opted to treat severe cases of glaucoma.

Note: A child may need one or more medications to control intraocular pressure even after surgery. Some may need more than one surgery to stop glaucoma from progressing.

Despite timely diagnosis and treatment, childhood glaucoma can cause other vision-related issues, such as nearsightedness (myopia), lazy vision (amblyopia), and misalignment of the eyes (strabismus), and warrant additional treatment.

Possible Complications Of Glaucoma In Children

Timely diagnosis and appropriate treatment can minimize the damage that glaucoma can cause to the eyes. However, if the condition is left untreated or worsens, it may lead to severe complications, such as (3)

• Loss of vision on the sides (peripheral vision).
• Loss of eyesight or permanent blindness.

Glaucoma in children cannot be cured, but one can control its progression with timely diagnosis and effective treatment. Hence, you must take a note of your child’s eye health and take prompt medical guidance if the child shows any of the signs and symptoms of an eye problem. Remember, treating glaucoma in children requires prompt medical intervention as a delay in treatment can cause permanent loss of vision.

References

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Reviewer

Dr. Garima Garg SethMD

     

Dr. Garima Garg Seth is a well-known pediatrician in Gurgaon, having more than 19 years of experience in this field. She has completed her education from topmost organizations in India, including AIIMS, New Delhi; Sir Ganga Ram Hospital, New Delhi; and CMC Vellore.

Read full bio of Dr. Garima Garg Seth