Children and glaucoma

Take Home Points

Glaucoma in children could take up an entire book all on its own (and there are some good professional texts). Here, I will only hit on the most important points. Children are affected by glaucoma in less than one in a thousand births. No one actually has good figures on it, but as with other forms of glaucoma, if there is another affected family member, particularly a relative who got glaucoma as a youngster, the chance is much greater. In one study we did, 10% of children with glaucoma had one or more affected young or old family member with glaucoma.

Second, to identify that glaucoma has happened to a child isn’t easy, but there are some typical signs. Children’s eyes get bigger when eye pressure is higher, so their whole eye looks big. Second, the clear front of the eye (cornea) gets cloudy when pressure is high, so the eye looks white and the colored iris is harder to see. Something about how glaucoma affects kids causes them to hate bright lights and, in addition, their eyes have much more tearing than normal.

To diagnose what’s going on in a child, we are fortunate that there is now a good pressure measuring device that works on them without anesthesia, the iCare tonometer. We also do ophthalmoscopy to evaluate the optic nerve head. When there is definite glaucoma in a child, our approach is often to suggest surgery as the best, first choice, for two reasons. First, a particular form of surgery (trabeculotomy or goniotomy) has a pretty high success rate. Second, if we can make the eye safe with surgery, it avoids years of eye drops daily.

There are children who have general body diseases that also have glaucoma as part of the disease. One of the more common is inflammatory disease, such as juvenile rheumatoid arthritis. Here, the approach should be a coordinated one between the specialist in arthritis and the eye specialist.

Premature babies have a particularly hard time developing their eyes normally and frequently need treatments for the inside of the eyes (retinopathy of prematurity), as well as later in life developing an unusual form of angle closure glaucoma.

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