Glaucoma most commonly affects adults above the age of 40 years. But can it affect children as well?
The answer is unfortunately, yes. Childhood glaucoma is a cause for concern as it may lead to blindness in affected children. Read today’s post about childhood glaucoma.
Today is Day#4 of World Glaucoma Week. Let’s discuss childhood glaucoma, a blinding disease that can affect newborn as well as older children.
How common is Childhood Glaucoma?
Fortunately, Childhood Glaucoma is relatively rare, and it’s reported incidence is 1 in 10,000 births among the general population.
Which age group does childhood glaucoma affect?
It can affect children of all age groups. Depending upon the age at which Glaucoma is diagnosed in a child, it can be classified into 2 types.
1. Congenital Glaucoma
These children are born with glaucoma. The symptoms appear soon after birth. Any child who is diagnosed with glaucoma before the age of 3 years is said to have congenital glaucoma.
2. Juvenile Glaucoma
This type of glaucoma affects children between 3-14 years of age.
This classification is important because the presentation of the two types of glaucoma is slightly different.
Why does childhood glaucoma occur?
In children with glaucoma, the development of the drainage channel of the eye known as “trabecular meshwork” is abnormal.
Therefore, the clear fluid that circulates in the eye is not able to exit the eye normally leading to a rise in eye pressure.
Is Childhood Glaucoma Hereditary?
Only 10% of cases of primary glaucoma are hereditary.
If a person has a history of glaucoma in their childhood, they can determine and minimize the risk of transmitting it to their children through proper genetic counseling.
What are the symptoms of Childhood glaucoma?
A child with congenital glaucoma will have
- Abnormally Large Eyes
- Cloudy cornea
- Excessive tearing
- Sensitivity to light
In children less than 3 years, due to rise in eye pressure, the size of the eye increases abnormally, because their tissues are still immature and therefore stretchable.
In older children, the eye tissues have achieved the normal adult size and rigidity, and the symptoms in these children are similar to adults and present with vision loss without an increase in eyeball size.
How is Childhood Glaucoma diagnosed?
Most cases are noticed by the parents or the care givers due to abnormally large cloudy looking eyes.
Examination is carried out by an eye specialist in collaboration with an anesthetist. General anesthesia is usually needed because very young children often do not cooperate for eye examination.
Under general anesthesia, the eye doctor will measure the child’s eye pressure and examine the angle of the eye for any abnormalities. Usually in cases of childhood glaucoma, an abnormal membrane covers the normal drainage pathway. The eye doctor will also evaluate the child for any refractive errors, abnormal elongation of the eyeball and look for damage to the optic nerve caused due to glaucoma.
What are the treatment options for Childhood Glaucoma?
Treatment is primarily surgical. The abnormal membrane covering the drainage pathway is removed by a procedure known as “goniotomy” or “trabeculotomy”.
The procedure is minimally invasive, wherein a small incision is made through the cornea and a small blade is inserted in the angle to remove a portion of the abnormal trabecular meshwork to allow for easy passage of the clear fluid out of the eye, thereby controlling the eye pressure.
These procedures have been used with a good success rate for several years in childhood glaucoma.
Here’s a short animated video that will help you understand these surgical procedures.
Medications in the form of eyedrops and pills may be sometimes used in children with glaucoma.
Also, laser procedures that use a small but powerful beam of laser to open up the drainage channels may be beneficial in certain cases of childhood glaucoma.
Problems associated with Childhood Glaucoma
Childhood glaucoma is a distressing disease, because unlike adults, children are often unable to report the difficulties faced by them. And like adult glaucoma, vision once lost cannot be restored.
The goal is to keep the eye pressure under control, but the follow up is more difficult, because unlike adults, children are unable to cooperate for eye examinations and might need to be examined repeatedly under anesthesia to measure the eye pressure.
Once the eye pressure is under control, the next step is to look for other problems that a child with glaucoma might face. These children have a higher chance of developing myopia, i.e. nearsightedness and might require glasses. They are also prone to develop “lazy eye” i.e. amblyopia and might need treatment for the same. Squints are also commonly seen in children with glaucoma.
What to expect
Since children are often unable to report their complaints, it is our responsibility to be alert and observe for signs that suggest an eye problem. You could read my other blog there I have listed 8 warning signs of vision problems among children.
Although vision loss and optic nerve damage that has already occurred cannot be reversed, the child’s vision can still be optimized to enable the to live a fairly normal independent life.
I hope I have helped you understand childhood glaucoma and its treatment options. If you have any questions, feel free to comment below or email me at email@example.com
I’ll meet you again tomorrow with another glaucoma related blog, till then take good care of your eyes and stay healthy!