A common stereotype for Glaucoma is that it is the “Elderly’s Disease.” However, both research and reality have shown a different picture. Although this disease mostly affects the elderly, it is also present in children, usually from the time of their birth. The chances of Pediatric Glaucoma are rare, but never zero. When this condition occurs, it causes vision issues for children. Early detection is a necessity because if that’s not done on time, the child can suffer for a lifetime. Consider this blog as your guide to combating the challenges that come with pediatric Glaucoma. Remember, acting right at the right time is the greatest strategy.   

Understanding Glaucoma

Glaucoma can be defined as a subset of eye conditions that cause considerable harm to the optic nerve. This nerve serves a crucial role in vision, as its main function is to transmit visual data to the brain. The damage to this nerve often takes a fatal turn due to the presence of intraocular pressure (IOP). This kind of pressure is a result of the accumulation of fluids inside the eye. If not treated on time, Glaucoma can lead to permanent loss of vision for the victim. 

The development of Glaucoma in adults is slow, which has led many to name it the “Silent Stealer of sight.” However, this is not the case for Pediatric Glaucoma. In children, glaucoma develops faster and is often infamous for its aggressive nature. 

Pediatric Glaucoma

Pediatric glaucoma refers to glaucoma that is identified in childhood. It is broadly classified into two main types:

  • Primary Congenital Glaucoma (PCG):   Identified during the time of birth or the initial years following the birth of the child. Often caused due to the abnormal development of the ocular drainage system. 
  • Secondary Pediatric Glaucoma: preexisting eye condition or eye trauma. It can also be a result of genetic disorders or previous eye surgeries.

Pediatric Glaucoma is not very common. However, there are fatal consequences if it is left untreated. Considering this, some risk factors of this type of glaucoma include:

  • Family record of pediatric glaucoma
  • Specific types of genetic syndromes (Axenfeld-Rieger syndrome)
  • Eye injury or any prior traumatic or invasive experiences involving the eye
  • Related to medical conditions such as neurofibromatosis or Sturge-Weber syndrome

Symptoms of Pediatric Glaucoma 

Adult Glaucoma is often without symptoms in its early stages. On the other hand, Pediatric Glaucoma has some easily noticeable signs. In fact, it is very easy for experienced healthcare providers to spot them. Once these symptoms are identified, the chances of the child seeing clearly increase by significantly.

The most common signs and symptoms are: 

  • Epiphora – Constant watery eyes without any allergies or infections
  • Photophobia – Squinting or  discomfort in excessive light
  • Buphthalmos – One or both eyes appear abnormally large due to increased eye pressure, expanding the eye wall.
  • Cloudy cornea – The generally clear front surface of the eye appears hazy or milky, a key sign of swelling.
  • Frequent eye rubbing – The child may rub their eyes often due to blurriness in vision or a feeling of discomfort. 
  • Poor vision or delayed visual milestones – In older children, this may show as difficulty recognising faces, tracking objects, or performing visual tasks.

Since young children cannot always express what they feel, as a parent, you must look for these signs and inform your ophthalmologist at the earliest.  

Methods of Diagnosis

Methods of Diagnosis (Pediatric Glaucom)

The processes involved with diagnosing pediatric glaucoma can often prove to be quite challenging due to several factors. These factors include the age of the child, the noticeability of the signs, and whether the child is willing to cooperate with the healthcare provider. In most cases, ophthalmologists use child-friendly equipment so as not to scare the child.   

The diagnostic process may include:

  • A Detailed family medical history – Helps in the identification of genetic connections or related conditions.
  • Comprehensive Eye Examination – Includes checking for corneal clarity, size, and any noticeable ocular abnormalities. 
  • Determining intraocular pressure (IOP) – IOP is often measured through the use of tonometry after sedating the child. 
  • Anaesthetic Examination (EUA) – Allows the doctor to perform an in-depth check. This includes gonioscopy (looking at the drainage angle of the eye) and optic nerve assessment.
  • Optic nerve evaluation – Using ophthalmoscopy or imaging to identify any traces of nerve damage.
  • Corneal diameter measurement – An abnormally large cornea is one of the strongest indicators of congenital glaucoma.

Because pediatric glaucoma is a rapidly progressive condition, frequent follow-up visits are essential, even after diagnosis and treatment.

Treatment Options

The ultimate aim of Pediatric Glaucoma treatment is to decrease the intraocular pressure. The lowering of this pressure can assist in the prevention of any further damage to the optic nerve. In this regard, the treatment is dependent on factors like the age of the patient and the type of glaucoma they are affected by.  

Considering this, some surgical treatment options are: 

  • Goniotomy – Opening the ocular drainage angle to enhance the outflow of fluids. 
  • Trabeculotomy – Similar to goniotomy, but the focus is on the external parts of the eye. 
  • Trabeculectomy – Creating a new drainage path to get rid of the excess fluid. 
  • Glaucoma drainage devices (tubes) – Used in complex or secondary cases.

Medication options include: 

  • Before surgery, lower eye pressure for a short period of time.
  • After surgery, to maintain control over the pressure
  • In cases involving secondary glaucoma, where surgical intervention might prove to be ineffective

Common Eye medications include beta-blockers, carbonic anhydrase inhibitors, and prostaglandin analogues. The dosage is according to the recommendation of the doctor. 

Everyday Management Tips 

Managing Pediatric Glaucoma daily requires the delivery of constant care and certain lifestyle modifications. In light of this, here are some tips: 

  • Stick strictly to treatment plans – Give recommended medications on the prescribed time and be regular about follow-up appointments. 
  • Look for changes – Constantly monitor for new or deteriorating symptoms like excessive tearing, redness, or changes in vision. 
  • Protect the eyes – Use protective eyewear during high-stress activities. 
  • Foster a child-friendly environment – Ensure proper light settings and look out for if your child is sensitive to light. 
  • Inform other adults involved in the child’s life – They should be aware of the child’s condition and any visual restrictions.

With proper management, it is possible for children suffering from pediatric glaucoma to live happy and normal lives.

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Conclusion 

The chances of Pediatric Glaucoma are narrow. However, if it occurs, it leads to lifelong issues. These issues can easily be avoided through the delivery of appropriate management and care. As a parent, it’s your duty to ensure that your child is receiving the right care at the right time. Remember, it is through your care they can live their lives up to their full potential.