The ability to see clearly is a factor most people take for granted, especially the young. While the majority think that serious eye problems and diseases only affect the elderly, they would be surprised to learn that certain eye conditions like glaucoma can strike children of all ages, including newborn infants. Keeping this in mind, routine eye exams are necessary to detect and treat such issues early on.
What Is Glaucoma
Loosely referred to as a group of eye diseases, glaucoma is a condition which can be hereditary in many cases. While adult glaucoma can be linked to a buildup of eye pressure, you usually don’t get it until later in life. Congenital and juvenile glaucoma, on the other hand, are more often than not caused by incorrect development of the eye’s drainage system before birth. All types of glaucoma are characterized by increased levels of intraocular pressure pushing on the optic nerve and causing enlargement in the optic disc area. If the elevated eye pressure is left untreated for too long, it can lead to further damages like cloudiness of the cornea, injury to the optic nerve and potential vision loss.
What Is Congenital or Infantile Glaucoma?
Although this is relatively rare, occurring in 1 in 10,000 births, congenital glaucoma, also referred to as infantile glaucoma, is very much a reality. In babies and young children, it is usually diagnosed within the first year of birth. While most cases are genetic, some are caused sporadically.
Symptoms And Diagnosis
If either the parents or the pediatrician are suspicious of any abnormalities in the eyes such as excessive blinking, sensitivity to light, or a cloudy or opaque cornea they should immediately request a consultation with an ophthalmologist. If the infant is not fussy then the doctor can conduct the diagnostic test in a clinic setting, otherwise, even the initial procedures may have to be made in an operating room. During this consultation the doctor is most likely to question the parents about the details of the child’s symptoms and enquire about any family history of glaucoma or other eye disorders. Once the questioning is completed and if the infant is still being cooperative, the doctor will quickly run a few necessary tests. One important test is to verify the measurement of the intraocular pressure. Vision is checked by making the infant follow a moving object with the eyes. Refraction error is taken into account by dilating the pupils and relaxing the focusing muscles. In kids who are a little older, a quick and simple tonometry test is able to check the pressure of their eyes.
Unlike in adult glaucoma where doctors can recommend drops or laser treatment, congenital glaucoma requires early surgery under anesthesia. When deemed necessary, it will most likely be performed right after the examination so the baby doesn’t have to endure anesthesia twice. During the surgical procedure known as a goniotomy, the surgeon will use either a tiny blade or laser to make the required cut which will open the blocked drainage systems and allow for the eye fluid to resume normal activity. If the cornea is too cloudy, however, then a trabeculotomy is the surgery of choice in which the surgeon will make an incision on the outer wall of the eye instead of directly in the eye’s filtration area. Post-surgery care will involve frequent follow up visits so the doctor can look out for any signs of infection or excess inflammation. For the longer term, patients are encouraged to visit their ophthalmologists so serial measurements of intraocular pressure can be conducted on a regular basis while a sharp eye is kept out for refractive error and optic nerve cupping.
What Is Juvenile Glaucoma?
When glaucoma affects people between the ages of five and 35, it is referred to as juvenile. Occurring in one in 50,000 cases, it can be associated with other eye disorders (secondary) but is more often than not hereditary (primary). Due to its rarity and the fact that it’s asymptomatic, people don’t even realize they have it.
Symptoms And Diagnosis
In fact in most cases it is only discovered incidentally in a routine eye examination, proving once again how important it is to pay regular visits to your ophthalmologist. Juvenile glaucoma does have symptoms which one can look out for in their kids such as sensitivity to light, problems adjusting to the dark, consistently red eyes, excessive blinking or eye pain. If your child comes to you complaining of any these or other eye related issues, immediately take them to a pediatric ophthalmologist for a consultation because timely diagnosis and appropriate care will prevent any future vision loss. The doctor will run a series of tests to deduce if the cornea has become cloudy and lost its transparency due to swelling of tissue from excess fluid in the outer and middle layer. A more detailed inspection may also reveal defects in the inner layer confirming high eye pressure. In order to retrieve accurate measurements, kids under three may have to be anesthetized during the initial examination and for any further follow ups. For older children, a slit lamp examination is usually enough to carry out successful inspection.
If results confirm the onset of juvenile glaucoma, the next step is to discuss whether the child needs to undergo medical treatment, surgery or both. In many cases, the patient may be prescribed to take topical eye drops and oral medications before the surgery is to take place. Just like in congenital glaucoma, a goniotomy and a trabeculotomy can be used as options in treating juvenile glaucoma as well. In the event where the cases are more complicated and advanced, treatments can include glaucoma implant surgery and cycloablation. The former involves the placement of a glaucoma implant to help balance the rate of aqueous humor drainage while the latter decreases the production of inner eye fluid to lower the inner eye pressure.
Living With Childhood Glaucoma
It is one thing to read about the symptoms and treatments of childhood glaucoma and it is another to watch your child cope with the disease. Although there may be many parents out there who have no idea what you are dealing with, rest assured that there are thousands of children in the world who have not only been diagnosed and treated with childhood glaucoma, but are living very normal lives. Once you learn to anticipate potential problems and develop possible solutions you will be able to help your child overcome obstacles in their daily routine. Offer them sunglasses or brimmed hats to ward off any glare and ease their sensitivity to light. Experiment with different light sources and create exaggerated contrasts between an object to increase your child’s visual performance.
Most people associate glaucoma with old age, which is not surprising since childhood glaucoma is a serious but rare pediatric medical problem. Both congenital and juvenile glaucoma are associated with high intraocular pressure in the eye leading to damage of the optic nerve. Whether developed as an inborn disorder or as a result of other eye related diseases, the sooner it is diagnosed and treated, the less chances there are of vision loss. Due to its rarity, parents and sometimes even doctors are unable to recognize the onset of the disease. Becoming aware of the signs and symptoms of childhood glaucoma is essential in monitoring the child’s journey through childhood.