Why parents need to know extensively about childhood glaucoma (1)

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Paediatric Glaucoma
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Paediatric Glaucoma

• Glaucoma is a disease in which the optic nerve,
  the nerve that connects the eye to the brain, is
  damaged. Generally, this damage is caused by high
  pressure in the eye. The eye makes and drains
  fluid when the drainage system becomes impaired
  pressure from the excess fluid builds up in the
  eye and results in glaucoma. It is a progressive
  condition that, without treatment, will lead to
  loss of peripheral (side) vision and,
  ultimately, blindness. When no specific cause
  is identified, we call it "primary glaucoma."
  When it is due to another condition, such as eye
  trauma or systemic disease involving the eye, we
  call it "secondary glaucoma." Most childhood
  glaucoma is primary, either congenital (present
  from birth) or infantile (developing between 1-24
  months of age). Most children with glaucoma are
  diagnosed within the first three years of life.
  Some cases of primary glaucoma may have a genetic
  component, but most are sporadic, occurring in
  families with no history of congenital glaucoma.

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Why timely treatment for childhood glaucoma holds
significance?

• Outlook for paediatric glaucoma without proper
  treatment is poor. In children under the age of 3
  or 4 years, in addition to progressive loss of
  vision due to damage to the optic nerve, the eye
  with elevated pressure expands, becoming very
  large. That doesn't happen in adults. This
  enlargement can lead to changes in refractive
  error (poor focusing of the visual image on the
  retina, or film that lines the back of the eye),
  changes in the shape and clarity of the cornea
  (the transparent covering of the front of the eye
  that assists with focusing of the visual image),
  and to other secondary causes of poor vision.
  Disturbance of the visual image sent from the eye
  to the brain in a young child will result in
  amblyopia ("lazy eye"), a condition in which the
  eye fails to develop normal vision. This can be
  permanent if not aggressively treated. That's why
  it's so important for parents to be aware of the
  signs of childhood glaucoma.

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Symptoms

• Glaucoma can occur in one or both eyes. While
  most adults with glaucoma have no symptoms,
  babies and young children with glaucoma may
  display the following signs 
• Excessive tearing, called epiphora
• Light sensitivity
• Excessive eye blinking, called blepharospasm,
  particularly in bright light
• Red, irritated eyes
• Large or bulging eyes, particularly noticeable
  when glaucoma occurs in only one eye

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How childhood glaucoma is diagnosed?

• Ophthalmologists  diagnose glaucoma by
  examining the child and measuring his or her eye
  pressure. The eye exam of a baby or young child
  is a bit challenging, compared to an adult. The
  eye specialists can perform some parts of the
  exam in the clinic with hand-held devices, but if
  any difficulty occurs, they can give anaesthesia
  and examine the child in the operating room. This
  allows for a more controlled examination to check
  the pressure inside the eye, and dilate the pupil
  to look at the optic nerve.

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Treatments

• The goal of treatment is to lower the pressure
  inside the eye to a normal level to protect the
  optic nerve from ongoing damage. While eye drops
  are the treatment of choice for adults, they are
  more difficult to use, don't work as well, and
  cause more side effects in children. So glaucoma
  in infants and young children is almost always
  treated with surgery to lower the
  pressure.Several different surgical procedures
  are available. The first-line operations all
  involve opening or "unclogging" the drains for
  the fluid in the eye. There are also procedures
  whereby we drain fluid to the surface of the eye
  either by making an opening in the natural
  tissue, or implanting an artificial tube. Many
  patients need more than one operation, and some
  require treatment with both surgery and
  medication to achieve a normal range of pressure
  in the eye. 

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Treatments
Continue

• That's the first part of treatment. The second
  part involves visual rehabilitation to prevent
  amblyopia, because vision doesn't necessarily
  normalise on its own after surgery, due to the
  way elevated eye pressure can permanently change
  the shape of the eye and distort the cornea.
  Therapy includes giving children the appropriate
  refractive correction, meaning the right
  eyeglasses, as well as patching the stronger eye
  so the child uses the weaker eye for a time. A
  lot of follow-up care and work on the part of the
  parents and the medical team are required to get
  a good visual outcome once the pressure is
  lowered.

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