Paediatric Glaucoma
This blog has been authored by Dr. Salman Waqar, Consultant Ophthalmologist in Cataract and Glaucoma Surgery for Children and Adults
While glaucoma is often associated with adults, it can also affect children, even from birth. Known as paediatric glaucoma or congenital glaucoma, this condition involves increased pressure inside the eye, which may damage the optic nerve and gradually affect a child’s side (peripheral) vision if not addressed early.
This blog outlines the causes, symptoms, diagnosis, and treatment options to help parents and caregivers understand the condition and seek timely care.
What Is Paediatric Glaucoma?
Paediatric glaucoma refers to a group of eye conditions in children where there is an abnormal increase in eye pressure. This happens when the fluid inside the eye, known as aqueous humour, does not drain properly through the eye’s natural drainage system.
In a healthy eye, this fluid flows in and out smoothly to maintain a stable pressure. In glaucoma, this balance is disrupted, leading to fluid build-up and increased pressure inside the eye. Over time, this pressure can damage the optic nerve that connects the eye to the brain.
Types of Paediatric Glaucoma
- Primary Congenital Glaucoma: The most common form, usually present at birth, caused by improper development of the eye’s drainage system during pregnancy. It affects around 1 in 10,000 births globally.
- Secondary Paediatric Glaucoma: This type may result from other eye conditions, previous eye surgery, trauma, or systemic conditions.
- Juvenile Open-Angle Glaucoma: Typically diagnosed in older children or teenagers, this type resembles adult glaucoma and also requires specialised care.
What are the causes of Glaucoma in children?
The cause of primary congenital glaucoma is often genetic and history of glaucoma in the family increases the risk. Other causes include:
- Improper development of the eye during pregnany
- Eye trauma or injury
- Past eye infections
- Inflammatory eye conditions
- Certain genetic syndromes such as Sturge-Weber, Axenfeld-Rieger)
What are the Symptoms of Glaucoma in children?
Young children cannot always describe what they see or feel. As a result, parents and caregivers must be vigilant for signs that could indicate a problem. Common symptoms include:
- Unusually large eyes: Increased pressure may cause the eyeball to stretch and appear abnormally large.
- Cloudy cornea: A hazy or milky-white appearance over the front of the eye.
- Excessive tearing: Frequent watery eyes without apparent cause
- Photophobia: Sensitivity to bright lights.
- Asymmetry between the eyes: A noticeable difference in eye size or shape between the two eyes.
If you notice any of these signs, it is important to seek care from a paediatric ophthalmologist or paediatric glaucoma specialist promptly.
How is Paediatric Glaucoma diagnosed?
Diagnosing glaucoma in infants and young children is complex and requires consultation with a specialised paediatric eye doctor. During the consultation with the specialist will utilise multiple techniques to ensure the correct diagnoses which include:
- Measuring the pressure inside the eye
- Checking the clarity of the cornea
- Using diagnostic imaging such as Optical Coherence Tomography (OCT) to assess the optic nerve
- Examining the drainage structures in and around the eyes
In young children who may not tolerate a full exam while awake, a specialised assessment under anaesthesia may be required. In certain cases, genetic testing may be recommended to identify inherited conditions.
Importance of early detection
Early detection can help preserve vision. Basic eye assessments during routine check-ups may include:
- Red reflex: A reddish glow that appears when light is shined into the eye. Its absence could indicate a problem with the cornea or lens.
- Corneal clarity: A cloudy cornea may point to elevated intraocular pressure.
These initial tests may not confirm glaucoma but can signal the need for further specialist evaluation.
What are the treatment options for glaucoma in children?
Treatment for paediatric glaucoma focuses on lowering the eye pressure to prevent further damage to the optic nerve. The appropriate treatment plan is tailored depending on the child’s age, glaucoma type, and severity
1. Medication: Eye drops or oral medicines to reduce fluid production or help fluid drain more effectively. Medications are often a temporary solution or used in preparation for surgery.
2. Surgery: Surgery is often the main approach for treatment of congenital glaucoma. Common procedures include:
- Goniotomy: A procedure that opens the drainage canals using a fine surgical tool.
- Trabeculotomy: A procedure used to create a new drainage pathway for fluids.
- Tube implants: These are surgically inserted devices to create a pathway for fluids inside the eye, used in complex or advanced cases.
The success of surgery depends heavily on early intervention, the child’s overall health, and regular follow-up. Like all surgeries, these procedures carry potential risks, which is why ongoing care is essential.
What happens after glaucoma treatment?
Children diagnosed with glaucoma require regular follow-up, even if the pressure is successfully managed. After surgery or medical treatment, ongoing care may involve:
- Eye pressure checks
- Monitoring optic nerve health
- Prescription glasses or contact lenses
- Visual aids if vision is affected
- Classroom and home support strategies
- Referral to low vision rehabilitation services if necessary
With early care and consistent monitoring, many children go on to lead full, independent lives. Adjustments such as bright lighting, the use of magnifiers, or support at school may be helpful.
Conclusion
Although rare, Paediatric Glaucoma is a serious condition that can affect a child’s vision if not managed early. However, when identified early and managed by a specialist, many children retain useful vision and enjoy a high quality of life.
If you have concerns about your child’s eye health or a family history of glaucoma, it is highly recommended to consult with a paediatric ophthalmologist or a paediatric glaucoma specialist in Dubai.
At Moorfields Eye Hospital Dubai, our glaucoma specialists are experts in diagnosing and caring for children with glaucoma. As a hospital accredited by JCI and ACHSI, we provide expert care in a warm, child-friendly environment, using the latest diagnostic technologies to ensure accurate and timely treatment
Frequently Asked Questions about Paediatric Glaucoma
- Is paediatric glaucoma hereditary?
Yes, certain forms of paediatric glaucoma are hereditary. In primary congenital glaucoma, which is the most common type seen in infants, genetics can play a significant role. If one or both parents have a history of glaucoma or other eye conditions, their child may have a higher risk of developing the condition. Additionally, some genetic syndromes linked to eye development abnormalities may include glaucoma as part of their presentation. If there is any family history of eye disease, it is important to inform your child’s ophthalmologist early on so that a tailored screening plan can be created. Genetic counselling may also be offered in some cases to assess risk for future children. - Can paediatric glaucoma affect both eyes?
Yes, paediatric glaucoma can affect both eyes, a condition referred to as bilateral glaucoma. In congenital cases, it is quite common for both eyes to be involved, although the degree of severity may vary from one eye to the other. This is why a thorough assessment of both eyes is essential, even if only one eye appears affected. Managing bilateral glaucoma may involve more complex treatment strategies, but with the proper care and follow-up, many children achieve good outcomes in both eyes. - How is paediatric glaucoma diagnosed in babies or toddlers who cannot communicate? Specialised paediatric ophthalmologists use a combination of clinical signs, imaging, and examinations under anaesthesia to assess eye pressure, corneal clarity, and optic nerve health when a child is too young to cooperate.
- What is the long-term outlook for children diagnosed with glaucoma?
The long-term outlook depends on how early the condition is diagnosed and how effectively it is treated. With prompt surgical or medical intervention and consistent follow-up care, many children with glaucoma can maintain usable vision into adulthood. However, because glaucoma causes permanent damage to the optic nerve, ongoing monitoring is essential to detect any pressure changes or vision deterioration. Some children may need additional procedures or vision aids over time, but many go on to lead full, independent lives. - Can children with glaucoma live a normal life?
With effective treatment, many children with glaucoma grow up attending mainstream schools, participating in sports, and enjoying social activities. Depending on the extent of vision loss, some adjustments may be necessary, such as classroom seating arrangements or using magnifiers. Emotional support from family, teachers, and healthcare providers is important in helping children adapt and thrive despite the diagnosis. - Are there any lifestyle changes or home adjustments needed after diagnosis?
There are several ways to support a child living with glaucoma. Ensure lighting is bright and evenly distributed at home to reduce eye strain. For reading and schoolwork, magnifiers or large-print materials may help. Some children may need to avoid high-impact sports or activities with a risk of eye injury. Most importantly, maintaining a strict medication routine and attending regular follow-up appointments are key to protecting their vision over time. Working closely with your child’s ophthalmologist will help determine the best support strategies tailored to their specific needs. - Can my child go blind from glaucoma?
If left untreated, glaucoma can cause permanent vision loss. However, with early diagnosis and effective treatment, most children retain functional vision and lead active lives.