Glaucoma In Children

By Edeline Anne Goh

You might know of 1 or 2 people in your life who have been diagnosed with glaucoma and it is highly likely that they are in the senior age group. However, no parent will expect a child or a baby as young as a few months old, to be diagnosed with this eye condition.

Dr Suraiya Mohamad Shafie, Paediatric Ophthalmologist from OPTIMAX, Seremban speaks to Urban Health about glaucoma in children and explains why there is no age discrimination when it comes to this disease.

UH: HOW DOES GLAUCOMA DEVELOP IN CHILDREN?

Dr Suraiya: Glaucoma is a condition whereby there is an increase in the pressure inside your eye, known as intraocular pressure which causes pressure damage to the optic nerve and loss of vision. The pressure rises as a result of accumulated aqueous humor (fluid inside your eye), which normally flows out of your eye naturally. In patients with glaucoma, the aqueous humor is not drained properly due to abnormal development or injury to the drainage tissues in the eye. Thus, the fluid collects inside the eye and causes an increase in intraocular pressure.

There are many causes of paediatric glaucoma. It can be hereditary or associated with other eye or systemic disorders. Most cases of pediatric glaucoma have no specific identifiable cause and are considered to be primary glaucoma. Secondary glaucoma is typically associated with other eye diseases such as aniridia, systemic conditions, medications such as steroids, eye injury or eye surgery.

UH: WHAT ARE THE RISK FACTORS AND CHANCES OF A CHILD DEVELOPING GLAUCOMA?

Dr Suraiya: Paediatric glaucoma is relatively rare. Primary congenital glaucoma occurs in approximately 1 in 10,000 births while some are hereditary. About 10% of primary congenital glaucoma cases are inherited. Children with certain eye or systemic conditions or children who have had to use steroids for medical conditions have a much higher risk of developing glaucoma. Children with a history of eye injury or eye surgery may also develop glaucoma.

UH: WHAT ARE THE SIGNS AND SYMPTOMS THAT PARENTS OR GUARDIANS SHOULD LOOK OUT FOR?

Dr Suraiya: The symptoms may not be apparent in children. Each child may experience symptoms differently and it is important to note that glaucoma can affect one or both eyes. The following are the most common symptoms of paediatric glaucoma:

For children who are below two years of age:

  • Unusually large eyes
  • One eye looks bigger than the other
  • Excessive tearing
  • Cloudy eyes
  • Child closes one or both eyes when exposed to sunlight
  • Child becomes irritable and fussy if there is eye pain and discomfort

Among older children:

  • Sensitivity to sunlight or bright lights such as from a camera flash
  • Difficulty adjusting to darkness
  • Eye aches or headaches
  • Frequent blinking or squeezing of eyes
  • Red eye
  • Vision loss

UH: WHAT IS YOUR ADVICE FOR PARENTS WHO SUSPECT THEIR CHILD MIGHT HAVE DEVELOPED GLAUCOMA?

Dr Suraiya: Take the child to an ophthalmologist for a proper assessment and examination. Early detection and treatment is very important to prevent loss of vision. Late detection, which causes a child to be deprived of treatment, may lead to blindness.

 

UH: WHAT ARE THE TREATMENT OPTIONS CURRENTLY AVAILABLE IN MALAYSIA?

Dr Suraiya: It is important to start treatment for glaucoma as soon as possible to prevent permanent vision loss.

The main aim of treatment in glaucoma is to lower the intraocular pressure and may include:

  • Medical treatment involving the use of topical eye drops and oral medications. These treatments help to lower the eye pressure by either increasing the drainage of aqueous humor from the eye or decreasing the production of fluid inside the eye.
  • Surgical treatment, which aims to create an opening in order to drain fluid from the eye.  There are two main types of surgical treatments namely filtering surgery and laser surgery. Filtering surgery (also known as micro surgery) involves the use of small surgical tools to create a drainage canal in the eye. Laser surgery on the other hand uses a small but powerful beam of light to make a small opening in the eye tissue.

Multiple procedures are often required to successfully control glaucoma.  After surgery, medication may still be necessary to control intraocular pressure. Both medication and surgery have been successfully used to treat childhood glaucoma although children with glaucoma may require lifelong medication, treatment and follow up.

UH: WHAT ARE THE TYPES OF SURGICAL PROCEDURES AVAILABLE?

Dr Suraiya: Surgical procedures used to treat glaucoma in children include the following:

Trabeculotomy and Goniotomy
Trabeculotomy and goniotomy, are the most common surgical interventions in younger children. Both procedures involve opening the drainage canal of the eyes.

Trabeculectomy
Trabeculectomy surgical procedure involves the removal of a part of the trabecular meshwork drainage system, allowing the fluid to drain from the eye. It creates a guarded opening from the front of the eye to a space underneath the conjunctiva.

Iridotomy
A small hole is made through the colored part of the eye (iris) to allow fluid to flow more freely in the eye. The surgeon may use a laser to create this hole, known as laser iridotomy.

Cyclophotocoagulation
A procedure that uses a laser beam to freeze selected areas of the ciliary body  (the part of the eye that produces aqueous humor) to reduce the production of fluid. This type of surgery is usually performed in severe cases of paediatric glaucoma.

UH: CAN A CHILD WHO HAS BEEN DIAGNOSED WITH GLAUCOMA DEVELOP ANY OTHER EYE CODITION?

Dr.Suraiya: Many children with glaucoma develop other eye problems such as myopia (nearsightedness) that require glasses. In these children, amblyopia (lazy eye) and strabismus (crossing or wandering eye) occur more frequently and may require treatment with either patching or surgery. Despite early and aggressive treatment, permanent vision loss can still occur.

UH: WHAT ARE YOUR TIPS TO PREVENT GLAUCOMA IN CHILDREN?

W TIPS ON HOW TO PREVENT GLAUCOMA IN CHILDREN?

Dr. Suraiya:  Most of the time, there is no way to prevent glaucoma. However, regular and complete eye examinations may aid in early diagnosis as well as timely and proper treatment to prevent vision loss.

UH: IF GLAUCOMA DEVELOPS AT A YOUNG AGE, IS THERE A HIGHER CHANCE OF OVERCOMING THE CONDITION?

It doesn’t matter whether glaucoma occurs at a younger age. What matters most is early detection and treatment as loss of vision can occur at any age. The ultimate goal of glaucoma management is for the child to have a normal life.  Although lost vision cannot be restored, it is possible to optimise the child’s remaining ability to see. Early diagnosis and treatment are essential for a successful outcome.

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