Home' Trinidad and Tobago Guardian : March 13th 2015 Contents 10
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What is glaucoma?
Glaucoma is a group of diseases characterized by
damage to the optic nerve that often occurs when the
eye pressure is too high. This causes optic nerve damage
and can result in severe vision loss. Most often the pres-
sure is too high because the eye is able to make the fluid
it needs, but is unable to sufficiently drain the fluid out.
Glaucoma is more common in the elderly but can de-
velop at any age. Infants and children with glaucoma
typically have different signs and symptoms than adults.
What are the different types and causes of
One way to classify glaucoma is based on the age of
onset. Congenital glaucoma is present at birth. Infantile
glaucoma develops between the ages of 1-24 months.
Glaucoma with onset after age 3 years is juvenile glau-
coma. Another way to classify glaucoma is to describe
the structural abnormality or systemic condition, which
has caused the glaucoma.
Most cases of paediatric glaucoma have no specific
identifiable cause and are considered primary glaucoma.
When glaucoma is caused by, or associated with a spe-
cific condition or disease, it is called secondary glau-
How common is paediatric glaucoma?
Childhood glaucoma is relatively rare. Primary congeni-
tal/ primary infantile glaucoma occurs in the general
population at a rate of approximately 1 in 10,000 births.
However, if a child has cataract surgery or one of the
other conditions listed above, the incidence of glaucoma
will be much higher. For example, 50% of patients with
aniridia will develop glaucoma during their lifetime.
Is paediatric glaucoma hereditary?
Some types of paediatric glaucoma are hereditary.
About 10% of primary congenital/infantile glaucoma
cases are inherited. Recent research has identified spe-
cific gene mutations linked to this disease; genetic test-
ing and counseling for affected families is available. In
the future, there may be genetic therapies available.
Other secondary glaucoma conditions such as neurofi-
bromatosis and aniridia are dominantly inherited and are
passed on to children about 50% of the time.
How is paediatric glaucoma evaluated and
If a baby is suspected of having glaucoma, an exami-
nation under anesthesia is typically performed. While
under anesthesia the ophthalmologist evaluates the in-
traocular pressure (for elevation), cornea diameter (for
increased size), cornea clarity (for cloudiness and Haab
striae which are breaks in the back surface of the
cornea), axial length (for elongation of the eye- caused
by stretching from increased pressure), refractive error
(for myopia- also caused by stretching), and the optic
nerve (for abnormal cupping which infers optic nerve
damage). Some parts of this examination can be per-
formed in the office on older, cooperative children.
How is paediatric glaucoma treated?
Paediatric glaucoma is
treated by lowering the
(IOP) via medical and/or
surgical means. Most
cases of primary paedi-
atric glaucoma are
treated with surgery. Tra-
beculotomy and go-
niotomy, which open the
drainage canals, are the
most common surgical
interventions. Other pro-
cedures create a bypass
route for the aqueous
(fluid made by the eye)
to drain out of the eye.
Control of the glau-
coma often requires multiple procedures and examina-
tions under anesthesia. Eye drops and oral medications
are the primary treatments for secondary and juvenile
glaucoma and are often used as adjuvant therapy after
surgery in primary paediatric glaucoma. One or more
medications may be necessary to control the intraocular
pressure (IOP), even after surgery.
The treatment of paediatric glaucoma is not simply a
matter of lowering IOP. Many children with paediatric
glaucoma develop myopia (nearsightedness) and require
glasses. Also, ambly-
opia (decreased vision)
and strabismus (cross-
ing or wandering eye)
occur more frequently
and may require treat-
ment with patching or
surgery. Despite timely
and aggressive treat-
ment, paediatric glau-
coma can still cause
significant and perma-
nent vision loss. Early
diagnosis and treat-
ment aid in a success-
and Cataract Family
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