Overview of glaucoma in infants and children
- Scott E Olitsky, MD
Scott E Olitsky, MD
- Professor of Ophthalmology
- University of Missouri - Kansas City School of Medicine
- Clinical Associate Professor of Ophthalmology
- University of Kansas
- James D Reynolds, MD
James D Reynolds, MD
- Professor of Ophthalmology
- State University of New York at Buffalo
Glaucoma is a group of eye diseases that are traditionally characterized by elevated intraocular pressure (IOP). However, glaucoma is more accurately defined as an optic neuropathy and may not always be associated with elevated IOP. Glaucoma can lead to optic nerve damage and consequent visual loss. Peripheral vision loss occurs first, but if glaucoma is untreated, central vision loss and complete blindness can occur . In infants and toddlers, additional damage to the visual system, including large refractive error, astigmatism, strabismus, and amblyopia, may occur. Early diagnosis and referral are crucial to ensuring optimal visual outcome.
An overview of the causes, presentation, and treatment of pediatric glaucoma will be presented here. Primary infantile glaucoma and glaucoma in adults are discussed separately. (See "Primary infantile glaucoma" and "Open-angle glaucoma: Epidemiology, clinical presentation, and diagnosis".)
The angle of the eye is the recess formed by the irido-corneal juncture. The scleral spur, trabecular meshwork, and Schwalbe's line lie within this angle. The trabecular meshwork is a fenestrated structure that transmits aqueous fluid to Schlemm's canal, from which it drains into the venous system (figure 1). When the drainage of aqueous fluid from the anterior chamber is compromised, a new steady state develops with abnormally high intraocular pressure (figure 2).
Pediatric glaucoma is classified into primary and secondary types to provide a framework for the evaluation and management of individual patients (table 1). Primary glaucomas are those with isolated angle malformations (trabeculodysgenesis) . Primary glaucoma may have onset at birth, in the first few years of life, or later in life (congenital, primary infantile, and juvenile glaucoma, respectively). The age at which symptoms first appear probably is related to the severity of angle dysgenesis. Although congenital, infantile, and juvenile glaucoma appear to represent three points on the spectrum of one disease, juvenile glaucoma traditionally is treated as a separate entity because it has a different clinical presentation. (See 'Juvenile glaucoma' below.)
Secondary glaucoma either is acquired or related to an underlying ocular abnormality; it can occur at any age and may be present at birth.
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- PRIMARY INFANTILE GLAUCOMA
- JUVENILE GLAUCOMA
- Clinical features
- SECONDARY GLAUCOMA
- Angle anomalies
- - Sturge-Weber syndrome
- - Aniridia
- - Anterior segment dysgenesis
- Retinopathy of prematurity
- Intraocular inflammation