When Mrs. & Mr. Xyz had their first daughter 8 months ago they were very joyous. The baby was very healthy and had a “beautiful large eyes”. The forth day the pediatrician felt that baby is having excessive tearing whenever their use to be bright sunlight and the clear central part of eye had blue shadow. They the pediatrician asks the parents to go and visit nearby ophthalmologist. The ophthalmologist suspected “primary congenital glaucoma” and ask patient to visit “Shreeji Eye Institute & Research Centre, Palak’s Glaucoma Care Centre & Palak’s Glaucoma Care Centre” for further management. The baby was examined under anesthesia and the diagnosis was confirmed. Her corneal diameter was 12 mm (normally for 1 month old child the corneal diameter would be approximately 10 mm) and the eye pressure was 26 mm Hg with corneal edema (normally in 1 month old child the eye pressure would be 10- 12 mm Hg). The parents were counseled about the gravity of situation and the baby was operated for glaucoma surgery (to control her eye pressure). After both eye surgeries, the eye pressure now is approximately 12 mm Hg, cornea is clear.

Last week, the same child came for follow up; whom I had operated when he was ONLY 8 DAYS OLD for congenital glaucoma; my youngest surgical patient. Now nearly 18 months old, Child was running and screaming with joy and playing with parents. For a glaucoma specialist that’s THE most pleasing site. It is always a satisfying to restore sight of a patient and save a child’s vision is emotionally much more satisfying.

 

Primary Congenital Glaucoma (PCG) is very rare but sight threatening disorders in children. Contrary to adult glaucoma, diagnosis of congenital glaucoma doesn’t depend on optic disc damage and visual field changes (documented on perimetry). Rather for diagnosis of Primary Congenital glaucoma, parameter like IOP, corneal diameter, corneal edema are considered crucial. Visual field testing is also not possible before surgery due to corneal clouding at the time of presentation in PCG. Surgery is only treatment option in primary congenital glaucoma and at the same time long-term surgical success is moderate. Hence the need for life long monitoring for early detection of progression is essential.

 

 

 

Childhood Glaucoma

 

Childhood glaucoma—also referred to as congenital glaucoma, pediatric, or infantile glaucoma—occurs in babies and young children. It is usually diagnosed within the first year of life.

This is a rare condition that may be inherited, caused by incorrect development of the eye’s drainage system before birth. This leads to increased intraocular pressure, which in turn damages the optic nerve.

 

It is usually seen in one in 10,000 live birth in india. It is more common is population where there is higher rate of consaganious marriage. In most cases, childhood glaucoma is diagnosed by the age of six months, with 80 diagnosed by the first year of life.

 

Signs of Childhood Glaucoma

• Unusually large eyes
• Excessive tearing
• Cloudy eyes
• Light sensitivity

Symptoms:

Symptoms of childhood glaucoma include enlarged eyes, cloudiness of the cornea, and photosensitivity (sensitivity to light).

How is it Treated?

In an uncomplicated case, surgery can often correct such structural defects. Childhood glaucoma is usually a surgical disease and medication is usually required till surgeon planns out the surgery and get anesthesia clerance. Medical treatments may involve the use of topical eye drops and oral medications.

 

There are two main types of surgical treatments: filtering surgery and laser surgery. Filtering surgery  involves the use of small surgical tools to create a drainage canal in the eye.

 

In a complicated childhood glaucoma, surgeeon may decide to impalnt the drainage device with valve to control the eye pressure.

 

What to Expect

Thousands of children with glaucoma can live full lives. This is the ultimate goal of glaucoma management. Although lost vision cannot be restored, it is possible to optimize each child’s remaining vision.

Does your child have glaucoma?

Review the checklist below and if you recognize any of these signs or symptoms in your own child, check with a pediatric ophthalmologist.

Signs and Symptoms of Childhood Glaucoma

What to watch for in children under the age of two:

• Does your child have unusually large eyes?
• Is there excessive tearing in your child’s eyes?
• Are your child’s eyes cloudy?

Other signs for all children under 18:

• Are your child’s eyes particularly sensitive to sunlight or a camera flash?
• Have you noticed significant vision loss in your child?
• Do your child’s eyes have difficulty adjusting in the dark?
• Does your child complain of headaches and/or eye pain?
• Does your child have red eyes all the time?

Other conditions to be monitored:

• Any child with eye injury or a history of a serious eye injury.
• Any child who has had cataract surgery. (Up to 30 % of patients can develop glaucoma after the surgery.

 

Childhood Glaucoma and Education

 

If you are the parent of a child with glaucoma, it is important to work closely with your school staff and the educational system to insure that the needs of your child are met. In many cities, special education services are provided to meet the needs of visually impaired children.

Tips For Your Child in the Classroom

• To avoid glare, teach your child to sit with his or her back to the windows or other bright light.
• Educational materials should be presented against a simple background. Keep the work area uncluttered.
• Talk with the teacher about flexible seating, especially if visual props are used. For your child, that may mean moving closer to the front of the classroom.
• Encourage the use of materials with high contrast and bold writing.
• During outdoor playtime, teach your child to use sunglasses and hats. Even overcast days can cause glare in the eyes.
• Have your child wear protective goggles during activities.
• Include ideas that enhance your child’s learning style and ability. If needed, use a Closed Circuit Television (CCTV) for enlarging print.
• If you have any areas of concern, consult with an educator, occupational therapist or low vision specialist to evaluate your child’s home and school environment. These evaluations can give you essential information about your child’s areas of strength as well as areas that need support services.

Develop a support system with your family and friends. Also, look into community groups and agencies that provide support groups and other resources.