Recognizing The Signs Of Pediatric Glaucoma Before Vision Loss Sets In

Glaucoma is a group of diseases that cause damage to the optic nerve in the eye. While glaucoma is more common amongst older patients, it can develop during childhood in a condition called pediatric glaucoma (aka childhood glaucoma).

Pediatric glaucoma is a rare, but potentially serious, condition. If left untreated, it can lead to irreversible damage to a child’s vision. Parents and caregivers should understand some key facts about the disorder to detect it and start treatment as early as possible with their child.

Glaucoma is a progressive disease that damages the optic nerve. It occurs when fluid builds up and causes high pressure in the eye.

Our eyes produce a fluid called aqueous humor. Healthy eyes both drain and replenish this fluid to keep levels in balance. When the fluid cannot drain naturally and begins to accumulate, intraocular pressure builds up. This pressure damages the eyes’ optic nerves.

When left untreated, the damage to the optic nerve can lead to vision loss and permanent blindness.

Pediatric glaucoma is a rare form of glaucoma that develops during childhood. It is caused by the improper development of the eye’s drainage system before birth, and affects around 1 out of 5,000 children under the age of 18.

There are numerous names for pediatric glaucoma, depending on the onset of the condition:

Pediatric glaucoma (childhood glaucoma): General name referring to glaucoma that affects those under the age of 18.

Congenital glaucoma: Affects those from birth to 3 years of age.

Juvenile glaucoma: Affects children after 3 years of age.

Detecting pediatric glaucoma symptoms early can have life-changing effects for a child. Early detection allows for early treatment which can help a child’s sight before vision loss sets in.

Common pediatric glaucoma symptoms include:

• Cloudy & Enlarged Cornea: A hazy or cloudy cornea is typically one of the first visible symptoms of pediatric glaucoma. Healthy corneas are transparent. Loss of transparency may signal increased swelling caused by excess fluid. The cornea may also appear enlarged in children with pediatric glaucoma.
  
  

• Excessive Tearing: An overflow of tears in a child’s eye can be a sign of pediatric glaucoma, as the eye attempts to clear out the excess fluid.
  
  

• Light Sensitivity (photophobia): Children with pediatric glaucoma may show discomfort, sensitivity, or pain when exposed to bright light. Signs of light sensitivity in a child can include frequent squinting, using hands to shield their eyes from light, and showing a preference for dim light.
  
  

• Vision Loss: Children with pediatric glaucoma can experience steady vision loss. Peripheral vision loss is especially common for those suffering from glaucoma.

Even if no symptoms are present, regular eye exams are essential for detecting and treating pediatric glaucoma. This is even more significant if there’s a family history of eye diseases or congenital glaucoma in the child’s family.

Related: Is Glaucoma Hereditary?

As pediatric glaucoma can lead to vision loss, the earlier the diagnosis the better. Prior to an eye examination, doctors will look at the child’s medical and family history for signs of glaucoma or other eye disorders.

From there, the eye doctor will typically conduct an eye exam. During the exam the doctor will dilate the child’s eyes to get a more accurate examination of the retina and optic nerve.

Doctors will typically perform a “tonometry.” This test measures the Intraocular Pressure (IOP) in a patient's eyes. This information is vitally important for a pediatric glaucoma diagnosis, as high intraocular pressure is a key indicator of glaucoma.

Additionally, doctors may conduct visual acuity and peripheral vision tests to measure the child’s overall visual ability.

Related: What Diseases Can Be Detected In An Eye Exam?

Diagnosing pediatric glaucoma requires running a number of exams that may be uncomfortable or intimidating for certain children.

For younger children, doctors will often use smaller handheld equipment during the exam, while older or more mature children may be examined with standard medical equipment. In certain cases, eye exams may require cooperation and help from the parent.

During the examinations, doctors may rely on anesthetics to help soothe children and get a better look in their eyes.

There are a variety of treatment options for pediatric glaucoma. No one option will be best for every child. Parents will collaborate with their eye doctor to determine a treatment that fits their circumstances.

Some common considerations are:

• The child’s age, health, and medical history

• The particular pediatric glaucoma symptoms they are experiencing

• The extent or course of the disease, as well as future expectations

• The child’s tolerance to specific medications and treatment options

• The opinions or preferences of the child’s parents and doctor

Medications are typically the first line of treatment for pediatric glaucoma. Medical treatments may involve the use of topical eye drops and oral medications.

The goal of these medical treatments is either to make it easier for fluid to exit the eye or to decrease the production of fluid inside the eye. Both of these processes will lower eye pressure and help treat pediatric glaucoma symptoms.

There are numerous surgeries and procedures that can treat pediatric glaucoma.

Trabeculotomy: The doctor will make an opening in the drainage area of the eye to create a better angle for fluid to drain freely. This lowers the intraocular pressure in the eyes.

Trabeculectomy: A procedure where part of a child’s trabecular meshwork drainage system is removed. This removal allows fluid to drain from the eye.

Iridotomy: In this surgery a small hole is made through the patient’s iris (the colored part of the eye) which allows fluid to flow more freely in the eye.

Cyclophotocoagulation: A laser-based surgery where the doctor freezes parts of the eye that produce aqueous humor. This is done to reduce fluid production. Cyclophotocoagulation is typically performed in more severe cases of pediatric glaucoma

The good news is that with early diagnosis and treatment it is possible to minimize the effects of pediatric glaucoma—especially those related to vision loss. With the right treatment, children with pediatric glaucoma can live happy and healthy lives.

However, children with glaucoma and their parents will need to take a number of precautions to manage the condition. These include consistent monitoring of IOP and optic nerve health, adhering to treatment plans, and addressing any vision impairments with visual aids or therapy.

Parents should also plan regular trips to the eye doctor to check on and manage their child’s condition.