Glaucoma in older
children (greater than 2 years old) and adolescents is similar to glaucoma
in adults. Glaucoma in children of all ages is rare,
unlike adult open angle (chronic) glaucoma, which is relatively common.
Glaucoma affects approximately 1 in 2000 children.
How would a parent
know if an older child is suffering from glaucoma?
In older children the eye responds to increased intraocular pressure in
a manner similar to adults. Unlike younger children there is no increase
in
the size of the eye and
the cornea does not become cloudy. Thus the onset of glaucoma in these
children is much more likely to be asymptomatic.
What causes
childhood glaucoma?
Glaucoma in children
older than two years is often secondary to other ocular disease or an underlying
general disease that affects the child. Examples associated with other
ocular diseases are glaucoma following surgery for congenital cataract
(aphakic glaucoma) and glaucoma secondary to iritis (inflammation of the
iris which in children that is often
associated with juvenile chronic arthritis). Examples of underlying general
diseases of childhood that may be associated with the development of glaucoma
are neurofibromatosis
type 1 (a disorder of the skin/ eye and nerve tissue) and Sturge-Weber
syndrome (a vascular birthmark or port wine stain on the face associated
with a risk of glaucoma and
epilepsy). Primary open angle glaucoma does occur rarely in older children
and adolescents.
What happens
when glaucoma is suspected in an older child?
The child needs to be assessed by an ophthalmologist. Ideally the child
should be referred to an ophthalmologist with experience in managing childhood
glaucoma. The nature
of assessment undertaken varies with the age of the child. In children over
7 years the tests used are very similar to those used for adults, i.e. pressure
measurement, visual
field assessment and examination of the optic disc after dilatation of the
pupil.
What treatment
will be needed?
The treatment for glaucoma in older children is generally
medical (eye drops) initially and if these fail, surgery is considered.
This is similar
to the situation with
older adults with glaucoma. Operations such as trabeculectomy or Molteno
tubes are used. These procedures aim to create a controlled leak or "fistula" by
which the aqueous can bypass the trabecular meshwork and escape from the
eye. As with adults
anti-inflammatory and antibiotic drops are used post operatively. When trabeculectomy
is performed in children an anti-metabolite such as 5-fluorouacil (5-FU for
short) is very
often used as children heal much more rapidly than adults.
Laser trabeculoplasty
is rarely used in the treatment of glaucoma in children of any age. A
cyclo-destructive procedure,
such as diode laser treatment of the ciliary body, is sometimes used in the
treatment of aphakic glaucoma in children.
Will
my child’s
vision be impaired?
As in any person if glaucoma is not appropriately treated there is a
risk of progressive visual impairment. Rarely does childhood glaucoma result
in severe visual
impairment but life long follow-up is needed for all children after a diagnosis
of glaucoma is made.
What are the chances
of another child of mine developing glaucoma?
Primary open angle glaucoma in adolescents may show a familial tendency
just as in adult open angle glaucoma. Inherited juvenile open angle glaucoma
is well recognized but
very rare. This form of glaucoma is generally not detectable till the twenties
rather than during later childhood.
Will
my child’s
lifestyle need to alter in any way?
In general there is little need to alter lifestyle. Adolescents often
have difficulty accepting the need for long-term medication and regular medical
review. Ensuring
compliance with regular use of eye drops may be especially difficult
What research
is being done into the causes and treatment of glaucoma in older children
and adolescents?
Most research into the causes and treatment of glaucoma is directed to
understanding adult glaucoma. Fortunately many of these advances can be modified
to treat children with
glaucoma
