Paediatric Glaucoma

What is Paediatric Glaucoma?

Paediatric glaucoma, also called childhood glaucoma, is a type of Glaucoma that is often inherited. The usual cause for this condition is where the eyes drainage system is improperly formed before birth. The incorrect drainage leads to an increased fluid pressure in the eyes and causes damage to the optic nerve, thus leading to paediatric glaucoma.

Are there any symptoms associated?

Each child is different and so are affected differently to others, in some cases symptoms are not shown at all by the child. However there are some signs that you can be aware of and look out for, such as:

• Sensitivity to light (Photophobia)
• Corneal opacification (hazy, grey cornea)
• Enlarged eyes and corneas
• Epiphora (Overflow of tears)
• Loss of vision

The earliest and most common sign of childhood glaucoma is the hazy cornea. A normal and healthy cornea is transparent. This occurs due to the swelling of the tissue in the eye because of the excess fluids present.

How is Paediatric Glaucoma treated? 

There are both medical and surgical forms of treatment available for paediatric glaucoma, with surgery being the main form of treatment . Paediatric glaucoma surgery aims to reduce the fluid pressure in the eyes by either increasing the amount of fluid that moves out of the eye or decreasing the amount of fluid that is produced in the eye, both forms of surgery are in order to reach a certain state of equilibrium. This is mainly done by correcting abnormal anatomy, creating a new route for the fluid to exit the eye or reducing the amount of fluid that is produced.

Correcting abnormal anatomy- By correcting the structure in the child’s eyes an increase of the amount of fluid exiting the eye can be achieved. In primary childhood glaucoma the drainage structure in the eye is abnormal as the anterior chamber where the fluid exits the eye is dysfunctional. There are two surgical procedures that may be used to correct this goniotomy and trabeculotomy.

Creating a new route for the fluid to exit the eye- The majority of other types of childhood glaucoma do not respond well to goniotiomy or trabeculotomy, thus an alternate way is needed for the fluid to exit the eye. An opening is made as a part of a trabeculotomy which allows the fluid to leave the eye and go under the conjunctiva. However as children heal well their bodies will try to close this opening, which would mean the procedure has failed so a medication would be applied at the time of the surgery to hinder the healing process, elevating the conjunctiva, showing results of a good surgical outcome. If the healing process is too fast or there is a higher level of risk to the surgery the surgeon will implant a drainage tube. This would be implanted into the eye and allow the fluid to flow under the conjunctiva and disperse.

Reducing fluid production- If the attempts to increase the amount of fluid leaving the eye is not successful, surgery to reduce the amount of fluid produced, or cyclodestructive procedures are followed to lower the fluid pressure in the eyes. Cyclodestructive procedures include using a freezing probe in order to freeze the ciliary body and reduce the fluid production. External laser probes may also be applied to the outside of the eye to achieve a similar result. As the probe is inserted into the eye the surgeon is able to carry out the laser surgery, this allows the surgeon to be able to see the ciliary body directly.