An Approach to Visual Loss in a Child
Vivek Lal in A Clinical Approach to Neuro-Ophthalmic Disorders, 2023
Any child who presents with photophobia, lacrimation and blepharospasm should be strongly suspected to have congenital glaucoma unless proved otherwise. Glaucoma in children usually occurs due to angle dysgenesis and is often associated with other congenital ocular abnormalities like Peter's and Rieger's anomaly (37,38). All children with congenital glaucoma should undergo regular testing for IOP, corneal diameter, anterior segment examination, cup to disc ratio and axial length measurement. Out of all these parameters, the corneal diameter is the most reliable indicator of severity of the glaucoma in children. A corneal diameter of greater than 14 mm indicates advanced buphthalmos and an advanced stage of the disease. Another characteristic feature of infantile glaucoma is the possibility of reversal of cup to disc ratio once pressure of the eye is controlled. Infantile glaucoma if not treated early may cause complete blindness in children. The treatment of choice is mostly surgical with goniotomy performed in eyes with clear corneas and angle filtration surgery preferred in eyes with hazy corneas (39). Complicated cases with failed filtration surgeries are usually treated with glaucoma shunt devices (40). Lastly, clinicians should always offer genetic counseling to the parents if more than one sibling gets affected.
Secondary Open-Angle Glaucomas
Neil T. Choplin, Carlo E. Traverso in Atlas of Glaucoma, 2014
Various ocular tumors are manifested by the phakomatoses. Unilateral glaucoma, congenital or later onset, may be seen in neurofibromatosis of both types (Figure 10.34). Half of all eyes with plexiform neuromas of the upper lid develop glaucoma. The glaucoma associated with encephalo-trigeminal angiomatosis (Sturge–Weber syndrome) is discussed below along with other causes of increased episcleral venous pressure. Congenital glaucoma may also be seen. Oculodermal melanocytosis (nevus of Ota) has been reported to have an incidence of glaucoma of 10%, including angle-closure, open-angle. and congenital varieties.
Optic nerve
Fiona Rowe in Visual Fields via the Visual Pathway, 2016
Congenital glaucoma is a rare form of glaucoma — a condition that is usually acquired. It is most frequently bilateral and asymmetrical, affecting boys slightly more than girls. It occurs sporadically or can be inherited. In congenital glaucoma, the anterior chamber angle and trabecular meshwork do not develop correctly leading to poor drainage of acqueous fluid and subsequent build of high intraocular pressure. As the sclera in young infants is malleable, the eye enlarges with the high pressure (buphthalmos).
Illuminated Microcatheter Passage Assisted Circumferential Trabeculotomy and Trabeculectomy (IMPACTT): An improved surgical procedure for Primary Congenital Glaucoma
Published in Seminars in Ophthalmology, 2022
The patient was a 4-month-old child, product of a normal pregnancy and his birth weight was 3 kg. The parents noticed gradual enlargement of the eyes with intolerance to light and tearing from the eyes since the second months of birth. They consulted a general ophthalmologist who referred the child to us with the provisional diagnosis of congenital glaucoma. His physical examination was unremarkable. Examination under anesthesia revealed horizontal corneal diameter of 13.5 mm with diffuse corneal edema with multiple Haab’s striae in both eyes. His intraocular pressures were 36 mm Hg in both eyes and the lenses were clear. Gonioscopic view was hazy, but flat insertion of the iris over the poorly developed trabecular meshwork could be appreciated. Indirect ophthalmoscopy revealed asymmetric cupping of the optic of the optic nerves (0.6 OD and 0.4 OS). The posterior pole of both the eyes was otherwise normal with an incomplete view of the fundus. On ultrasound B-scan, both the eyes showed anechoic posterior segment. With this history and clinical findings, a diagnosis of bilateral primary congenital glaucoma was established, and the child underwent surgical intervention.
Current and emerging fixed combination therapies in glaucoma: a safety and tolerability review
Published in Expert Opinion on Drug Safety, 2020
Anastasios G. Konstas, Leopold Schmetterer, Vital P. Costa, Gábor Holló, Andreas Katsanos, Philippe Denis, Luciano Quaranta, Murat Irkec, Miguel A. Castejón, Miguel A. Teus, Alan L. Robin
Pediatric patients with congenital glaucoma present particular management challenges. In these cases, although the definitive treatment of choice is usually surgery [50], the use of topical glaucoma medications may be required as temporary preoperative measure, or as adjunctive postoperative therapy [51,52]. Since children have relatively small blood volume and slow drug metabolism compared to adults, the systemic absorption of topical glaucoma medications can result to higher plasma levels for a longer period, thus increasing the risk of serious systemic adverse events [53]. To date, no published studies have evaluated BTFC in a pediatric population, but this FC should not be used in children as it has already been shown that brimonidine is contraindicated in children due to its ability to cross the immature blood-brain barrier and cause potentially serious central nervous system depression and apnea [54–56].
Clinical Manifestations of Strabismus in Patients with Primary Congenital Glaucoma
Published in Seminars in Ophthalmology, 2019
This study was approved by the Institutional Review Board of Dong-A University (IRB number: HR-011–02). Informed consent was obtained from each participant’s parent or guardian, and all study procedures adhered to the tenets of the Declaration of Helsinki. We retrospectively reviewed the medical records of consecutive patients less than 6 years old who underwent glaucoma surgery for congenital glaucoma between 1994 and 2012 at the Dong-A University Medical Center (Busan, Republic of Korea). PCG patients who were followed for at least 3 years after glaucoma surgery were included in the study. Patients with any of the following characteristics were excluded: (1) systemic disorders, including central nervous system abnormalities; (2) developmental delay; (3) trauma; (4) tumor; and (5) secondary glaucoma associated with other ophthalmic disorders and surgeries; and (5) pre-existing ophthalmic disease. PCG was defined by the Childhood Glaucoma Research Network (CGRN) classification and new classification system for pediatric glaucoma.8,9
Related Knowledge Centers
- Aniridia
- Blepharospasm
- Epiphora
- Glaucoma
- Intraocular Pressure
- Ocular Hypertension
- Anterior Chamber Angle
- Ophthalmology
- Sturge–Weber Syndrome
- Dominance