Dr. Mimiwati Zahari
MBBS (UM), M.Oph(UM), FRCSOph (Ed), MMedOPh (Sing), Professor, Department of
Ophthalmology, University of Malaya.
Sadly, glaucoma can also occur in babies and young children. Due to abnormal development of the drainage angle of the eye, the resultant increase in intraocular pressure (IOP) from the obstructed outflow will eventually damage the optic nerve and cause irreversible blindness if left untreated.
Since the child is born with the condition the term congenital glaucoma is used and can be
diagnosed anytime from birth up to the age of 3 years. It may be primary (without an obvious
cause) or associated with a syndrome or other diseases like congenital rubella.
The term infantile glaucoma is used for those whose disease present a little later, between 3
months - 3 years. Prevalence of primary congenital/infantile glaucoma is rare and depending
on different countries and ethnic groups range from 1:1250 to 1:22,000 live births. It is commonly bilateral and is associated with a gene mutation. Another category under childhood appears in older children/ young adults between 3 years -35 years of age and is termed juvenile glaucoma.
Unlike open-angle glaucoma in adults and juvenile glaucoma which are largely asymptomatic, congenital/infantile glaucoma will have symptoms as a result of the stretching of the ‘softer’ outer coats of the immature eyeball from the increased IOP. This will cause them to experience ocular pain and increased sensitivity to bright light (photophobia), which will cause them to respond by tearing, shutting their eyelids, and squinting their eyes due to the discomfort. The cornea of the affected eye will appear greyish and cloudy and will be unusually large. The diagnosis is made based on the findings of a high IOP, signs of optic nerve damage, and an abnormal appearance of the drainage area. Refraction and measurement of the eyeball length are also performed, as an indicator to monitor the progression of the disease and also to detect and treat refractive errors resulting from the eyeball lengthening.
The definitive treatment for this condition is surgery. A procedure aimed to improve the outflow of the drainage angle called goniotomy or trabeculotomy is performed. These procedures have high success rates if performed early. Medication (eye drops or combined with oral medication) is started as a temporary measure while waiting for the procedure to be performed. Other surgical options may be considered if angle surgery fails and medical therapy is inadequate.
Early treatment in normalizing the IOP may reverse the glaucoma damage and have minimal
impact on vision. The child will need to be followed up throughout their life. Regular check-ups in the early childhood years are important not only to monitor the level of the IOP but also to correct refractive errors to avoid amblyopia.