While glaucoma typically affects older adults, the American Association for Pediatric Ophthalmology and Strabismus (AAPOS) states that the disease can occur at any age — even in babies and children.
Relatively few children develop glaucoma, with the congenital form of the disease occurring in about one out of every 10,000 births. Approximately one in every 10 cases of pediatric glaucoma is inherited.
A serious problem at any age
Glaucoma is actually a group of eye diseases in which optic nerve damage develops as a result of abnormally high intraocular pressure. Patients can experience partial or severe vision loss, and they may eventually lose their sight altogether. Most cases of the disease develop when the eye is unable to drain away the excess fluid it produces. The built-up fluid exerts unusual pressure on the eye.
The AAPOS notes that a diagnosis of glaucoma in children can be challenging, since their symptoms typically differ from those found in elderly patients. According to the American Academy of Ophthalmology (AAO), glaucoma in children can be more aggressive but generally develops more slowly in elderly people. Children and teens with glaucoma can lose their eyesight quickly, which is why prompt detection and appropriate treatment are especially vital for this age group.
Congenital, infantile and juvenile glaucoma
According to AAPOS, one method of classifying pediatric glaucoma relies on the patient’s age when the symptoms initially appear. “Congenital glaucoma” is the term physicians use to refer to glaucoma when it is present at birth. “Infantile glaucoma” develops between one to 24 months. If a child develops glaucoma at age three or older, then the disease is known as “juvenile glaucoma.”
Primary and secondary forms of the disease
Ophthalmologists also classify glaucoma into various categories depending on which overall condition or structural problem they have identified as the cause.
In “primary glaucoma,” which accounts for most of the cases of childhood glaucoma, no one specific cause can be pinpointed. On the other hand, children can sometimes develop the disease as a side effect of another health condition, in which case it is referred to as “secondary glaucoma.”
Children can develop glaucoma as a result of physical trauma or surgery, which includes the removal of cataracts. They may develop glaucoma in connection with an identified disease such as neurofibromatosis, which the Mayo Clinic defines as a genetically based condition in which tumors form in nerve tissue.
Signs, symptoms and diagnosis
Diagnosing pediatric glaucoma can be challenging, since young children are rarely able to stay still long enough for a definitive diagnosis. In addition, normal behavior, such as crying, can artificially raise intraocular pressure during an examination. Babies and young children can undergo anesthesia in order for a physician to perform a thorough exam to detect or rule out glaucoma.
According to the AAPOS, the most frequently encountered symptoms associated with congenital glaucoma include sensitivity to light and excessive amounts of tearing. Parents should be cautioned, however, that excessive tearing in conjunction with eye discharge or matting of the eyelids typically has nothing to do with glaucoma, but is rather associated with a simple blockage in the tear ducts. Another common sign of congenital glaucoma is an enlarged and clouded cornea. A healthy cornea is normally clear.
Recently, researchers have discovered certain genetic mutations connected to pediatric glaucoma and they have developed genetic testing systems for families who may need them.
Sturge-Weber Syndrome as a cause
The nonprofit Sturge-Weber Foundation describes Sturge-Weber Syndrome (SWS), also known as encephelotrigeminal angiomatosis, as a disease caused by a genetic mutation that can lead to developmental delays and severe eye conditions, including glaucoma.
A port wine birthmark on the face is the most noticeable early sign that a child may have SWS, although only about 8-to-15 percent of children born with such a mark have the condition. Roughly one-third to two-thirds of children diagnosed with SWS will also develop glaucoma.
Axenfeld-Reiger Syndome can affect multiple parts of the body
Secondary glaucoma also often occurs in children with Axenfeld-Reiger Syndome. The United States National Library of Medicine notes that, while the condition mainly affects the eyes, it can impact numerous other parts of the body.
Axenfeld-Rieger Syndrome features abnormalities in the front portion of the eye. These include an underdeveloped or unusually thin iris or an irregularly shaped pupil. The condition is also sometimes associated with corneal defects.
Approximately 50 percent of people with Axenfeld-Rieger Syndrome develop glaucoma, which usually begins to appear later in childhood or during the teen years. Some infants with Axenfeld-Rieger Syndrome can also develop glaucoma.
A strong correlation with aniridia
According to the AAPOS, about half of all patients diagnosed with aniridia — in which the entire iris or a part of it is absent, which results in misshapen pupils — will develop glaucoma at some point in their lives.
A nuanced, broad-based approach to treatment
Since glaucoma in children presents numerous additional complications, ophthalmologists typically take a holistic approach to deal with the developmental and other issues accompanying the condition.
Experts are also careful to note that treatment for pediatric glaucoma can exacerbate secondary conditions.
For example, many children with glaucoma are at increased risk for developing amblyopia. If a physician succeeds in reducing intraocular pressure in a child with glaucoma, the potential for the child’s amblyopia to worsen increases. Additionally, surgery to correct glaucoma can lead to the development of cataracts.
The AAO experts point out that pediatric glaucoma is different in degree and in type from adult glaucoma. Therefore, treatment and management programs for children differ significantly from those designed for adults.
According to the AAO, in childhood glaucoma the elevated intraocular pressure produces damage to the whole eye, rather than only the optic nerve. The problem has implications for the overall functioning of children’s eyes and their developing structure.
AAPOS points out that physicians who work with children with glaucoma need to remain aware of a host of issues, which include obtaining the proper corrective lenses to fix refractive errors as the problem is treated. Since a young child’s nervous system is at a peak period of development, failing to address refractive problems immediately can result in a rapid rewiring of the brain that in effect “turns off” the functions of the eye.
The medications usually prescribed for adults with glaucoma attempt to correct eye drainage problems. However, in children, these problems have typically been present from the start, and thus medication simply delays the inevitable need for corrective surgery. Generally, surgery is the first option in treating glaucoma in younger children.
Typically, older children can receive eye drops and oral medication as the primary treatment. Medication as a course of treatment can also follow surgery.