Glaucoma is a group of optic nerve diseases characterized by specific abnormalities, caused by various factors, and primarily related to intraocular pressure. In adults, glaucoma may or may not be associated with high eye pressure, but glaucoma in children is almost always accompanied by elevated intraocular pressure. This high eye pressure causes severe eye pain, headaches, and worsening vision in children. The severity of symptoms depends on the level of eye pressure.
High intraocular pressure exerts pressure and damages the optic nerve head as well as the optic nerve fibers. This damage results in permanent loss of the visual field or the width of vision, which cannot be restored to normal even if the eye pressure is later reduced.
Glaucoma in Infants and Young Children
Glaucoma in infants and young children is a subgroup of diseases that is unique in terms of its onset, characteristics, associated diseases, disease progression, and even treatment methods. The disease may be present at birth or diagnosed later.
The definition of “child” by the National Institutes of Health (NIH) of the United States and the United Nations Convention on the Rights of the Child (CRC, UNCRC) refers to individuals under 18 years of age. The definition of “childhood glaucoma” according to the Childhood Glaucoma Research Network (CGRN) refers to a disease presenting at least 2 of the following 5 diagnostic criteria:
- Intraocular pressure greater than 21 millimeters of mercury
- Abnormalities of the optic nerve head caused by glaucoma, such as an enlarged central cup or pit, notching or grooves at the edge of the optic nerve head, or a difference in cup-to-disc ratio between the two eyes greater than 0.2
- Changes in the cornea, such as increased diameter, horizontal curved tears in the inner corneal tissue (Haab’s striae), or corneal edema
- Progressive myopia (increasing nearsightedness)
- Visual field defects consistent with glaucomatous optic nerve head abnormalities and no other causes of visual field defects
Incidence of Glaucoma in Children
Glaucoma causes blindness in about 5% of the pediatric population and affects more than 300,000 children worldwide. It occurs in children of all ethnicities, is more common in boys than girls, and 70-75% of patients usually have bilateral involvement. The incidence of glaucoma varies among newborn populations in different regions, as follows:
- In Western countries, approximately 1:10,000 to 1:20,000
- In developed countries, approximately 1:17,000 to 1:43,000
- In Middle Eastern countries such as Palestine, approximately 1:8,200
- In Saudi Arabia, approximately 1:2,500
- The highest reported incidence is 1:1,250 among Slovakian Gypsies
Types of Glaucoma in Children
Childhood glaucoma is classified into 3 types according to the Childhood Glaucoma Research Network criteria:
- Glaucoma suspect (glaucoma suspect)
- Primary glaucomas (primary glaucomas) with unknown cause and not related to other systemic abnormalities. These are subdivided by age of onset into:
2.1 Primary congenital glaucoma occurring before 3 years of age
2.2 Juvenile open-angle glaucoma occurring between 3-35 years or 3-40 years depending on the definition. This type is less common than primary congenital glaucoma and differs from adult glaucoma in that juvenile glaucoma is associated with genetic abnormalities, begins at a young age, has very high intraocular pressure, is often asymptomatic, and is detected incidentally. It shows wide fluctuations in eye pressure over time, leading to rapid visual field deterioration.
3. Secondary glaucomas (secondary glaucomas) with known causes, the most common type, such as after cataract surgery, associated with systemic or ocular diseases, and hereditary conditions.
Causes of Glaucoma
Glaucoma can arise from multiple causes. Studies show that 90% of glaucoma patients do not have a family history of the disease. Although it can be inherited genetically, this is rare, and genetic expression may vary or be influenced by environmental factors.
Consanguineous marriage is another important factor that may contribute to the disease. The use of steroid medications to treat diseases such as allergies, either unknowingly or without medical supervision, can also be a factor.
Symptoms of Glaucoma in Children
Most parents bring their infants to the doctor within the first year of life due to three key suspicious symptoms: tearing without discharge, light sensitivity, and eyelid twitching. These symptoms result from elevated intraocular pressure affecting the cornea. In severe cases, corneal edema and clouding may also be present. These symptoms are not specific to glaucoma alone. Further examination often reveals other abnormalities such as enlarged cornea, tears in the corneal tissue, high intraocular pressure, deep anterior chamber, and enlarged eyeball. These signs help confirm the diagnosis more accurately. Generally, once diagnosed, optic nerve head abnormalities are always found.
However, tearing without discharge, light sensitivity, and eyelid twitching can also be caused by other conditions such as nasolacrimal duct obstruction, iritis, corneal degeneration, or birth trauma. Therefore, differential diagnosis is important, including family history of glaucoma and consanguineous marriage.
Treatment of Glaucoma in Children
Although treatment of childhood glaucoma includes both medication and surgery, the main treatment is surgery, which has various methods and must be considered on a case-by-case basis. Eye drops are usually used while waiting for surgery or after surgery if intraocular pressure remains high, to help control eye pressure and slow disease progression. Using only eye drops for treatment is often ineffective.
What to Do If Glaucoma Is Suspected?
Early detection of glaucoma is crucial and greatly affects treatment outcomes. If a child shows suspicious symptoms, parents or guardians should promptly take the child to an ophthalmologist for accurate diagnosis and timely treatment. This helps reduce disease severity, slow progression, and preserve vision longer with continuous treatment. It is also recommended that parents and siblings of children with glaucoma undergo screening to ensure no hidden glaucoma exists in other family members.
A key symptom often overlooked or diagnosed late is an enlarged eyeball or cornea in children, caused by increased intraocular pressure. The general public may perceive large eyes as a cute or attractive feature, not realizing it is a dangerous condition.
