Recognizing childhood glaucoma in the primary pediatric setting

Key Points

Unilateral eye enlargement in an infant

The infant in this case has buphthalmos. This term describes the enlargement of the globe of the eye and usually appears in the infancy period up to the first year of life.

The baby's pediatrician referred her immediately to an ophthalmologist. Increased intraocular pressure of the right eye was measured associated with no other ocular abnormalities, thus confirming the diagnosis of glaucoma.

Childhood glaucoma defined

Glaucoma is a group of eye conditions characterized by common features that may include elevated eye pressure, damage to the optic nerve, and potential for vision loss. It is a condition infrequently encountered by pediatric health care providers, making the diagnosis challenging, difficult, and often delayed. When childhood glaucoma is not recognized and treated promptly, more permanent visual loss will result.

Etiology

If the pressure remains elevated for a prolonged period, the optic nerve fibers are permanently damaged, causing irreversible blindness.¹ There are many possible mechanisms for the drainage problem that result in childhood glaucoma, including congenital anomalies, inflammation, tumors, and trauma.

Epidemiology

Primary congenital glaucoma, the most common of the pediatric glaucomas, occurs in 1 out of 10,000 births.¹ The overall incidence of childhood glaucoma in a US study in Minnesota was reported to be 1 in 43,575 patients younger than 20 years.² In this population, glaucomas secondary to other eye conditions were more common than the hereditary types of glaucoma.