Overview

If a child is suspected of having glaucoma, it's crucial to seek immediate evaluation by an ophthalmologist to safeguard their eyesight. In some instances, a pediatrician might recommend a referral to an ophthalmologist for further assessment.

A comprehensive eye examination by the ophthalmologist is essential to detect signs of glaucoma. Certain tests can be performed in the ophthalmologist's office, while others necessitate an operating room setting (refer to "Exams and Tests").

Tonometry, a method for measuring intraocular pressure (IOP), can be conducted in the ophthalmologist's office. Monitoring IOP is critical, as elevated pressure may indicate the presence of glaucoma.

Tonometry can often be carried out on a child's eye using a handheld instrument known as a Perkins tonometer. Occasionally, the pressure reading in the office may be temporarily elevated due to the child's lack of cooperation during the examination.

Corneal changes may also be noticeable during the office visit. Particularly in the early years of life, corneal alterations may suggest the possibility of glaucoma.

In cases of primary congenital glaucoma, the cornea typically exhibits enlargement and swelling due to increased IOP, giving the appearance of a larger eye. The cornea might also appear cloudy or hazy as a result of elevated pressure.

Self-Care Guidelines

There are no effective self-care measures. Immediate evaluation by an ophthalmologist is imperative to mitigate the risk of vision loss.

Follow-up Visits

Frequent follow-up appointments are necessary post-surgery. During these visits, the ophthalmologist will assess the child's eyes and gauge the procedure's effectiveness in lowering IOP.

Children diagnosed with primary congenital glaucoma must continue to receive ongoing care throughout their lives. Surgery can manage IOP and help prevent vision loss but does not provide a cure for glaucoma. Children remain at risk for developing glaucoma and experiencing vision loss during their lifetime.

Prevention

Primary congenital glaucoma cannot be prevented. However, if suspected, prompt evaluation by an ophthalmologist can safeguard the child's visual future and mitigate the risk of vision loss.

Prognosis

The most favorable outcomes are observed in infants who undergo surgery between the second and eighth month of life. As a child ages, the effectiveness of surgery in preserving vision tends to decrease.

Intraocular pressure (IOP) plays a significant role in determining a child's future vision. Nevertheless, even with well-controlled IOP, approximately 50% of children do not achieve vision better than 20/50. Reduced vision may result from the following factors:

• Corneal swelling: The cornea may remain swollen for weeks even after successfully reducing IOP, affecting vision.
• Nystagmus: The eye exhibits repetitive up-and-down and/or side-to-side movements, leading to unstable or blurry vision.
• Amblyopia (also known as lazy eye): Vision is impaired and cannot be corrected with glasses.
• Large refractive errors: Vision is impaired but can usually be corrected with strong prescription glasses.

The least favorable prognosis is associated with infants who have elevated pressures and cloudy corneas present at birth.