Glaucoma in children pdf

Hence, the incidence of traumatic glaucoma. Since a rebleed can cause a substantial approximately two per 10, children per year. The risk of rebleed is, however, not related to the the following: size of hyphema. Uveitis Ghost Cell Glaucoma The initial IOP is often low due to traumatic iritis causing a After vitreous hemorrhage, erythrocytes degenerate from transient ciliary body shutdown.

The IOP elevation occurring biconvex cells into spherical khaki colored ghost cells and after a few days is usually mild and easily controlled.

Red blood cells take 1 to 2 weeks to degenerate trabecular meshwork contributing to the outflow obstruction. This in turn leads to iris Fig. Acutely, the intraocular pressure is raised due to: The incidence of angle recession Fig. Pupillary block secondary to a clot involving both the recession will go on to develop glaucoma.

The possibility of anterior and posterior chambers. If more than of raised IOP but in patients with sickle cell disease high of the anterior chamber angle is involved, there is a greater IOP can be seen with a small hyphema. Usually visual chance of subsequently developing glaucoma. Posterior dislocation is less likely to cause glaucoma but if the vitreous prolapses, pupillary block glaucoma may ensue or if the dislocated lens becomes cataractous and lens proteins leak, phacolytic glaucoma may also occur.

Vitreous Hemorrhage Traumatic causes account for Adrenergic agonists such as apraclonidine or but after wound closure, glaucoma may develop Fig. Structural alterations. Pilocarpine is avoided as this increases vascular 2. Blockage of the trabecular meshwork by blood cells from permeability and excarbates pupillary block. Prostaglandin a hyphema, inflammatory debris, lens particles, or ghost analogues cause an increased inflammatory response in cells.

The use of 3. However, longer acting 4. Angle closure may occur due to iris bombe synechial cycloplegics are usually indicated in the setting of hyphema closure at the pupillary margin, or lens swelling. The mean time after injury when the glaucoma was first diagnosed elsewhere or at our center In cases of total hyphema or partial hyphema with sustained was 1.

After trauma IOP greater than 30 mm Hg for 3 days on maximum medical therapy or any evidence of corneal staining, surgical washout Fire cracker of the anterior chamber is usually performed. A total of 35 patients Angle recession was The following are the risk factors for a greater chance of seen in 10 The IOP at presentation was developing glaucoma after ocular trauma reported in various Out of 35 patients with hyphema, in 32 1.

Advancing age If the visual field looks relatively normal, optic disc imaging or photography is usually the next step to document the appearance of the optic nerve. Imaging of the optic nerve or nerve fiber layer provides the advantage of immediate diagnostic comparison, whereas disc photography assists with later comparisons.

Be sure, however, to take into account the previously mentioned caveats regarding normative comparisons and movement. CCT should be interpreted in light of the available normative pediatric data and correlated with other factors such as a family history of glaucoma. In this case, Goldmann visual field testing was full bilaterally.

An OCT evaluation of the nerve fiber layer was within adult normative values. Repeated IOP assessments have been normal, and there has been no change in the optic discs' appearance with serial examinations. These patients are likely at increased risk of developing glaucoma, but their risk of developing the disease in the near and intermediate term may be quite low. Proper management in these cases usually involves documenting the appearance of the optic disc, with routine surveillance for elevated IOP, changes in the disc, or reproducible visual field abnormalities.

Supported, in part, by an unrestricted grant from Research to Prevent Blindness Inc. Beck may be reached at ; abeck emory. Current Issue Archive. Allen Beck, MD. Race-, age-, gender-, and refractive error-related differences in the normal optic disc.

Arch Ophthalmol. The Ocular Hypertension Study: baseline factors that predict the onset of primary open-angle glaucoma. Influence of optic disc size on neuroretinal rim shape in healthy eyes. J Glaucoma. The ISNT rule and differentiation of normal from glaucomatous eyes. Retinal and optic disc findings in adolescence: a population based OCT study. Invest Ophthalmol Vis Sci.

Retinal nerve fiber layer thickness in normal children measured with optical coherence tomography. Macular and retinal nerve fiber layer analysis of normal and glaucomatous eyes in children using optical coherence tomography.

Pediatric glaucoma is associated with a wide variety of pathology. Several classification systems have been developed to organize and categorize childhood glaucomas. The majority of systems are based on etiology and describe two main groups: primary and secondary glaucoma. Congenital and developmental glaucomas associated with syndromes and systemic abnormalities fall under the umbrella of primary glaucomas. Causative pathologies ranging from uveitis to congenital cataract surgery fall under secondary glaucoma.

Population study in Olmstead County. Clinical Findings Manifestations of elevated IOP in children can vary depending on age of onset and rate of pressure elevation. Gradually increasing pressure can result in little to no corneal clouding. In contrast, those children with acute pressure elevations present with corneal clouding. This finding can also be seen at birth See Figure 2.

Firm tactile pressure in these cases can be apparent and helpful in differentiating other causes of corneal opacification. The presence of a poor red reflex can elucidate subtle corneal clouding, although absence of a red reflex can be related to other pathology as well. This finding signifies a history of elevated IOP associated with rapid eye growth. Figure 1. Buphthalmos of both eyes, right worse than left. Obtaining IOP measurements in children is challenging. Rebound tonometry has the advantage of not requiring anesthetic drops; however, the child must be upright.

Recent studies have suggested that although IOP by rebound tonometry correlates well with Goldmann Tonometry, there is a tendency to overestimate IOP, particularly in children with glaucoma. Handheld applanation tonometry can also be performed in all positions. An exam under anesthesia is essential in diagnosing childhood glaucoma.

Pre-intubation IOP, refraction, axial length, corneal diameter, gonioscopy, and ultrasound biomicroscopy when visibility is poor, are key components of the exam. Progressive myopia, increasing axial length and changing corneal diameter in the face of borderline IOP and cupping are suggestive of fluctuating high pressures.

Tracking these factors also aids in determining treatment response. In children more than 3 years of age, changes associated with buphthalmos become less apparent due to decreased scleral elasticity. A large number of syndromes have associated glaucoma.

Sturge-Weber has a sporadic inheritance pattern and is characterized by nevus flammeus port wine stain of the face, angioma of the meninges and, rarely, involvement of the airway. Incidence of glaucoma has been reported to be as high as 71 percent. Corneal clouding found at birth with elevated intraocular pressure. Incidence of glaucoma has been reported to be 47 to 71 percent.

Approximately 50 percent of patients diagnosed with ARS will develop glaucoma. Onset typically occurs during late childhood but can present during infancy and into adulthood. Aniridia is characterized by hypoplastic iris tissue and is associated with foveal hypoplasia, cataracts, keratopathy secondary to limbal stem cell deficiency and, occasionally, optic nerve hypoplasia. The inheritance pattern is autosomal dominant, but can be inherited sporadically. Prevalance of glaucoma is reported to be from 30 to 50 percent.

Eyes with an associated plexiform neurofibroma have a 50 percent risk of glaucoma. Medical therapy in pediatric glaucoma is often supplementary to surgical management. It is often used for preoperative treatment to facilitate clearing of corneal edema. In addition, it can play a role in treating patients who are too unstable to undergo anesthesia. Timolol is often used as a first-line agent and has been shown to effectively lower IOP in the pediatric population.

There is an increased risk for bronchospasm, apnea and bradycardia. The use of betaxolol b1 selective antagonist , timolol 0. Overall, however, timolol drops are generally well-tolerated.

Side effects are minimal, although darkening of the irides can occur, as in adults. They are generally well-tolerated with minimal side effects. Oral treatment carries a risk of systemic side effects, such as metabolic acidosis.