Pediatric glaucoma a rare but significant cause of blindness in children

SNOWBIRD, Utah — Childhood glaucoma is often overlooked by pediatricians and parents, and ophthalmologists should look for signs and symptoms of glaucoma when performing pediatric eye exams, a speaker here said.

Photophobia, tearing, corneal clouding, corneal enlargement, decreased visual acuity and progressive myopia are among the signs and symptoms that can be clues to the presence of pediatric glaucoma, said David Walton, MD, here at the American Glaucoma Society meeting.

“Childhood glaucoma is unusual, but it causes 10% to 20% of world blindness in children,” Dr. Walton said.

Photophobia is a symptom of glaucoma that may be seen in the first year of life, and it generally goes unnoticed by pediatricians and parents, he said. Often parents accept their child’s intolerance of light and do not believe it is a problem, he said.

Corneal opacities are probably the most common sign of glaucoma characteristically seen in newborn infants, Dr. Walton said.

Corneal enlargement can be a sign of elevated IOP, he said. Corneal enlargement is difficult to measure, but it can be estimated by comparing the size of the child’s cornea to that of the child’s mother, he said.

Tears in Descemet’s membrane typically occur in older children, Dr. Walton said.

Children taking steroids may be at increased risk of developing glaucoma, and their eyes may have a “cushioned” appearance and elevated IOP, he said.

He suggested using hand-held instruments to examine children more easily. Slit-lamps, tonometers and gonioscopes are among the instruments available in hand-held forms.

“The secret of care is in understanding and caring for the patient,” Dr. Walton said.