Glaucoma in Childhood A Review

Childhood or pediatric glaucomas are a heterogeneous group, comprising the true primary developmental glaucomas, associated with developmental anomalies in the eye since birth and other secondary glaucomas. Early onset primary open angle glaucoma, the so called juvenile glaucoma, as well as angle closure glaucomas both primary and secondary are also seen in the pediatric age group. Pediatric glaucoma is a potentially blinding disease accounting for about 4.2% of childhood blindness.1 Early diagnosis and prompt surgical intervention form the mainstay of management of this condition. The aim of treating pediatric glaucomas should be to lower the IOP permanently, to preserve visual acuity and field and help in the development of binocular single vision. Surgeries such as goniotomy, trabeculotomy and trabeculectomy formed the mainstay of surgical treatment and are still the commonest procedures performed today, albeit with modifications. Aqueous drainage devices and intraand post-operative use of antimetabolites are the more significant recent advances in the surgical management of glaucoma. Medical management is only a temporizing measure while the child is awaiting surgery. However medical management does continue to play a role in older children with raised IOP or progression of glaucoma after failure or limited success of surgical procedures. Topical carbonic anhydrase inhibitors and prostaglandin analogues are the newer drugs tried in the management of paediatric glaucoma though beta blockers continue to be the most often prescribed. Continued long-term follow up and management of associated refractive errors and amblyopia are of prime importance. Early identification and prompt referral to ophthalmologists by paediatricians is very critical if functional, stable vision is to be achieved in the long term.