Childhood glaucoma is a rare but serious eye disease in which raised intraocular pressure damages the optic nerve and, if left untreated, can lead to blindness. Unlike glaucoma in adults, childhood glaucoma almost always requires surgical treatment. Early diagnosis and consistent, lifelong follow-up are crucial for preserving vision.
How does childhood glaucoma develop?
In a healthy eye, aqueous humor is constantly produced and leaves the eye again through a fine drainage system (trabecular meshwork) in the drainage angle. In glaucoma, this outflow is impaired, so fluid builds up and the pressure inside the eye rises. Over time, this raised pressure damages the optic nerve and leads to visual field loss.
Types
Primary congenital glaucoma
Occurs in the first years of life (often already at birth or within the first months)
Caused by a congenital malformation of the drainage angle that obstructs the outflow of aqueous humor
Can affect one or both eyes; in about 70% of cases both eyes are affected
More common in boys
Infantile and juvenile glaucoma
Occurs after the 1st or after the 3rd year of life
Mechanism similar to congenital glaucoma, but the diagnosis is often made later
Secondary glaucoma
Develops as a result of another eye disease or a syndrome:
Axenfeld-Rieger syndrome and other anterior chamber anomalies
Symptoms
In infants and toddlers
The symptoms can be subtle. Watch for:
Watery eyes (epiphora): often the first sign
Light sensitivity (photophobia): the child squints in light or turns the head away
Enlarged eye (buphthalmos, "ox eye"): because the child's eye is still soft and stretchable, it can grow larger under raised pressure
Cloudy cornea: a milky-blue haze over the cornea caused by edema
Enlarged corneal diameter: over 12 mm in a newborn is suspicious
In older children
Often less obvious, as the eye no longer grows
Blurred vision or increasing nearsightedness
Abnormal vision test results at school
Headaches (rarely as the only symptom)
Watery, Light-Sensitive Eyes in Your Baby?
Watery eyes, sensitivity to light, a noticeably large eye or a milky, cloudy cornea in an infant should be evaluated promptly by an ophthalmologist. Call us and we will assess the urgency: Dr. Stefan Langenegger examines children's eyes from infancy at our practice right at Zurich main station and coordinates further treatment if glaucoma is suspected.
A complete work-up includes (in small children often under anesthesia):
Measurement of intraocular pressure (tonometry)
Examination of the cornea: diameter, clarity, thickness (pachymetry)
Gonioscopy: assessment of the drainage angle with a special lens
Examination of the optic nerve: assessment of the cupping (optic disc excavation). An enlarged cupping indicates pressure damage
Axial length measurement: an unusually long eye in an infant can indicate chronically raised pressure
Optic nerve imaging (OCT) in cooperative older children
Treatment
Surgical therapy (first-line treatment)
Unlike adult glaucoma, which is initially treated with medication, surgery is the first choice in most cases of childhood glaucoma:
Goniotomy / trabeculotomy: opening the malformed drainage channel from the inside or outside. The standard procedure for primary congenital glaucoma, with good success rates.
Trabeculectomy: creating an artificial drainage channel under the conjunctiva. Used when goniotomy/trabeculotomy is not sufficiently effective.
Glaucoma drainage implant (tube shunt): a small tube drains the aqueous humor under the conjunctiva. Used in complex or previously operated cases.
Cyclodestructive procedures: destruction of the aqueous-producing tissue using laser or cold (cyclophotocoagulation, cyclocryocoagulation). Used as a last resort.
As a supplement after surgery if the pressure has not been lowered enough
For some forms of secondary glaucoma
Glasses and amblyopia treatment
Because glaucoma in childhood often goes hand in hand with refractive errors and reduced vision, accompanying treatment with glasses and, if necessary, occlusion is important.
Prognosis
The prognosis depends on several factors:
Time of diagnosis: the earlier treatment begins, the better
Type of glaucoma: primary congenital glaucoma often has a good prognosis with early surgery
Severity of corneal clouding and optic nerve damage at the time of diagnosis
Response to treatment: some children need several operations
Despite successful pressure reduction, optic nerve damage that has already occurred cannot be reversed. This is why early detection is so crucial.
