Glaucoma in children is a serious eye disease, which received its name from the greenish hue of the fixed and dilated pupil during an acute attack. The second name of the disease is green cataract. To date, there is no common understanding of the causes and pathogenesis of glaucoma, there are differences even in the definition of the disease.
Glaucoma is characterized by constant or periodically increased intraocular pressure (abbreviated – IOP), accompanied by the development of trophic disorders in the outflow of intraocular fluid in the retina and in the optic nerve, which causes typical defects in the visual field and the development of the regional depression of the optic nerve.
The term ” glaucoma ” means more than 60 diseases with such features :
- IOP elevated (constantly or in periods)
- The optic nerve fibers are affected, which ultimately ends in atrophy.
- Violation of visual functions
The disease in question may be in people of any age, including newborns. However, its frequency among children and adolescents is significantly lower than among older and older people. Only 1 newborn per 10000-20000 is ill. Glaucoma can cause blindness, which cannot be eliminated by any means.
Types of glaucoma in children :
Congenital glaucoma can be transmitted “inherited” or caused by diseases and injuries of the embryo, injury can be received during childbirth. This type appears at least in the first week, and a maximum in the 2nd month of life. But there are cases that the first manifestations occur in the 2-3rd year of life of the child. This disease is rare, as mentioned above.
In 60 cases out of 100, congenital glaucoma is diagnosed in the neonatal period. In the literature, sometimes comes across another name – gidrofftalm, otherwise – dropsy eyes. The cornea is enlarged in both eyes, sometimes the entire eyeball is enlarged.
Juvenile glaucoma is also known as juvenile, it happens in children from 3 years. Secondary glaucoma appears due to diseases (common or ocular).
What triggers / Causes of Glaucoma in children:
Congenital glaucoma in children causes congenital anomalies of the development of the angle of the anterior chamber and the drainage system of the eye, which creates an obstacle to the outflow of intraocular fluid or its significant difficulty. This leads to the fact that IOP rises. The reason may lie in the pathological conditions of the mother, especially in the first trimester of fetal development. It can be:
- ionizing radiation, etc.
Diseases of the mother leading to congenital glaucoma of the child :
Pathogenesis (what is happening?) During Glaucoma in children:
Anatomy and physiology of intraocular fluid outflow tracts
In the cavity of the eye there are light-conducting media: watery moisture that fills the chamber, lens and vitreous body. The circulation of intraocular fluid in the chambers of the eye affects the regulation of metabolism in intraocular structures and the tone of the eyeball.
Intraocular fluid (IGL) is an important source of nutrition for structures that are inside the eye. The aqueous humor is involved in the metabolism of the cornea, lens , vitreous body, trabecular apparatus. This is reflected at the level of IOP (intraocular pressure).
The condition of the drainage system of the eye is assessed using gonioscopy . The width of the anterior chamber angle may be narrow, medium or wide. This method allows you to detect different manifestations of glaucoma, open-angle and angle-closure . There is a balance between the inflow and outflow of intraocular fluid. In violation of its changes in IOP. With persistent and prolonged increase in intraocular pressure, blocks appear.
In the pathogenesis of glaucoma in children, hereditary factors, anomalies of the structure of the child’s eye or individual characteristics, malfunctions in the nervous, cardiovascular or endocrine system play a role .
Stages of development of the pathological process in glaucoma :
- disturbed and worsened outflow of aqueous humor from the cavity of the eyeball
- IOP rises to the level of intolerance to the eye
- intissueseyesgetting worsecirculation
- in the area of exit of the optic nerve begins hypoxia and impaired blood supply to the tissues
- nerve fibers are compressed in the zone of their exit from the eyeball, as a result, their function is disturbed and death occurs
- dystrophy, destruction and atrophy of optic fibers begins
- glaucomatousopticneuropathydevelops, the optic nerve dies
In case of glaucoma, part of the nerve fibers of the optic nerve atrophy, and some are in a state of parabiosis, which gives a chance for their restoration by medical means.
Symptoms of Glaucoma in children:
Typical symptoms of glaucoma in children :
- changesthe diskvisualnerve
- increase in corneal diameter and limb width
- an increase in the size of the eyeball, which is rapidly progressing
In congenital glaucoma, children may have defects in other organs and systems:
With congenital glaucoma there may be other pathological processes in the eye :
In most cases, congenital glaucoma appears in two eyes. Often, the child has no complaints, except that caused by corneal syndrome. This means that the disease proceeds as an open-angle glaucoma. Late stages of the disease are manifested by the appearance of staphylosis, sometimes scleral ruptures, there may be a sprain and thinning of the conjunctiva, a complicated cataract. At the beginning of congenital glaucoma, the fundus is normal.
In the case of a congenital form of glaucoma, the child’s visual functions deteriorate, as first changes in the cornea, refractive errors occur, and then damage to the optic nerve and retina.
Syndromes, including children’s glaucoma
In some diseases in some cases, the child has glaucoma.
Syndrome Sturge -Vebera (Angioma person)
With this syndrome, intracranial angiomas, purple telangiectasias of the face, and glaucoma appear. It is diagnosed in a third of patients with this syndrome. Fix glaucoma can, while the child is very small. But there are many cases when manifestations of glaucoma began in children of preschool and school age.
Marbality of the skin in congenital telangiectasia
This is a rare syndrome that is similar to the one described above . Vascular disorders due to skin lesions appear. A child has a marble skin, apoplexic strokes, sometimes convulsions and glaucoma.
With this disease, the first type may be glaucoma. Its frequent combination in these cases with plexiform neuromas of the orbit and ipsilateral coloboma of the iris or eyelid. The reasons lie in the pathology of tissue angle of the anterior chamber or the closing angle, which is caused by neurofibromatosis .
Rubinstein- Teyby Syndrome
It is extremely rare, characterized by an anti- mongoloid eye cut, hypertelorism , wide fingers, lengthening of eyelashes, an increase in toes. Presumably, glaucoma is the result of an underdeveloped anterior chamber angle.
This is the central corneal clouding that occurs in a child from birth; eye combined with defects of the Descemet’s membrane, stroma and endothelium.
Juvenile open – angle glaucoma
This form of glaucoma is rare, it is inherited in an autosomal dominant manner. Clinical examination does not give the doctor the necessary information. Effectively histological examination as a diagnostic method.
The pathology of the lens and its interaction with the iris diaphragm
With spherophacia, there is a tendency to move the lens forward and cause glaucoma. The disease can be with isolated spherophacia and with Weil- Marquezani syndrome .
The disease can begin several years after cataract extraction. The pathogenesis remains a complete mystery, but in some cases it is related to the development of pathological changes in the anterior chamber angle. The prognosis is unfavorable.
Retinopathy of prematurity
Glaucoma can occur with severe retinopathy. premature when total retinal damage occurs.
This disease often passes as a skin process, and more rarely, intraocular, which causes glaucoma (it usually appears due to hemorrhages).
Glaucoma in inflammatory eye diseases
The disease in question may result from uveitis . The treatment is to suppress the inflammation. In some cases, glaucoma can cause blockade of the exudate trabecular network and acute trabeculitis .
In case of a blunt trauma of the eyeball ( hyphema , angle recession), glaucoma may also occur in children.
Diagnosis of Glaucoma in children:
If you suspect a child with glaucoma, a full diagnosis is performed requiring general anesthesia. Measure IOP (intraocular pressure), examine the condition and functioning of all parts of the eye, including the optic nerve head.
For young children, many diagnostic methods that are relevant to adult patients cannot be tried. It is difficult for children under 6 years old to carry out computer perimetry, tonometry in the clinic. Corneal opacities and scars make it more difficult to examine the optic nerve.
Treatment of Glaucoma in Children:
Conservative treatments for many forms of glaucoma in children are not effective enough. Often, oral medication and intravenous administration of acetazolamide , as well as pilocarpine and betaxalol, are often combined . Doses can be different, they depend on the age of the child and his weight.
Treatment of glaucoma in children with surgery is common. at most countries of the world. An operation called goniotomy is effective when the baby’s cornea is transparent.
Young children are examined under anesthesia. It is not recommended to use intubation, suksametonium and ketamine , which can increase IOP. And reduce the pressure inside the eye Bimatoprost and similar means. Intraocular pressure should be measured immediately after entering the means for anesthesia. Measure the horizontal and vertical diameter of the cornea from limbus to limbus.
Also, the cornea is examined for the presence of breaks in the Descemet’s membrane and to assess its overall transparency. Examine the optic nerve head , the size of the eyeball by ultrasound, refraction. Yttrium aluminum garnet laser goniotomy may presumably lead to a longer compensation of intraocular pressure compared with surgical goniotomy . But other researchers question this.
Trabeculotomy is used to treat primary congenital glaucoma in cases where there is no good view of the anterior chamber angle of the eye. Such treatment methods as trabeculectomy , endolaser , cyclic cryotherapy , and drainage implantation are also effective . For the latter method, tubular drains are used – only in In cases where the previous operation did not produce results.
Prevention of Glaucoma in children:
The best prophylactic is the detection of the disease at the beginning of its development. This avoids disability. Health education is important – people should be aware of the causes and manifestations of glaucoma. Today there is enough information on the Internet. Once every 12 months you need to organize an examination of the child by an ophthalmologist.
If you find any problems with your eyesight, you need to consult a doctor, strictly adhere to his recommendations. It is better to have a child or teenager lead a healthy lifestyle. Sufficient motor activity is recommended.
Should be excluded from the life of a child with glaucoma factors that can worsen the course of the disease. It is recommended to give up bad habits, if any. It should be rationally fed. Doctors do not advise to be long with the head tilted forward. Reduce the amount of stress in the child’s life, normalize his full rest. These rules help avoid blindness, which is a frequent complication of glaucoma in children and adults.
For the prevention of glaucoma, the ophthalmologist may prescribe eye drops to the child, which affect the decrease in the amount of fluid produced and the pressure in the eyes. At the beginning of the development of the disease in combination with the main therapy can be applied folk remedies. Effective physiotherapy treatment methods, which are resorted to 2 times a year.
Doctors to avoid eye problems are advised not to lift weights weighing 10 kg or more. You need to sleep at least 8 hours a day, and children of preschool age – even more, according to age. With poor lighting, you cannot read, sit at the computer and watch TV, as well as work with small details (sculpt from clay, embroider, etc.).
If the doctor has prescribed glasses / lenses to the child , do not discard them. When working at a computer, a child must take a break every 45 minutes for at least 15 minutes. You can not drink a lot of liquid in one gulp, it is advised on average to use 1 glass of water every hour. It is not recommended to wear shirts and t-shirts with tight collars that adversely affect blood circulation.
Protect your eyes from bright flashes, including when photographing. Sharp light drops are also harmful, for example, in movie theaters.