Glaucoma is an irreversible cause of blindness in children. The prevalence of primary congenital glaucoma (PCG) is 1 in 3,300 live births and PCG accounts for 4.2% of all childhood blindness in the Indian population. This has a very important impact on the quality of life and also since the life expectancy is longer, one has to endure more years of suffering.Read also – Glaucoma: causes, symptoms and why the signs should not be ignored
PCG can occur in neonates (i.e. true congenital glaucoma seen at birth or intrauterine), infantile (Read also – Can high coffee consumption cause blindness? Here’s what we know
PCG has a triad of symptoms
- Epiphora or excessive tearing of the eyes.
- Photophobia or inability to see in light.
- Blepharospasm or close eyes tightly. Parents can give an eye rubbing story.
The presentation can also be with bull’s eye or buphthalmos when the cornea is enlarged and becomes blurry due to increased pressure in the eye. A good eye exam by a qualified ophthalmologist should be sought at the earliest if any of these symptoms appear. Read also – Early signs of glaucoma progression to blindness can be spotted by AI
As most say prevention is better than cure, it can be prevented to some extent by fully immunizing the mother, especially rubella, before pregnancy. Also avoid teratogenic drugs and drug abuse during pregnancy.
Most of these children should be examined under general anesthesia for intraocular pressure, corneal diameter, retinoscopy, ophthalmoscopy, and gonioscopy. Depending on the severity of the damage, the management varies and is mainly surgical. Initially, medical treatment is used to lower intraocular pressure using hyperosmotic agents, beta-blockers, carbonic anhydrase inhibitors. While miotics and alpha agonists are contraindicated in PCG.
Surgery can be
- Incisional surgery – we have goniotomy (only possible if the cornea is clear and
- Filtration surgeries are trabeculectomy with adjunctive antimetabolites. The best standard surgical procedure is primary trabeculotomy and trabeculectomy combined with antimetabolites in PCG.
- Glaucoma drainage devices are the last resort. It may be a Baerveldt, AADI or Ahmed glaucoma valve.
(Contributions by Dr. Anita. C. Kamarthy, Glaucoma Surgeon, MaxiVision Eye Hospital – Hyderabad)