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Glaucoma, Primary Congenital

Intro

Any child suspected of having glaucoma should be seen as soon as possible by an ophthalmologist to prevent vision loss. In some cases, a pediatrician might refer a child with possible glaucoma to an ophthalmologist.

With a complete eye examination, the ophthalmologist can look for signs of glaucoma. Some of the tests can be done in the office, while others must be performed in the operating room (see Exams and Tests).

Tonometry, a method used to measure the pressure inside the eye, can be done in the office. Measuring the pressure is important because increased IOP can be a sign of glaucoma.

Tonometry can often be performed on a child's eye with a handheld instrument called a Perkins tonometer. Sometimes, the pressure measurement taken in the office may be artificially elevated because of the child being uncooperative during the examination.

Changes in the cornea may also be evident during the office visit. Often, especially within the first few years of life, corneal changes can be seen that might indicate glaucoma.

With primary congenital glaucoma, the cornea is usually enlarged and swollen because of the increased IOP, so the eye appears large. The cornea may also appear cloudy or hazy because of the elevated pressure

Self-Care at Home

No self-care is effective. Immediate treatment by an ophthalmologist is necessary to try to prevent vision loss.

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Follow-up

Frequent follow-up visits are needed after surgery. During these visits, the ophthalmologist examines the child’s eyes and evaluates the effectiveness of the procedure in reducing IOP.

Children who have been diagnosed with primary congenital glaucoma must continue to receive follow-up care throughout their lives. Surgery can control IOP and help prevent vision loss; however, it does not cure children of the glaucoma. Children are still at risk for further glaucoma development and vision loss during their lifetime.

Prevention

Primary congenital glaucoma cannot be prevented, but, if suspected, immediate treatment from an ophthalmologist can protect the child’s visual future and prevent vision loss.

Outlook

The most favorable outcome is seen in infants who undergo surgery between the second and eighth month of life. As the child gets older, surgery tends to be less effective in preserving vision.

IOP is a significant factor in determining the child’s future vision. However, even when IOP is well controlled, approximately 50% of children do not achieve vision better than 20/50. Reduced vision may result from the following:

  • Corneal swelling: The cornea may remain swollen for weeks even after successfully reducing IOP. This swelling can affect vision.
  • Nystagmus: The eye repeatedly moves up and down and/or from side to side. This continuous drifting of the eye can cause vision to become unstable or blurry.
  • Amblyopia (also known as lazy eye): Vision is impaired and cannot be corrected with glasses.
  • Large refractive errors: Vision is impaired but can usually be corrected with glasses. For large refractive errors, a very powerful lens is often needed to improve vision.

The worst prognosis occurs in infants with elevated pressures and cloudy corneas that are present at birth.

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