Eye problems in children: what is congenital glaucoma?

Congenital glaucoma, also known as childhood glaucoma, is a rare condition that can occur in infants and young children. Like other forms of glaucoma, this type can be split into primary and secondary types. Primary congenital glaucoma occurs when the disease does not result from another condition or illness, whereas secondary congenital glaucoma develops as a result of an injury or disorder.

In the UK, studies suggest that primary congenital glaucoma can occur in ¹ per 18,500 births annually.1 The condition can affect just one eye, but it’s usually present in both. By definition, infantile glaucoma refers to the condition being diagnosed before the age of 3. In most cases, it is discovered before the child’s first birthday.

What causes congenital glaucoma?

Congenital glaucoma is caused by abnormal development of the drainage system (known as the trabecular meshwork) in the eye. This prevents the aqueous humour, a clear fluid present in the eye, from draining out. The result is an increase in the intraocular pressure (pressure inside the eye), which can damage the optic nerve that relays visual signals to the brain and allows us to see. If left untreated, congenital glaucoma can result in permanent blindness.²

What are the symptoms of congenital glaucoma?

Some of the signs for possible eye trouble in children are not obvious. For childhood glaucoma, symptoms may include:

• Unusually large eyes due to increased pressure
• The cornea (transparent front section of the eye) may appear cloudy
• The child may also exhibit excessive tearing and photosensitivity (closing one or both eyes with exposure to light)
• There may be signs and symptoms indicative of poor peripheral vision (for example, running or bumping into objects)
• Some children with childhood glaucoma may complain of discomfort or pain in the eye if there is a rapid increase in intraocular pressure.
• Babies with this condition may become irritable and refuse to feed.³

Diagnosis of congenital glaucoma

In addition to a complete medical history and eye examination, several tests are used for the diagnosis of congenital glaucoma. Young children may also require an examination under anaesthesia. Some of the tests that may be requested by a doctor include:

• Visual acuity or eye chart test with letters and numbers to assess the child’s vision
• An eye exam with eye drops to dilate the pupils and carefully examine the retina and optic nerve
• Visual field testing to assess peripheral vision
• Tonometry to measure intraocular pressure

Treatment options for congenital glaucoma

Modern medical management and surgical techniques have resulted in a great improvement in the prognosis of congenital glaucoma. Treatment needs to start as early as possible, however, to limit the damage to the optic nerve and prevent further vision loss.

Glaucoma eye drops

Medications such as eye drops are usually the first line of treatment for congenital glaucoma. They reduce the pressure in the eye for the short-term by causing the eye to either produce less fluid or drain more fluid. The balancing of intraocular pressure to safe levels can be achieved with eye drops in the majority of children with primary and secondary glaucoma.¹

Glaucoma surgery

Another treatment option for congenital glaucoma is surgery. This can be performed conventionally or with lasers and microsurgery. These procedures create an opening for the fluid to leave the eye. Surgical procedures for childhood glaucoma include:³

• Trabeculectomy (removing part of the trabecular meshwork through which the fluid drains)
• Goniotomy (a type of internal trabeculectomy performed for congenital glaucoma)
• Iridotomy (making a hole in the iris or coloured part of the eye to allow fluid drainage)
• Cyclophotocoagulation (freezing part of the ciliary body, the structure that secretes the fluid)

Childhood glaucoma can lead to permanent sight loss. However, early diagnosis and treatment can greatly improve the outcome and allow the child to lead a normal or near-normal life.

For more information on the causes of glaucoma, see our dedicated glaucoma resource.