Glaucoma is a group of eye diseases that can damage the eye’s optic nerve. The optic nerve is the connection between the eye and the brain. It must function normally for the brain to “see” the image created in the eye. The eyes produce fluid, and when that fluid does not drain sufficiently, it creates too much eye pressure. This can damage the optic nerve and cause severe vision loss and blindness.
Children who are diagnosed with glaucoma need long-term care from an experienced ophthalmologist to manage their condition. Ophthalmologists at Riley at IU Health are experts in treating pediatric eye disorders. Our physicians are board certified in ophthalmology and have had one or more years of fellowship training in pediatric ophthalmology.
Childhood glaucoma is relatively rare, occurring in about one out of every 10,000 births in the United States. Pediatric glaucoma is usually diagnosed by the age of 6 months. Eighty percent of pediatric cases are diagnosed in a child’s first year of life. In about 75 percent of diagnosed cases, glaucoma affects both eyes.
If a child has glaucoma at birth, it is called congenital glaucoma. Infantile glaucoma develops between the ages of 1 year and 24 months. Glaucoma that develops after age 3 is called juvenile glaucoma.
Glaucoma can be categorized by the condition that caused the eye disease. If no specific cause is found, it is called primary glaucoma. Most childhood glaucoma is considered primary. About 10 percent of primary congenital/infantile glaucoma cases are inherited.
Secondary glaucoma is caused by or linked to a specific condition or disease, such as Axenfeld-Reiger Syndrome, Sturge-Weber Syndrome, aniridia, neurofibromatosis, microphthalmia, chronic steroid use, trauma and persistent fetal vasculature (PHV)—also known as persistent hyperplastic primary vitreous (PHPV). It is also linked to previous eye surgery such as procedures for childhood cataracts.
Infants and children with glaucoma typically have different symptoms than adults. In children under age 2, these symptoms include:
- Large, sometimes cloudy cornea (the normally clear “window” on the front of the eye)
- Enlarged eyes (buphthalmos)
- Excessive tearing (epiphora)
- Light sensitivity (photophobia)
For children over the age of 2, there are often no signs or symptoms until the late stages of glaucoma. However, parents may notice:
- Light sensitivity
- Significant vision loss
- Difficulty adjusting to the dark
- Headaches or eye pain
- Excessive blinking or squeezing of eyes
- Chronic red eyes
Children who have had a serious eye injury and/or eye surgery have a higher risk of developing glaucoma. Up to 25 percent of children who have had cataract surgery may develop glaucoma, and up to 50 percent of children who have had blunt trauma to the eyeball are at risk of developing glaucoma.
Diagnosis of Glaucoma
If glaucoma is suspected, infants are evaluated while under anesthesia. Ophthalmologists check the intraocular pressure (IOP) and evaluate several other areas, including the cornea, iris and optic nerve.
Older children may complete a diagnostic exam in a doctor’s office to test peripheral vision. Additional imaging tests may also be useful in evaluating and monitoring possible glaucoma.
The goal of treatment is to preserve a child’s vision. Treatment depends on the type of glaucoma, and may include medication and/or surgery to lower the child’s eye pressure. Multiple procedures and examinations under anesthesia may be needed to control this condition.
In addition to providing on-going medical care for your child, Riley at IU Health can help you find support services if poor vision impacts development and learning.
Most cases of primary pediatric glaucoma are treated with surgery. The most common procedures are trabeculotomy and goniotomy, which open the drainage canals. Laser surgery is an option in some cases.
Eye drops or oral medications can help lower eye pressure either by increasing the exit of fluid from the eye or decreasing the production of fluid inside the eye. Eye drops are the main treatment for secondary and juvenile glaucoma. Eye drops or oral medications may also be used after surgery in primary pediatric glaucoma.
Congenital glaucoma is difficult to treat, but infantile glaucoma often has better outcomes from certain kinds of surgery. Even when diagnosed early and treated properly, pediatric glaucoma can still cause significant and permanent vision loss. Early diagnosis and on-going treatment by an ophthalmologist can help children avoid or limit a loss of vision.
Children with glaucoma can develop other vision problems that require treatment, including myopia (nearsightedness), amblyopia (lazy eye) and strabismus (crossing or wandering eye).
Key Points to Remember
Key Points to Remember
- Glaucoma is a group of eye diseases that can damage the eye’s optic nerve, causing severe vision loss and blindness.
- Vision loss due to glaucoma cannot be restored, but remaining vision can be optimized and preserved.
- Symptoms of glaucoma in children are different than adult symptoms.
- Medication and/or surgery are common treatment options to lower a child’s eye pressure.
- Even when diagnosed early and treated properly, pediatric glaucoma can still cause significant and permanent vision loss, so early diagnosis and on-going treatment is important.
Support Services & Resources
Support Services & Resources
Riley at IU Health offers a broad range of supportive services to make life better for families who choose us for their children's care.
This website has information for parents and caregivers on causes and treatment for glaucoma in infants and children.
The American Academy of Ophthalmology is the largest national membership association of eye doctors. Their website contains recent research parents can use to understand diagnosis and treatment of childhood glaucoma.
Our physicians are committed to excellence in pediatric ophthalmology care, demonstrated through participation in research at the Indiana University School of Medicine. Recent research explores the use of intraocular lens and secondary Artisan lens implants in children as a treatment for cataracts, new drugs to treat glaucoma, new therapies for macular degeneration and treatment of strabismus. We have also completed research in molecular biology of the chemical cycle of vision, neurophysiology of eye movements and physiology of blood flow in the eye.