Congential Glaucoma – early threat to our vision

In past articleS we talked about chronic glaucoma, a condition in which the patient loses their vision in both eyes progressively, and acute glaucoma where the patient loses vision in one eye suddenly, but today we will dedicate our talk to another type of glaucoma seen at an extremely young age with a very unfavourable progress in most cases if not detected in time. {{more}}

Obstruction

Congenital glaucoma is a result of abnormal development of the trabecular meshwork producing obstruction in the drainage of the aqueous humor.

This in turn causes an increase in the intra-ocular pressure, optic nerve atrophy, abnormal growth in the anterior-posterior diameter of the eyeball and alterations of the cornea. In about 75% of these patients the condition will be bilateral (affecting both eyes) and in about 50% of these cases the manifestations would appear before their first birthday.

Complaints

Why does the patient come to see us? The most frequent complaints include tearing, photophobia (light sensitivity) and an increase in the corneal diameter.

What does the ophthalmologist find on examining the patient? There is photophobia, tearing, corneal edema, increase in the corneal diameter (from the normal value of 10.5 mm to 12 mm and more) and corneal clouding. In the eye fundus (examination of the back of the eye) there will be excavation and atrophy of the optic nerve, abnormal development of the trabecular meshwork, abnormal biometric test and as before mentioned an increase in the intraocular pressure.

How is this dangerous and precocious disease treated? From an early stage local medication is indicated with Timolol drops and acetazolamide (Diamox) tablets to prepare the patient for immediate surgery as this is the absolute treatment of congenital glaucoma. Some of the surgical techniques used are goniotomy, trabeculectomy and valve implants all of which have as principle objective to lower the intraocular pressure via evacuation of the aqueous humor.

Can be cured

If this fatal disease is detected in the early stages about an 80% of these patients can be cured. The reason for this is if any of the above is noted in your child’s eye(s) they must be taken to the ophthalmologist as quickly as possible. Remember my fellow reader our children are the hope of tomorrow’s world.

l Dr. Pedro A.F. Suarez is a Consultant Ophthalmologist at the Milton Cato Memorial Hospital.