Childhood Glaucoma: Symptoms, Causes, Diagnosis, and Treatment

Childhood glaucoma is an eye condition that develops in children and causes damage to the optic nerve, which can lead to vision issues such as blindness. Glaucoma in children can lead to symptoms including an enlarged cornea, sensitivity to light and loss of vision. Childhood glaucoma is typically categorised into primary and secondary. Primary glaucoma is any type that is not caused by other eye conditions whereas secondary glaucoma is caused by another eye problem. Diagnosis for childhood glaucoma can be performed by an optometrist and treatments include various types of surgical procedures such as trabeculectomy, goniotomy and cyclophotocoagulation as well as medication. Other terms may be used to describe this eye condition, including paediatric glaucoma and infantile glaucoma. Keep reading to learn more about childhood glaucoma and how it differs from glaucoma in adults.

What is Childhood Glaucoma?

Childhood glaucoma is a term used to refer to different types of glaucoma that affect children. Glaucoma is a term for a group of eye diseases that cause damage to the optic nerve, which can lead to vision issues such as blindness. The optic nerve is the connection between the eyes and the brain, sending light signals that the eye sees to the brain. Childhood glaucoma is rare and more common in adults and the elderly. The below image shows a child whose eye has been affected by glaucoma.

What are the Other Terms for Childhood Glaucoma?

Other terms for childhood glaucoma can include the different categories of this eye condition. These terms include primary congenital glaucoma, primary childhood open-angle glaucoma, juvenile glaucoma, secondary glaucoma, infantile glaucoma and paediatric glaucoma. Glaucoma in children can be classified by when the glaucoma occurs and the cause of the development.

How Rare is Childhood Glaucoma?

Childhood glaucoma is rare compared to glaucoma in adults and the elderly. According to the Royal Children’s Hospital Melbourne, glaucoma very rarely affects infants and according to Glaucoma.org, the prevalence of childhood glaucoma is 1 in 10,000 births for primary congenital/primary infantile glaucoma and glaucoma from birth to 18 years affects 1 in 5,000 children.

What is the Age Range for Childhood Glaucoma?

The age range for childhood glaucoma is from birth to 18 years of age. Glaucoma can be present at birth, which is known as congenital which may be inherited from the parents. If a person older than 18 develops glaucoma, then it is not classified as childhood glaucoma.

What are the Classifications of Childhood Glaucoma?

The two classifications of childhood glaucoma are primary glaucoma and secondary glaucoma. These classifications and their definitions are listed below.

Primary glaucoma: Primary glaucoma is any type of glaucoma that is not caused by another medical condition.
Secondary glaucoma: Secondary glaucoma is a category of different types of childhood glaucoma that is caused by another eye problem or disorder.

1. Primary Glaucoma

Primary glaucoma is any type of glaucoma that is not caused by another medical condition. Types of childhood glaucoma that fall under primary glaucoma include primary congenital glaucoma and juvenile open-angle glaucoma, according to the American Academy of Ophthalmology.

2. Secondary Glaucoma

Secondary glaucoma is a category of different types of childhood glaucoma that is caused by another eye problem or disorder. According to the American Academy of Ophthalmology, secondary glaucoma can be divided into four categories which are, associated with non-acquired ocular anomalies, associated with non-acquired systemic disease or syndrome, associated with acquired conditions and following cataract surgery.

What are the Symptoms of Childhood Glaucoma?

The symptoms of glaucoma are typically rare in children but can include photophobia (light sensitivity), one eye appearing larger than the other one, excessive tearing (epiphora), cloudy, enlarged cornea and loss of vision. The symptoms of childhood glaucoma and their definitions are listed below.

Photophobia (light sensitivity): Photophobia, colloquially known as light sensitivity, can be a symptom of glaucoma in children.
One eye appears larger than the other one: Due to increased intraocular pressure, the affected eye can appear larger than the other one.
Excessive tearing (epiphora): Excessive tearing, known scientifically as epiphora, can be a symptom of childhood glaucoma.
Cloudy, enlarged cornea: An enlarged cornea in children with glaucoma is a result of raised intraocular pressure that causes the eye to increase in size.
Loss of vision: Glaucoma in children may cause loss of vision including partial loss such as nearsightedness.

1. Photophobia (Light Sensitivity)

Photophobia, colloquially known as light sensitivity, can be a symptom of glaucoma in children. Photophobia is a symptom of childhood glaucoma due to the eye increasing in size because of raised intraocular pressure which may cause a split in the cornea which can cause sensitivity to light. According to an article published in the National Library of Medicine, photophobia is described as an abnormal sensitivity to light, especially of the eyes.

2. One Eye Appears Larger Than the Other One

The affected eye of a child with glaucoma can appear larger than the other one due to increased intraocular pressure. According to The Royal Children’s Hospital Melbourne, this raised intraocular pressure causes the eye to stretch, leading to a change in size. The affected eye expands in all directions.

3. Excessive Tearing (Epiphora)

Excessive tearing, known scientifically as epiphora, can be a symptom of childhood glaucoma, especially in primary congenital glaucoma, according to the American Academy of Ophthalmology. This symptom of primary congenital glaucoma is often accompanied by photophobia, known as sensitivity to light, and blepharospasm, which is recurring twitches or closing of the eyelids involuntarily.

4. Cloudy, enlarged Cornea

An enlarged cornea in children with glaucoma is a result of raised intraocular pressure that causes the eye to increase in size. This symptom is the result of another symptom as when the eye becomes larger it makes the cornea bigger also. According to The Royal Children's Hospital Melbourne, this can cause issues with the cornea, leading to a spilt and the cornea becoming cloudy (corneal opacification) due to fluid that enters the cornea, which is known as corneal oedema.

5. Loss of Vision

Glaucoma in children may cause loss of vision including partial loss such as nearsightedness. Complete loss of vision is rare, however, according to Glaucoma Australia, it is still the leading cause of irreversible blindness in children worldwide. Nearsightedness, known scientifically as myopia, is caused by glaucoma due to the eye changing shape as a result of intraocular pressure, according to The Royal Children's Hospital Melbourne.

What Causes Glaucoma in Children?

The causes of glaucoma in children are dependent on the type of glaucoma. For example, infantile glaucoma is caused by blockage of the aqueous drainage at the trabecular meshwork of the anterior chamber angle, according to The Royal Children’s Hospital Melbourne. Some children may inherit glaucoma from their parents, meaning it can be a congenital cause.

Is Childhood Glaucoma Inherited?

Yes, childhood glaucoma can be inherited. According to Glaucoma Australia, there are indications that primary congenital glaucoma can be inherited in a dominant pattern, as well as recessive.

What are the Eye Tests for Diagnosing Childhood Glaucoma?

According to the Children’s Hospital of Philadelphia, the eye tests performed to diagnose childhood glaucoma are a tonometry test, pupil dilation, a visual acuity test and a visual field test. These eye tests and their definitions are listed below. The answer to how childhood glaucoma is diagnosed is through an eye test with an eye care professional.

Tonometry: A tonometry test is used to check the intraocular pressure in the child's eye as it can be a sign of glaucoma.
Pupil dilation: Pupil dilation is a test used to allow an optometrist to closely observe the eye’s retina and optic nerve.
Visual acuity test: A visual acuity test determines the sharpness and clarity of a patient’s vision.
Visual field test: A visual field test is used to see if there is any vision loss in a patient’s vision, specifically their peripheral vision in the case of glaucoma.

An image of a child having an eye test to diagnose glaucoma.

1. Tonometry

Tonometry is a diagnostic test used to check the intraocular pressure in the child's eye as it can be a sign of glaucoma due to slowly draining fluid in the eye. There are many types of tonometry tests including non-contact tonometry, also known as air puff tonometry. Non-contact tonometry uses a rapid air pulse to flatten the cornea which is how it measures intraocular pressure. Another type of tonometry test is Applanation tonometry which requires the patient's eyes to be numb and the pressure is measured with a diagnostic tool.

2. Pupil Dilation

Pupil dilation is a test used to allow an optometrist to closely observe the eye’s retina and optic nerve. This type of eye test involves dilating the patient's pupils, meaning they expand, to allow the optometrist to have a better view of the eye’s inner structures. Other than glaucoma, this test can be used to diagnose macular degeneration and diabetic retinopathy. A patient’s eyes may stay dilated for between 4 and 24 hours which can cause blurry vision and sensitivity to light.

3. Visual Acuity Test

A visual acuity test is used to measure the sharpness and clarity of a person's vision. This is typically performed using a letter chart such as a Snellen or LogMAR chart but depending on the child's reading ability, it may contain recognisable shapes instead of letters. A visual acuity test examines the eyes individually so the patient will be asked to cover one eye when looking at the chart.

4. Visual Field Test

A visual field test is used to see if there is any vision loss in a patient’s eyesight. In the case of childhood glaucoma, it will specifically check for peripheral vision loss in the child as this can be an indication of glaucoma. A visual acuity test maps a person’s visual scope to identify vision loss. This test usually involves the patient identifying objects or light that appears in their periphery and they are tasked with pressing a response button when they see a light pop up.

Can an Optometrist Diagnose Childhood Glaucoma?

Yes, an optometrist can diagnose childhood glaucoma as well as other eye care professionals including an ophthalmologist. The tests an optometrist may perform to diagnose childhood glaucoma include a tonometry test to check intraocular pressure, a visual acuity test to check vision, a visual field test to check peripheral vision and a dilated pupil test to check the inner structures of the eye.

Is Early Childhood Glaucoma Reversible?

No, early childhood glaucoma is not completely reversible, however, according to Eye and Ear of the Palm Beaches, congenital glaucoma can be controlled and vision loss may be prevented.

Can Glaucoma in Children Lead to Blindness?

Yes, glaucoma in children may lead to blindness. According to Glaucoma Australia, while glaucoma in children is rare compared to adults, this type of eye condition is the leading cause of irreversible blindness in children worldwide, accounting for approximately 6.9% of childhood vision impairment.

What are the Treatments for Childhood Glaucoma?

The treatments for childhood glaucoma include medications, tube shunt, trabeculectomy, goniotomy, iridotomy, trabeculotomy and cyclophotocoagulation. The treatments for childhood glaucoma and their definitions are listed below.

Medications: Medications may be used to treat childhood glaucoma, specifically primary congenital glaucoma.
Tube shunt: A tube shunt is a type of eye surgery that may be used to treat childhood glaucoma by draining the eye of excess fluid and helping to lower eye pressure.
Trabeculectomy: A trabeculectomy is a type of eye surgery that can be used to treat childhood glaucoma by creating new paths for fluid to drain in the eye and lowering eye pressure.
Goniotomy: Goniotomy is one of the most common surgeries to treat infantile glaucoma.
Iridotomy: Iridotomy is a type of surgery used to treat childhood glaucoma by creating a hole in the iris so the aqueous humour can flow into the anterior chamber.
Trabeculotomy: Trabeculotomy is one of the most common operations used to treat infantile glaucoma.
Cyclophotocoagulation: Cyclophotocoagulation is a type of procedure for childhood glaucoma that has been utilised in paediatric glaucoma refractory.

1. Medications

Medications may be used to treat childhood glaucoma, specifically primary congenital glaucoma. According to the American Academy of Ophthalmology, medical therapy is used in addition to surgery and may include a combination of timolol and dorzolamide. Medication for childhood glaucoma is used to control and in some cases reduce intraocular pressure.

2. Tube Shunt

Tube shunt is a type of surgery that can be used in the treatment of glaucoma, including childhood glaucoma. Tube shunt surgery aims to drain fluid from the eye, lower eye pressure and help in preventing further vision loss caused by glaucoma. Tube shunt surgery involves a plastic tube with a silicone drainage pouch being placed in the eye to drain fluid, according to British Columbia Health Link. A tube shunt is usually conducted if a trabeculectomy has failed.

3. Trabeculectomy

A trabeculectomy is a type of surgical procedure performed to control glaucoma by lowering intraocular pressure, according to Glaucoma Australia. This is a very common surgical treatment for patients with glaucoma and works by creating a pathway for aqueous fluid so that it can drain out of the eye. Glaucoma Australia reports that the success rate for trabeculectomy in controlling intraocular pressure is between 70-90%, with many patients not requiring glaucoma eye drops after surgery.

4. Goniotomy

Goniotomy is one of the most common surgeries to treat infantile glaucoma. Goniotomy is a procedure in which an eye doctor uses a lens called a goniolens to make an opening in the eye so that fluid can drain out of the eye, according to My Health Alberta. This procedure is only performed on children and only when their cornea is not cloudy. Risks of goniotomy may include infection, cataracts and bleeding. According to a 2020 study published in the Cochrane Database of Systematic Reviews, a year after the surgery was performed, the surgery was successful in more than 80 out of 100 children who did not have glaucoma at birth.

5. Iridotomy

Iridotomy, also known as laser peripheral iridotomy, is the first-line treatment for close angle glaucoma according to the Glaucoma Research Foundation. This procedure reduces the risk of more acute attacks of glaucoma as well as reduces intraocular pressure in an acute attack. According to Glaucoma Australia, this surgery delivers a beam of energy into the eye to make a small hole in the iris so that aqueous humour can flow into the anterior chamber.

6. Trabeculotomy

Trabeculotomy is one of the most common operations used to treat infantile glaucoma, according to The Royal Children’s Hospital Melbourne. This procedure involves lowering the pressure in the eye by allowing fluid known as aqueous humour to drain easily for the eye. Trabeculotomy is an outpatient surgery, according to the Children’s Hospital of Pittsburgh, meaning the child can go home after the procedure is performed. A child will need follow-up care by their doctor after the surgery to make sure everything is progressing as normal. Trabeculotomy is performed in children typically in cases where the cornea is cloudy and is sometimes used in certain forms of adult glaucoma.

7. Cyclophotocoagulation

Cyclophotocoagulation is a surgical procedure for childhood glaucoma that has been utilised in paediatric glaucoma refractory. According to the American Academy of Ophthalmology, cyclophotocoagulation is a cyclodestructive procedure, another type being cyclocryotherapy, and is used when other methods of glaucoma treatment have failed to achieve decreased intraocular pressure. Cyclodestructive procedures attempt to lower intraocular pressure through the destruction of the ciliary body, reducing aqueous humour formation, according to an article published in the National Library of Medicine.