Congenital glaucoma

Congenital Glaucoma is a rare, severe form of glaucoma that occurs in infants and young children. It is a condition characterized by an abnormal development of the eye's drainage system before birth leading to increased intraocular pressure (IOP), which can cause damage to the optic nerve and loss of vision. Early diagnosis and treatment are crucial to prevent vision impairment or blindness.

Causes and Risk Factors

Congenital glaucoma is primarily caused by genetic mutations that affect the development of the eye's aqueous humor outflow pathways. These mutations can be inherited in an autosomal recessive manner, meaning both parents must carry and pass on the defective gene for the child to be affected. Other risk factors may include certain prenatal factors or conditions associated with systemic diseases or syndromes.

Symptoms

Symptoms of congenital glaucoma often appear in the first few months of life. They may include:

• Buphthalmos (enlargement of the eyeball)
• Excessive tearing
• Sensitivity to light (photophobia)
• Cloudy, opaque appearance of the cornea
• One eye may appear larger than the other due to increased IOP

Diagnosis

Diagnosis of congenital glaucoma involves a comprehensive eye examination, which may be challenging in young children. Key diagnostic tests include:

• Measurement of intraocular pressure (IOP)
• Examination of the drainage angle (gonioscopy)
• Assessment of the optic nerve
• Corneal measurement (pachymetry)
• Visual field testing, when possible

Treatment

Treatment aims to reduce intraocular pressure to prevent damage to the optic nerve. Options include:

• Medication: Topical eye drops to lower IOP.
• Surgery: Procedures like goniotomy or trabeculotomy are commonly performed to improve drainage of aqueous humor. In some cases, trabeculectomy or glaucoma drainage devices may be necessary.

Prognosis

With early diagnosis and appropriate treatment, many children with congenital glaucoma can maintain good vision. Regular follow-up care is essential to monitor eye pressure, optic nerve health, and visual development.

Prevention

There is no known prevention for congenital glaucoma, but genetic counseling may be beneficial for families with a history of the condition.