Childhood Glaucoma

Childhood Glaucoma

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Diagnosing and managing glaucoma in children requires child-appropriate examination techniques and child-specific surgeries and medications because infants and young children are not simply small adults. Families bring their children from across the U.S. and from other countries to seek care for their child’s glaucoma at Duke. Our goal is for your child to achieve the best vision possible, ideally normal or near-normal vision.

Our Doctors

Meet our childhood glaucoma specialists, view their profiles, and select the one that’s right for you.

About Childhood Glaucoma

Childhood glaucoma refers to a group of disorders that involve high pressure in the eyes. Left untreated, glaucoma can cause permanent vision loss and disfigurement in infants and children. Primary or congenital glaucoma may present at birth or in the first year of life. Childhood glaucoma may be a complication of an underlying eye condition such as uveitis, trauma, or removal of a cataract the child was born with. It can also result from a condition such as neurofibromatosis or Sturge-Weber syndrome. 

    Our Locations

    Duke Health has locations throughout the Triangle. Find one near you.

    Treatments

    Medical Management

    Eye drops and oral medicine may be prescribed to help reduce eye pressure in pediatric glaucoma. Depending on your child’s needs, we will recommend one or a combination of medications to reduce eye pressure and minimize optic nerve damage.

    Goniotomy and Trabeculotomy

    These minimally invasive procedures, also called angle surgery, treat glaucoma by opening the pathway through which fluid flows out of the eye. (This is also called “the angle” and includes the trabecular meshwork and Schlemm canal). The procedures may control glaucoma for years in certain types of pediatric glaucoma, especially primary congenital glaucoma.

    Trabeculectomy

    Also called “filtration surgery,” this procedure creates a small opening to bypass the natural pathway of fluid out of the eye. It works only in selected pediatric glaucoma cases because a child’s natural healing ability tends to close the opening created during the procedure.

    Tube Shunt Surgery

    An artificial (usually silicone or another type of plastic) drainage device is placed against the wall of the eye and attached to a small tube that drains fluid from inside the eye to a reservoir around the device.

    Cycloablation

    Laser energy is applied to the eye to decrease its ability to make fluid, which decreases eye pressure. This may be done from the outside of the eye through the eye wall, or endoscopically through a tiny incision. The endoscopic approach provides the doctor a better view of the area within the eye that produces fluid. 

    Iridotomy/Iridectomy

    While uncommon in children, this procedure may be helpful in cases where there is “narrow angle” glaucoma. (If the angle between the iris and the cornea is too small, the iris may bulge forward and block off the pathway for fluid to reach the normal path to flow out of the eye.)  A laser or surgical tool is used to create a small opening in the outside portion of the iris.

    Combination Procedures

    When childhood glaucoma occurs in conjunction with other eye disorders, a combination of surgeries may be performed. For example, a cataract may be removed at the same time that a glaucoma drainage implant is placed.

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    Tests

    Your child’s glaucoma specialist will conduct a thorough examination of your child’s eyes. If your child is cooperative, the tests may be performed in the office. If your child cannot fully cooperate with needed testing, the exams may be performed under anesthesia and immediately followed by appropriate surgical treatment, if necessary.

    Tonometry

    Measures the eye pressure. Several devices may be used for this test; however, the newest instrument -- the iCare rebound tonometer -- has been extensively studied at the Duke Eye Center for its usefulness in evaluating children with known or suspected glaucoma. Because it does not require an eye drop to numb the eye before taking the eye pressure, this device is well suited for in-office use on infants and children.

    Optical Coherence Tomography (OCT)

    OCT uses light to create a 3-D image of structures within the eye, including the retina and optic nerve. The images are used to measure the thickness of the nerve fiber layer around the optic nerve so that it can be tracked over time to assess for damage from glaucoma. Since many children cannot cooperate with accurate testing of their peripheral vision, OCT provides a powerful tool for monitoring optic-nerve health in children with known or suspected glaucoma. Handheld OCT recently became available for use in the operating room and may soon prove useful for evaluating optic-nerve health in infants and children too young to have traditional imaging and peripheral-vision testing.

    Perimetry

    Measures the peripheral vision (also called the visual field) in each eye. During the test, your child looks straight ahead while lights flash at various levels of brightness in their side vision. The test allows doctors to detect defects in the visual field. It is used to diagnose and determine the progression of glaucoma but is only used in older children who can concentrate and whose central vision is good enough to fixate on the central target during testing.

    Gonioscopy

    A small contact lens is placed on the surface of the eye to view the outflow pathway (the “angle structures”) of the eye. This test can be done in the office, or during an examination under anesthesia for infants and young children. The detailed structure of the outflow pathway allows your doctor to determine the best surgical treatment for your child's glaucoma.

    Ultrasound

    Sound waves are used to measure the thickness of the cornea and the length of the eye and to create images of the vitreous, the retina, and any glaucoma drainage implants that have been placed in the eye.

    Caring for Children with Glaucoma

    Internationally Recognized Experts
    Duke is one of only a handful of eye centers in the U.S. with internationally recognized experts who provide comprehensive care to children with glaucoma. Our board-certified, fellowship-trained glaucoma specialists and pediatric ophthalmologists travel internationally to lecture and teach courses on treating and managing childhood glaucoma. Our extensive experience and knowledge mean your child is cared for by some of the nation’s most respected glaucoma specialists.

    A Team Approach
    Caring for children with glaucoma often requires a long-term team effort involving ophthalmologists, pediatricians, low-vision educators, social workers, and other therapists. Glaucoma in children can affect other parts of the eye and cause vision loss from amblyopia, corneal scarring, and strabismus. Our team specializes in treating these and other eye conditions in children.

    Latest Treatment Advances
    We use the latest medical and surgical treatments to control glaucoma in children and to manage other eye disorders often associated with childhood glaucoma. 

    Powerful Imaging Devices
    Our advanced imaging technologies include optical coherence tomography (OCT), which provides 3-D views of the eye’s internal structures, including the retina and the optic nerve. Researchers in Duke’s Pediatric Retina and Optic Nerve Imaging Center are pioneering new uses for this noninvasive technology, including using it to care for eye disorders in premature infants.

    Compassionate, Supportive Environment
    We offer patient and family support services, including educational materials and programs, a low-vision rehabilitation program, and a dedicated social worker to help your child and your entire family cope with the management of your child’s glaucoma.
     
    Dedicated Surgical Suite
    Our skilled surgeons work closely with anesthesiologists and surgical nurses who are trained and experienced in caring for children with eye conditions. We are expertly equipped to care for and treat complex and multiple eye problems, including retinal and corneal diseases.
     
    Promising Research
    We are studying advances in the diagnosis and treatment of childhood glaucoma using existing therapies. We also collaborate with specialists at Duke and apply new technologies to the care of children with childhood glaucoma as soon as they are shown to be safe and effective.

    Best Children's Hospital in NC

    In addition to being among the best in the country, Duke Children's Hospital & Health Center is proud to be nationally ranked in nine pediatric specialties.