Childhood Glaucoma

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Overview

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 outcome possible, despite the challenges of managing childhood glaucoma.

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About Childhood Glaucoma

Content

Childhood glaucoma refers to a group of disorders that result in high pressure in the eyes due to inadequate drainage of fluid. Left untreated, glaucoma can cause permanent vision loss and even eye disfigurement in infants and children. There are two types of childhood glaucoma, primary and secondary.

Primary congenital glaucoma is the most common type of primary childhood glaucoma. In most cases, it is diagnosed at birth or in the first year of life. It usually changes the appearance of the eyes.
Juvenile glaucoma is another type of primary childhood glaucoma. It is often diagnosed in children who are being treated for myopia (near-sightedness) and are found to have very high eye pressure or damaged optic nerves. It can also be discovered after a child fails a vision test at a well-child checkup or school screening. Otherwise, there may be no symptoms.
Secondary childhood glaucoma occurs as a complication of an underlying eye condition such as uveitis, trauma, or removal of a cataract a child was born with. It can also result from a systemic condition such as neurofibromatosis or Sturge-Weber syndrome, among others.

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

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Treatments for Childhood Glaucoma

Medical Management

Description

Eyedrops and oral medicine may be prescribed to help reduce eye pressure in children with 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

Description

These minimally invasive procedures 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.) These procedures, often called "angle surgery," may control certain types of pediatric glaucoma for years, especially primary congenital glaucoma and some cases of juvenile open-angle glaucoma.

Trabeculectomy

Description

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 some childhood glaucoma cases because a child’s natural healing ability tends to close the opening created during the procedure.

Glaucoma Drainage Device

Description

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

Cycloablation

Description

Laser energy is applied to the eye to decrease its ability to make fluid, which lowers 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 your child's doctor with a better view of the areas within the eye that produces fluid.

Iridotomy/Iridectomy

Description

While uncommon in children, this procedure may be helpful in cases of narrow-angle glaucoma. This occurs when the angle between the iris and the cornea is too small, and the iris bulges forward and blocks the pathway for fluid 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

Description

When childhood glaucoma occurs along with other eye disorders, more than one surgery 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

Tests Overview

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

Tonometry

Description

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

Optical Coherence Tomography (OCT)

Description

OCT is a powerful tool for monitoring optic nerve health in children with known or suspected glaucoma, even if they are too young to actively participate in traditional imaging and peripheral vision testing. OCT uses light to create a 3D 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 and in the small, central portion of the retina (the macula). These measurements can be tracked over time to assess for damage from glaucoma.

Perimetry (Visual Field Testing)

Description

This 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 to determine the progression of glaucoma. It is only suited for children who are mature enough to concentrate and whose central vision is good enough to fixate on the central target during testing.

Gonioscopy

Description

A small contact lens is placed on the surface of the eye to allow your child's doctor to view the outflow pathway (the angle structures) of the eye. It can be done with or without anesthesia. The test helps your child's doctor determine the best surgical treatment for their glaucoma.

Ultrasound

Description

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

Related Conditions and Treatments

Vision Rehabilitation

Caring for Children with Glaucoma

Content

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, visual rehabilitation experts, 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 effective 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 handheld optical coherence tomography (OCT) for evaluating optic nerve health in infants and young children in both the office and hospital settings. Researchers in Duke’s Pediatric Retina and Optic Nerve Imaging Center are pioneering new uses for this noninvasive technology, including caring for premature infants with eye disorders. We are also exploring new ways to make it easier to track peripheral vision loss in at-risk infants and children.

Compassionate, Supportive Environment
We offer patient and family support services, including educational materials and programs, a vision rehabilitation program, and a dedicated social worker to help 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 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

Duke Children's Hospital & Health Center is proud to be nationally ranked in nine pediatric specialties.

Patient Resources

American Association for Pediatric Ophthalmology and Strabismus

Pediatric Glaucoma and Cataract Family Association

This page was medically reviewed on 05/16/2022 by

Sharon F. Freedman, MD | Ophthalmologist