Glaucoma, congenital
also Glaucoma
Epidemiology
- 1/12,500
- 5% incidence in sib of affected child
- 5% incidence in child of affected parent
- 2/3 are male
Associations
- May occur with aniridia, iridocorneal dysgenesis, systemic syndromes,
after trauma, Sturge-Weber, Rubinstein Taybi syndrome, congenital rubella,
chronic uveitis
Cause
- embryonic defect in development of trabecular meshor or filtration area of
eye
- behind the iris, the ciliary processes make aqueous fluid, which flows
forward through the pupil, into the anterior chamber and drains into the the
trabecular meshwork
PE
- irregular light reflex or dulled red reflex (because infants with ~ get
corneal edema)
- pain/squinting/blepharospasm (because epithelial edema causes breakdown of
corneal epithelium)
- photophobia/blinking (because stromal edema scatters light and causes
glare)
- In kids < 2 yo, may see increased corneal diameter because of increased
intraocular pressure (normal corneal diameter is 9.5 mm, @ 2 yo it is 11.5 mm)
- epiphora (tearing) is a sign of glaucoma (will see rhinorrhea)...
ddx
obstruction of the nasolacrimal duct, which has NO rhinorrhea (see
Nasolacrimal duct issues)
Beware
- increased IOP causes optic nerve damage
- nl IOP in infants, young kids: <20 mmHg
- IOP > 25 suggests ~.
- estimate by palpating globe over closed eyelids