CHILDHOOD BLINDNESS CONGENITAL GLAUCOMA

by Professor A. Rasheed Dow International Medical College

ALSO CALLED AS BUPHTHALMOS, MEANING OX EYE 1. CONGENITAL GLAUCOMAS IS A GROUP OF RARE BUT POTENTIALLY BLINDING DISORDERS CONGENITAL GLAUCOMAS ARE EITHER PRESENT AT BIRTH OR APPEAR DURING THE FIRST 3 TO 4 YEARS OF LIFE.

ABOUT 80% OF CONGENITAL GLAUCOMAS IS EVIDENT BY

3 MONTHS OF AGE.

CONGENITAL GLAUCOMA OCCURS IN ABOUT 1:10,000 BIIRTHS THE CAUSE IS USUALLY AN ABNORMAL DRAINAGE AT THE TRABECULAR MESHWORK IF THE GLAUCOMA IS PRESENT AT BIRTH, THE IOP IS RAISED. IF THE GLAUCOMA DEVELOPS A YEAR OR TWO AFTER BIRTH, THE PROBLEM IS LESS SEVERE. THE YOUNGER THE AGE WHEN GLAUCOMA APPEARS, THE MORE DIFFICULT IS TO TREAT IT SUCCESSFULLY. ABOUT HALF OF CONGENITAL GLAUCOMA IS PRIMARY IN NATURE. THE YOUNGER THE EYE THE SOFTER AND ELASTIC IT IS. SO THAT, IT ENLARGES WHEN THE IOP RISES IN GLAUCOMA. THIS DOES NOT HAPPEN SO MUCH AFTER THE AGE OF THREE OR FOUR.

 MALE BABIES ARE MORE COMMONLY AFFECTED - (65%).THE CONDITION IS BILATERAL 70% OF THE TIME.

ALTHOUGH BOTH EYES ARE USUALLY AFFECTED, ONE EYE IS MORE SEVERELY AFFECTED

THAN THE OTHER. SO THAT ONE EYE MIGHT APPEAR LARGER THAN ITS FELLOW. HEREDITY IS OCCASIONALLY A FACTOR. ALTHOUGH AUTOSOMAL RECESSIVE TRAIT IS BLAMED BUT THE EXACT NATURE OF THE INFLUENCE IS NOT KNOWN. HEREDITY IS OCCASIONALLY A FACTOR. ALTHOUGH AUTOSOMAL RECESSIVE TRAIT IS BLAMED BUT THE EXACT NATURE OF THE INFLUENCE IS NOT KNOWN. AS THE EYE ENLARGES, TEARS APPEAR IN THE DESCEMETS MEMBRANE (HABBS STRIA )LEADING TO CORNEAL CLOUDING AN EYE WITH CLOUDY CORNEA BECOMES PAINFUL AND THIS LEADS TO WATERING. THERE IS SENSITIVITY

TO LIGHT (PHOTOPHOBIA) and BLEPHROSPASM. THUS, CONGENITAL GLAUCOMA GIVES A LARGE, WATERY EYE WITH CLOUDY CORNEA WHICH DOES NOT SEE WELL AND IS SENSITIVE TO LIGHT. THE VISUAL SYSTEM IS NOT FULLY DEVELOPED AT BIRTH. BINOCULAR VISION DEVELOPS ONLY WHEN BOTH EYES SEE PROPERLY.
IF ONE EYE DOES NOT SEE PROPERLY, THE VISUAL SYSTEM DOES NOT MATURE ON THAT SIDE. THIS MAY CAUSE AMBLYOPIA.

IF ONE EYE DOES NOT SEE PROPERLY, HE VISUAL SYSTEM DOES NOT MATURE ON THAT SIDE. THIS MAY CAUSE AMBLYOPIA. EARLY DETECTION AND TREATMENT IS ESSENTIAL TO PRESERVE THE VISUAL FUNCTION. EARLY DETECTION AND TREATMENT IS ESSENTIAL TO PRESERVE THE VISUAL FUNCTION. ABOUT 50% OF CONGENITAL GLAUCOMA HAVE ASSOCIATED OCULAR OR SYSTEMIC ABNORMALITIES.

SECONDARY GLAUCOMA ABOUT 50% OF CONGENITAL GLAUCOMA HAVE ASSOCIATED OCULAR OR SYSTEMIC ABNORMALITIES. SECONDARY GLAUCOMA CONGENITAL GLAUCOMA CAN OCCUR SECONDARY TO SUCH SYSTEMIC CONDITIONS AS: -NEUROFIBROMATOSIS -CONGENITAL RUBELLA -LOWEs SYNDROME -STURGE WEBER SYNDROME -HOMOCYSTINURIA -MARFANs SYNDROME -WEILL MARCHESANI SYNDROME CONGENITAL GLAUCOMA CAN OCCUR SECONDARY TO SUCH OCULAR CONDITIONS AS: -AXENFELD ANOMALY -REIGERs ANOMALY -PETERs ANAMOLY -ANIRIDIA -PHPV -NANOPHTHALMOS -MICROPHTHALMIA AN EUA IS USUALLY REQUIRED TO EXAMINE THESE BABIES FOR THE PURPOSE OF DIAGNOSIS. DIAGNOSIS IS MADE FROM:

-INDEX OF SUSPICION -CLINICAL FEATURES -EUA PROGNOSIS OF CONGENITAL GLAUCOMA HAS IMPROVED IN THE RECENT YEARS. THE TREATMENT IS ESSENTIALLY SURGICAL. MEDICAL TREATMENT GIVEN ONLY UNTIL SURGERY CAN BE PLANNED. TREATMENT MUST BE STARTED AS EARLY AS POSSIBLE. FOLLOWING SUCCESSFUL TREATMENT, A CHILD WITH CONGENITAL GLAUCOMA NEEDS LONG TERM FOLLOWUP, WHICH MAY LAST FOR LIFE. SUCCESSFUL TREATMENTOFCONGENITALGLAUCOMA CAN RESULT IN REVERSAL OF SOME OF THE EFFECTS OF GLAUCOMA PROGNOSIS OF CONGENITAL GLAUCOMA HAS IMPROVED IN THE RECENT YEARS. IS

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