Young Rania Shetty is conscious of her thick glasses, particularly as they mist up with the constant tearing up of her eyes, something she cannot control. Then there’s that constant heaviness behind her eyes that makes it impossible for her to experience the world of visuals and sunlight, both of which cause her pain. As a result, she has become a social recluse. She is suffering from glaucoma, or what is best known as a potentially blinding disease, and is awaiting her first round of surgical correction.
Congenital glaucoma is responsible for four to eight per cent blindness in childhood. This disease damages various parts of the eye due to high intra-ocular pressure on the optic nerve. The longer the duration of the disease, the greater the damage and vision loss. If not treated on time, it can cause irreversible vision loss in children. Fortunately, they show symptoms early enough which can be easily identified by parents and paediatricians. If a child shows classical symptoms of watering eyes, intolerance to bright light and involuntary closure of the eyelids, parents must sense the red alert and immediately consult their ophthalmologist.
What is childhood Glaucoma?
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Childhood glaucoma is categorised broadly into primary and secondary glaucoma. In-utero malformations of the draining angle lead to primary glaucoma, whereas glaucoma due to some other ocular or systemic pathology leads to secondary glaucoma.
To assess the severity of the disease, doctors prefer to take a detailed history of the complaints, their duration, presence of similar disease in the family members, any specific risk factor present at the birth of the child, consanguineous marriage, any past trauma, eye infection, use of long-term steroids and cataract surgery and presence of any systemic disease. Since children are uncooperative patients, an eye examination and necessary investigations are performed under general anaesthesia. This list includes retinoscopy, ophthalmoscopy, refraction testing, gonioscopy, tonometry, pachymetry, axial length measurement and OCT.
Medical therapy is not the mainstay of this treatment because of its systemic side effects in vulnerable neonates. Also, it does not correct the primary pathology. But it does play an auxiliary role in treating the disease until the surgery is planned. Under regular monitoring, drugs like beta blockers and carbonic anhydrase inhibitors can be given. Prostaglandin analogues and Pilocarpine are usually avoided. Brimonidine is contraindicated in children whose weight is less than 40 lbs as it depresses the brain activity. It notoriously causes hypotension, seizures and altered consciousness in children.
Why surgery is most effective
Surgical therapy is the most effective and definitive form of treatment for glaucoma. There are different types of surgical options available. The ophthalmologist decides the best surgery suitable for the patient on the basis of several factors, including the underlying nature of the disease. Various surgical options available nowadays with success rates of 80 per cent and above are trabeculotomy and goniotomy. Other procedures are trabeculectomy, combined trabeculotomy and trabeculectomy and glaucoma drainage devices to name a few. Earlier the surgery is performed, the better is the outcome. Children presenting the onset of glaucoma between three to 12 months of age have a better prognosis than those who report the onset of glaucoma at birth.
Frequently asked questions
Can surgical intervention restore my vision? Only if you catch it in time. If you are diagnosed late, then you will not be able to get your vision back. This is because the glaucoma damages the optic nerve by putting pressure on it, which leads to loss of vision.
What is normal eye pressure? Normal eye pressure is 10 to 20 millimetres but increase in pressure damages the optic nerve and can even lead to ischemia, which is the loss of blood supply to the optic nerve.
Is glaucoma reversible? In children, it is reversible if it is caught early. The structural anomaly can be treated via surgery – the angle can be corrected and damage prevented. In adults who have been living with the condition for a long period of time, it is just a matter of management.
What does surgery do? Surgically, the structural anemology can be corrected, an alternative passage can be created to drain the fluid, a drainage tube can be inserted in the eye to drain the fluid and even minimally invasive glaucoma surgeries (which are safer) can be conducted. It cannot be permanently cured but managed and controlled with regular eye check-ups and screening – these will help determine if the patient is stable or not. Surgery comes with its own set of complications and in cases, which are very advanced, we often tell the patient not to undergo it as it may not prove to be useful. We also have to watch out for diabetes.