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CONGENITAL GLAUCOMA |
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What does Glaucoma mean?
The word Glaucoma is derived from Greek word meaning Glaucos. It is one of leading causes of blindness all over the world. In India, nearly one out of 50 patients loses sight due to Glaucoma.
This figure of the eye demonstrates the anatomy of the eye. In order to maintain the spherical shape of the eye, a fluid called aqueous humor is produced inside the eye. This fluid is continuously formed and drained out of the eye. There is a delicate balance between this 'inflow' and 'outflow' of the aqueous humor due to which the eye functions normally. If, this balance is disturbed, which can happen if, there is overproduction of aqueous humor or if the 'exit' channels are not functioning, the process inside the eye, also exerts pressure on blood vessels inside the eye as well as the optic nerve. The optic nerve cannot withstand this raised pressure for a long time. Therefore, some nerve fibers, due to pressure effect, start dying. Once, nerve fibers of the optic nerve are damaged, patient begins to lose visual field. |
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What is 'visual field’?
Our vision comprises of central vision and peripheral vision. Central visual field and peripheral visual field together form what is known as visual field. ON connect the eye to the brain. It carries visual impulses to the brain which then analyses and processes the information and we are able to see. Then these nerves are damaged, because of raised pressure in the eye, the brain receives less informalities and patient reports a 'defect' in his visual field. The peripheral visual field is damaged before the central field. |
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Do children also get glaucoma? ALTERNATIVELY, is it only a disease of the adults?
Yes, children can also get glaucoma. Some infants have glaucoma since birth. It is called a congenital glaucoma. If glaucoma presents after about 3 - 4 years of age, it is called juvenile glaucoma.
Most of such glaucoma has genetic origins. It is seen approximately in 1 out of 10,000 births. Males are more commonly affected than females. Different other abnormalities involving the whole body can also be associated with childhood glaucoma.
Genetics involved in congenital glaucoma:
Congenital glaucoma can occur in an infant with no family history of glaucoma. Such cases are called sporadic. Different other types of inheritances are a possible. A positive family history of child glaucoma in parents or 1st degree relation can often be elicited.
The chances of having a child affected by this problem can be described as follows:
When there is no family history of congenital glaucoma, the affected has approximately 5% chance that he/she has a child also suffering from congenial glaucoma. If the first born is affected, then there is 5% chance of a second child being affected. |
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How will I know that my baby has congenital glaucoma?
There are specific problems of the eye which will be noteworthy. Not all symptoms will be seen at the same time but the eye may have constant watering, or the baby may be unduly sensitive to light of normal intensity - photophobia. The baby may even refuse to open his/her eyes in light. As the infant slightly gets older, you may notice enlargement of the cornea. This enlargement of cornea has been described in medical terminology as 'buphthalmos', called 'cow’s eye' in layman's language. This so, because the eyes appear enlarged, resembles the cow or the bull. Any such findings, noted by the mother or the family, must immediately be shown as paediatric ophthalmologist. |
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What treatment options are available for congenital / juvenile glaucoma?
Unlike in adults, surgery for glaucoma is the mainstay of treatment. Many a times repeated surgeries may be necessary. All the surgeries aim at reducing the intraocular pressure. Upto 80 to 85% of cases can be well controlled with surgery. Remaining > 10percentage of glaucoma cases are complicated and may present life long challenge. Certain medications and eye drops are also utilized. However, all of these can have several side effects on the young child. Severity of the disease, at times, warrants use of these medications. Often life long therapy is needed. Newer drugs are now showing promise with a high safety profile in these young patients. |
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What postoperative care needs to be taken?
Diligent follow-up is necessary in all cases of childhood glaucoma. After any surgery or after a change in medical therapy, control of the eye pressure needs to be assessed within 2 weeks. Size and clarity of cornea, appear to be frequently assessed. Sometimes, if the child is too uncooperative, examination under short general anesthesia may be necessary. Careful repeated follow up is the only way to ensure control over the deadly disease and preservation of vision. Even children, apparently cured after successful surgery, can relapse years later and have visual loss. Hence, follow up should continue years after surgery. Other problems which can occur in a glaucomatoses eye, which reduce vision are formation of large number glasses, lazy eye cataract formation, scarring of the cornea, astigmatism, to name a few. Appropriate therapy for all these is necessary as well, in order to optimize vision in these children |
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