What is Congenital Glaucoma?
Primary congenital glaucoma (PCG) is a type of glaucoma that affects children between the ages of birth and 3 years. Glaucoma is a disease of the eye which exhibits a typical optic neuropathy resulting in progressive visual field loss. This condition causes damage to the eyeís optic nerve and is known to get worse over time.
If glaucoma appears after about 3-4 years of age, it is known as juvenile glaucoma.
What causes Congenital Glaucoma?
- Heredity: Most congenital glaucoma cases have genetic origin. It affects about one in every 10,000 infants. Males are more commonly affected than females.
- Metabolic disorders and syndromes: This condition is also seen in children with abnormalities of other systems of the body and eye.
Congenital glaucoma can also occur in infants with no family history of glaucoma. Such cases are sporadic.
When there is no family history of congenital glaucoma, thereís approximately a 5% chance that he/she will have a child also suffering from congenial glaucoma. If the first born is affected, then there is 5% chance of a second child being affected.
What are the symptoms of Congenital Glaucoma?
- Photophobia ñ oversensitivity to normal light
- Excessive tearing
- ‘Buphthalmos’ or Cow’s eye ñ enlargement of the cornea (in infants who grow slightly older)
- Cloudiness of the cornea
- Enlargement of one or both eyes
- Red eye
What treatment options are available for congenital / juvenile glaucoma?
The first choice for treating primary congenital glaucoma is almost always surgery. If the condition affects both eyes, the doctor may operate on both at the same time.
Many a times repeated surgeries may be necessary. All the surgeries aim at reducing the intraocular pressure. About 80 to 85% of cases can be well controlled with surgery. Remaining cases of glaucoma are complicated and may present a lifelong 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 lifelong therapy is needed.
What postoperative care needs to be taken?
- Diligent follow-up is necessary in all cases of childhood glaucoma. Careful repeated follow up is the only way to ensure control over the 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.
- After a surgery or a change in medical therapy, control of the eye pressure needs to be assessed within 2 weeks.
- Size and clarity of cornea need to be frequently assessed.
- Sometimes, if the child is too uncooperative, examination under short general anesthesia may be necessary
NIO is one of the best eye care hospitals in Pune for treatment of glaucoma. NIO offers quality health care services with the help of experienced doctors, and state-of-the-art facilities.
You can call our Healthcare team on 02025536369 / 41460100 if you have any queries regarding your childís eye.
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It can take yoursight away
Glaucoma also known as ìKala Motiaî or ìKach Bindu ì is one of the leading cause of blindness all over the world. In India one out of every 50 patients who have lost their sight are glaucoma patients. One of every seven patients of glaucoma is totally blind before they reach the hospital for treatment. The most disturbing fact is thatthis blindness is needless and preventable. A proper awareness, careful examination and meticulous adherence to prescribed treatment can certainly prevent blindness due to glaucoma.
What is glaucoma?
To retain configuration and biodynamicfunctions of the eye, a fluid is formed inside the eye. This fluid is called aqueous humour. This fluid is being continuouslyformed and simultaneously drained out of the eye. Nature has provided a very delicate balance of inflow and outflowof this fluid. As long as this balance is retained, the eye functions normally. This balance can be disturbed if either the production of aqueous increases or drainage is hampered resulting increase in pressure that presses on the blood vessels that bring blood supply to the optic nerve, resulting inpoor nutrition and oxygenation of the optic nerve. This process eventually kills the optic nerve fibres. Optic nerve is like an electric cable. It contains millions of wires, each carrying messages of vision from the eye to the brain. They join together to provide sharp central vision as well as ìside vision: or peripheral vision.
Glaucoma damages these wires, causing blind spots in the peripheral vision. Unfortunately, patients rarely notice these blind areas in their side vision until significant optic nerve damage has occurred. In advanced cases, total visual loss can result as the entire optic nerve may be damaged. Unlike cataract, this loss of sight is permanent and irrecoverable. Fortunately, this can be prevented if glaucoma is diagnosed early and treated before major damage happens.
Proper and periodic examination of the eyes by competent specialist is of utmost importance for all adults, especially over the age of 40 years.
Causes and symptoms
Generally,glaucoma patients have no complaints and they are diagnosed on routine eye examination. It is for this reason that Glaucoma has been rightly labeled as the silent thief of vision. Depending on the manner in which the exit channels get closed or obstructed, glaucoma manifests itself in 4 ways.
Open angle glaucoma:
Here the rise in pressure of the eye ball is gradual and is due to increased resistance to the drainage channels which start to narrow down. The process is so gradual that the eye usually gets acclimatized to the new pressure levels. This condition can steal vision so quietly, that the patient is generally unaware of visual loss until the optic nerve is severely damaged. As glaucoma remains untreated, people may lose side vision significantly. The only way to prevent this loss of peripheral sight is by periodic eye check up and early diagnosis. Occasionally, patients with this type of glaucoma may complain of frequent change of glasses.
Angle closure glaucoma
Sometimes the drainage channels get clogged rapidly, resulting in sudden rise of pressure inside the eye. Such a sudden blockage of fluid flowing out of the eye results in ìAcute angle closure glaucomaî. Blurred vision, severe pain, rainbow halos around light, nausea and vomiting will develop and these patients should be quickly brought to an eye specialist.
Here the drainage channels are poorly formed at birth. An infantís tissue being more elastic than adults, these eyes expand in size with increasing pressure. The front portion of the eye (Cornea)becomes enlarge andfoggy and the eye acquires a bluish hue (Bullís eye). These children should be taken to the eye centre at earliest.
Any injury, drugs like steroids, tumours, bleeding, inflammation etc can sometimes block the outflow channels. This can lead to increased pressure and is called secondary glaucoma.
Detection and dianosis
Early detection of glaucoma is of utmost importance. The most common form of glaucoma is ì Open angle Glucomaî which is asymptomatic and generally occurs in adults over 40 years of age. Hence a thorough yearly eye check by your ophthalmologist is essential especially in this age group.
Glaucoma detection requires a comprehensive eye exam with the help of a few specialized equipments.
This measures the pressure inside the eye, a non contact air pulse or Goldmann applanation tonometer is routinely used. Anaesthesia drops are applied to your eyes for this test.
Non-aspheric (traditional) lens
Non-aspheric lenses are lenses whose surfaces are parts of a plane or parts of a sphere. Compared to aspheric lens, non aspheric lens are simple and relatively cheaper.
How is the IOL power calculated before surgery?
IOL power calculations at NIO are done by trained personnel and every endeavor is made to minimize errors. This is done using Ziess IOLMaster and or ultrasound biometry.
What is the life span of an IOL?
Once implanted in the eye, it remains in place for the remainder of oneís lifetime.
What will happen if you decide not to go for operation?
Cataract usually gets worse day by day. Leaving a Cataract untreated will not threaten your vision immediately; however, it can slowly disable your eyes until you have little vision left. In worst case scenario, untreated Cataract can also damage the optic nerve of your eye due to raised intraocular pressure which can damage the nerve.
What type of anesthesia is used during surgery?
The surgery usually takes about 20 minutes. The operation is usually performed under a local anesthesia in the form of injection or eye drops. Rarely, a general anesthesia is used. Your anesthetist or surgeon will discuss the options with you and recommend the best form of anesthesia for you.
Dilated eye exam
This is to visualize the optic nerve at the back of the eye after drop are added to widen, or dilate the pupils. Your eye care professional uses a special magnifying lens to assess the damage. After the exam, your near vision may remain blurred for few hours.
Perimetry is a special test that produces a map of the complete field of vision. Glaucoma damage firstappears as slight changes in peripheral (side) visual field.
In automated perimetry, a computer flashes points of light in a bowl shaped area. Patient is asked to respond by pressing a buzzer as soon as they see the light, even though it might be dim. One area of the visual field where it is normal not to see the light in a perimetry test is ìblind spotî . This corresponds to the area where the optic nerve enters the back of the eye.
This is used to visualize the drainage channels of the eye with specialized contact lenses and a slit lamp.
when you need to worry?
- Have possible history of glaucoma in the family.
- Intermittent blurring of vision
- Loss of field of vision
- Difficulty in seeing at night.
- Frequent change of glasses.
- Seeing coloured haloes around light.
One need to be meticulous in following the treatment prescribed by the eye surgeon depending on the evaluation of glaucoma. Glaucoma can be treated with drugs, laser or by surgery. Regular instillation of eye drops and maintenance of proper periodicity of drug is very important. These medicines either reduce the aqueous formation or improve the drainage channels.
Surgery and laser are used to create artificial channels if the drugs fail to achieve targed pressure.
Complications of modern glaucoma surgery are thankfully rare:
Visual loss due to cataract is recoverable unlike glaucoma that can blind you permanently. The key is to consult your eye specialist periodically for glaucoma if you are above 40 years of age or if you are experiencing any of the symptoms listed above.
Your doctor is the only person who can guide you to preserve your own vision.
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