Pediatric glaucoma

Question 1

Define glaucoma.

Answer 1

A chronic progressive optic neuropathy caused by a group of conditions which lead to optic nerve damage.

Question 2

What is the most common pediatric glaucoma?

Answer 2

Congenital glaucoma

Question 3

Define congenital glaucoma.

Answer 3

Congenital glaucoma are a group of diverse disorders in which abnormal high intraocular pressure results due to developmental abnormalities of the anterior chamber angle obstructing the drainage of aqueous humor.

Question 4

Name the 3 types of primary congenital glaucoma (without associated anomalies).

Answer 4

• True congenital glaucoma (birth-few months post delivery)
• Infantile congenital glaucoma (up to 3 yrs)
• Juvenile glaucoma (>3yrs)

Question 5

Name the 5 types of developmental glaucoma (with associated anomalies).

Answer 5

• Glaucoma with iridocorneal dysgenesis
• Glaucoma with aniridia
• Glaucoma with ectopia lentis syndromes
• Glaucoma with phakomatosis
• Miscellaneous conditions

Question 6

Describe the pathogenesis of primary congenital glaucoma.

Answer 6

Primary congenital glaucoma is due to failure or abnormal development of the trabecular meshwork leading to impaired aqueous outflow resulting in raised IOP

Question 7

What is trabeculo-dysgenesis characterized?

Answer 7

Trabeculodysgenesis is characterized by absence of the angle recess resulting in dysfunction of drainage

Question 8

Give 4 risk factors for primary congenital glaucoma.

Answer 8

• Consanguinity
• Family history
• Pseudophakia
• Genetic mutations (CYP1B1)

Question 9

Mention the triad for congenital glaucoma.

Answer 9

Photophobia( early sign), Blepharospasm, Epiphora

Question 10

Give 4 clinical signs for congenital glaucoma.

Answer 10

• Eye rubbing
• Hazy cornea
• Buphthalmos
• Reduced visual acuity

Question 11

What is Haab’s straie?

Answer 11

Tears and break in Descemet’s membrane) -Tears are usually peripheral and concentric.

Question 12

List 3 examinations that can be done for congenital glaucoma.

Answer 12

• Gonioscopy
• Tonometry
• Fundoscopy (dilated)

Question 13

Give 3 differential diagnosis for congenital glaucoma.

Answer 13

• Nasolacrimal duct obstruction
• X-linked congenital megalocornea without glaucoma
• Birth trauma – especially with assisted delivery e.g. forceps
• Keratitis or uveitis
• Retinoblastoma

Question 14

How is congenital glaucoma managed?

Answer 14

• Goniotomy for clear corneas
• Trabeculotomy for hazy corneas (rates similar)
• Trabeculectomy and shunt procedures only when goniotomy or trabeculotomy fails. Also preferred for glaucoma with associated conditions e.g. phakomatosis

Question 15

Give 3 complications of congenital glaucoma.

Answer 15

Myopia, Astigmatism, Amblyopia, Lens dislocation, Retinal detachment