Congenital Glaucoma
Congenital glaucoma is a rare eye condition that is present at birth or develops during early infancy. It occurs when the eye’s normal fluid drainage system does not develop properly.
Normally, a clear fluid called aqueous humour is continuously produced and drained through specialised pathways within the eye. In congenital glaucoma, the drainage pathways may not develop properly or may become blocked. This blockage leads to fluid build-up and increased pressure inside the eye.
This increased eye pressure can damage the optic nerve, which carries visual information from the eye to the brain. If left untreated, congenital glaucoma can lead to serious and permanent vision loss.
Although congenital glaucoma is rare, it is an important cause of preventable childhood blindness. It may affect one or both eyes and is more commonly seen in boys than in girls.
Why Does It Happen?
It could be a result of:
- The disease occurs without a particular cause being known
- The disease is inherited genetically among family members
- The existence of rare diseases that cause
What are the Symptoms?
Classic Symptoms
- Excessive Watering of Eyes: The child's eyes can remain constantly watery
- Sensitivity to Bright Lights
The child can:
- Avoid bright lights
- Shut eyes
- Get irritated outside
- Constant Eye Rubbing: Eye rubbing may be observed because of irritation felt by the child.
Other Key Indicators
In babies, the eyes are more flexible. Increased eye pressure can cause the eyeball to enlarge, making the eye appear unusually large.
Parents can observe:
- Large eyes
- Cloudy eye surface (Cornea)
- Eye redness
The child can have:
- Problems tracking objects
- Difficulty seeing
- Visual delays
Warning signs that need immediate medical attention: Contact your eye doctor if you notice:
- Increased watering of the eyes
- New eye redness
- Cloudiness of the cornea
- Child avoiding light
- Enlarging eyes
Why Is Early Diagnosis Important?
High eye pressure gradually damages the optic nerve. Without treatment, this can lead to Permanent loss of vision / Severe visual impairment. Vision lost from optic nerve damage cannot be restored. Therefore, early diagnosis and treatment are extremely important.
How Is Congenital Glaucoma Diagnosed?
An eye specialist (ophthalmologist) will perform a detailed eye examination.
Tests may include:
- Eye Pressure Measurement: Checks whether the pressure inside the eye is elevated.
- Corneal Examination: Looks for corneal enlargement or cloudiness
- Optic Nerve Evaluation: Assesses whether glaucoma has damaged the optic nerve
- Examination Under Anaesthesia (EUA): Young children often cannot cooperate for detailed testing. In such cases, examination under anaesthesia may be required
How Is Congenital Glaucoma Treated?
Eye Drops
Eye drops may be prescribed:
- Before surgery
- After surgery
- To temporarily reduce eye pressure
However, eye drops alone are usually not a permanent solution in congenital glaucoma.
Surgery is the Main Treatment. Unlike adult glaucoma, congenital glaucoma usually requires surgery to correct the drainage problem.
Common surgical procedures include:
- Goniotomy: A small opening is created in the drainage angle to improve fluid outflow
- Trabeculotomy: The blocked drainage pathway is opened
- Combined Procedures: Some children may require more than one surgery depending on disease severity.
Does Surgery always cure the disease? Not always. Some children:
- Respond well after one surgery
- May need additional surgeries
- May require long-term eye drops
Regular follow-up is essential even after successful surgery
What Happens After Treatment?
After treatment, the child will need regular Eye Check-ups to monitor:
- Eye pressure
- Corneal clarity
- Optic nerve health
- Visual development
Vision Assessment:
- The doctor will monitor whether vision is developing normally
- Glasses: Some children may need glasses to achieve the best vision
- Amblyopia (Lazy Eye) Treatment: If one eye sees less than the other, patching or other treatments may be recommended.
Can Congenital Glaucoma Be Prevented?
- Early detection can prevent severe vision loss
- Families with a history of congenital glaucoma should inform their eye doctor
- New-borns and infants with unusual eye symptoms should be examined promptly
Long-Term:
The outlook is often good when:
- The disease is diagnosed early
- Treatment is performed promptly
- Follow-up visits are maintained regularly
Many children with congenital glaucoma can develop useful vision and lead normal lives with appropriate treatment and monitoring.
Key message for parents
Excessive tearing, sensitivity to light, cloudy cornea, or unusually large eyes in a baby should never be ignored. Early diagnosis and timely treatment can save your child’s sight.