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Glaucoma can't be cured. Check out these warning signs in children to prevent it

ByZarafshan Shiraz, Delhi
Jan 29, 2022 01:44 PM IST

Glaucoma is an irreversible cause of blindness in children where as much as 40% of vision can be lost without a person noticing. Doctors spill the beans on early signs of ‘the silent thief of sight’ and effective ways and treatment to prevent disease progression and vision loss.

To spread the word about the sight-stealing disease, January is marked as National Glaucoma Awareness Month as it is the leading cause of irreversible blindness where as much as 40% of vision can be lost without a person noticing. Glaucoma can affect children even before 3 years of age but the clinical signs and symptoms are different.

Symptoms or warning signs of Glaucoma in children and how to prevent it  (Twitter/lilachcsllc)
Symptoms or warning signs of Glaucoma in children and how to prevent it  (Twitter/lilachcsllc)

What is Glaucoma?

Dr Aparna Darawal, Senior Consultant and Head Ophthalmology at Asian Hospital explains, “Glaucoma is a disease of progressive Optic Nerve damage caused by increase in intraocular pressure. Congenital/Infantile glaucoma starts before 3 years of age and juvenile glaucoma is seen in more than 3 years of age.”

Glaucoma can lead to optic nerve damage and consequent visual loss. Dr Vineet Sehgal, Senior Consultant at Sharp Sight Eye Hospitals describes it as a heterogeneous group of eye diseases that are characterized by a progressive optic neuropathy, manifested by cupping of the optic disc and usually, but not always, associated with increased intraocular pressure (IOP).

“The prevalence of primary congenital glaucoma (PCG) is one in 3,300 live births and PCG accounts for 4.2% of all childhood blindness in Indian population. This has a very major impact on the quality of life and also since life expectancy is more, one has to endure more years of suffering,” alerts Dr Anita C Kamarthy, Glaucoma surgeon at Maxi Vision Eye Hospital in Hyderabad.

Glaucoma damages the connection between the eye and the brain which in turn leads to slow shrinking of area of vision that one can see (visual field) and ultimately may progress to complete blindness.

Dr Sandeep Buttan, Global Technical Lead Eye Health Asia at Sightsavers, reveals, “Unlike other common causes of vision loss (like cataract), where complete vision can be fully restored in most cases, the field loss in Glaucoma is not reversible if left unchecked as the optic nerve cannot regenerate once damaged." He added, "Anyone can have Glaucoma and the risk increases with increasing age.”

Causes of Glaucoma:

“The most common cause of childhood glaucoma is inadvertent use of steroidal eye drops for various allergic diseases of the eye. These eye drops can cause blinding glaucoma. So even for slightest ailment of the eye patient needs to consult an eye specialist as child’s eyes are very sensitive,” says Dr Vineet Sehgal.

He added, “Glaucoma often follows cataract surgery in babies and young children. Cataract surgery replaces the lens in the eye if it has become cloudy. The IOP fluctuations post cataract surgery can lead to glaucoma. It can also occur if the eye becomes inflamed for any reason, such as in children who have a childhood form of arthritis, as the drainage channels may get blocked with inflammatory cells.”

According to Dr Anita C Kamarthy, “Secondary glaucoma’s can be due to other ocular anomalies like trauma, infection, inflammation, steroid use, small eyes (nanopthalmos) or some systemic problems like Sturge-Weber’s syndrome.”

Dr Sandeep Buttan points out, “People with a family history of Glaucoma, those who wear high minus glasses (or used to but have got spectacle removal surgery done) or those with a history of an eye injury are at higher risk for developing the disease. Some other factors like high or low blood pressure and long-term use of steroid eye drops are also risk factors.”

Symptoms or warning signs of Glaucoma:

The doctors list that children affected with glaucoma may have:

1. Excessive watering (Epiphora),

2. Photophobia - sensitivity to light or inability to see in light,

3. Enlargement of eyes (buphthalamos),

4. Pain and redness. 

5. A cloudy cornea is one of the common signs of congenital glaucoma. The healthy cornea is transparent. The loss of this transparency is caused by edema, or swelling of tissue from excess fluid accumulation due to high IOP. This occurs in the corneal epithelium (outermost layer of the cornea) and in the corneal stroma (middle layer of the corneal tissue). The careful inspection of the cornea may also reveal defects in its inner layer, which is further proof of a raised eye pressure (IOP).

6. Blepharospasm or closure of eyes tightly. Parents may give a history of eye rubbing.

7. In the initial stages of Glaucoma, there may be absolutely no eye complaints. Some people may have non-specific symptoms like headache, watering or seeing a coloured halo but these may or may not be present.

Parents and caregivers should look for these symptoms and get an early consultation with ophthalmologist if they notice these signs.

Treatment of Glaucoma:

“Early diagnosis and management of intraocular pressure are mainstay of treatment in Glaucoma. Medical therapy and surgical procedures are both viable options and the doctor will choose it depending on the type of glaucoma and extent of optic nerve damage," says Dr Aparna Darawal.

She suggested, “If there is a family history of childhood glaucoma, early check-ups by ophthalmologist should be for glaucoma screening. Even though congenital glaucoma is not completely reversible, early and effective treatment can prevent disease progression and vision loss.”

Highlighting that the disease cannot be cured but it can be effectively managed over time, Dr Vineet Sehgal shared, “Control of eye pressure, either through daily eye drops, laser or glaucoma surgery from a glaucoma specialist, can halt the progress of glaucoma and preserve one’s vision for life. Early detection and meticulous monitoring of the optic nerve over time are the keys to good management of glaucoma.”

Revealing easier prevention methods, Dr Anita C Kamarthy offered, "As most say prevention is better than cure, it can be prevented to a certain degree by mother’s getting fully vaccinated especially rubella prior to pregnancy. Also avoiding teratogenic drugs and drug abuse during pregnancy. Most of these children have to be examined under general anaesthesia for intraocular pressure, corneal diameter, retinoscopy, ophthalmoscopy and gonioscopy. Depending upon the severity of involvement, the management varies which is mostly surgical. Initially medical treatment is used to lower intraocular pressure by using hyperosmotic agents , beta-blockers,carbonic anhydrase inhibitors. While miotics and alpha agonists are contraindicated in PCG."

She also suggested that a good ocular examination by a trained ophthalmologist should be sought at the earliest in case of any of the symptoms. Dr Anita listed some surgeries including: 

1. Incisional surgery - We have Goniotomy (possible only if cornea is clear and <14mm) and Trabeculotomy. Recent technologies include endoscopic goniotomy, fibre optic microcatheter trabecolotomy.

2. Filtration surgeries are Trabeculectomy with adjunctive antimetabolites. The best standard surgical procedure is primary combined Trabeculotomy and Trabeculectomy with antimetabolites in PCG.

3. Glaucoma drainage devices are last resort. It can be a Baerveldt, AADI or Ahmed glaucoma valves.”

Dr Sandeep Buttan advised, “Glaucoma tends to run in families. If you're at increased risk, you may need more frequent or earlier screening. If a member of your family has been diagnosed with glaucoma, rest of the members (brothers, sisters and children) should get their eyes tested to rule of early disease. Everyone above the age of 40 years must get an annual screening for glaucoma, irrespective of any eye complaints."

He added, "Depending upon the type and stage of the disease, treatment of Glaucoma may include eye drops, laser therapy or eye surgery or a combination of these. Due to the chronic nature of the disease, it needs lifelong follow up and monitoring. All modes of treatment for Glaucoma and essentially aimed at preventing further damage to the optic nerve and cannot reverse the damage already done! Regular annual comprehensive eye examination is the only way to detect Glaucoma in the early stages before any significant visual loss has occurred.”

 

 

 

 

 

 

 

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