How Glaucoma Affects Children

Once a month, Monica Ertel, MD, PhD, and Michael Puente, MD — both assistant professors of ophthalmology at the University of Colorado School of Medicine — lead a childhood glaucoma clinic at the Sue Anschutz-Rodgers Eye Center where they see more than a dozen patients and help to manage the disease.

Similar to adults, children can experience high intraocular pressure (IOP) that requires long term treatment. Glaucoma is rare in pediatric patients and requires a timely diagnosis to ensure the patient retains their vision.

“The problem arises when the natural drainage system in the eye has not developed properly and so kids are born with high eye pressure. That pressure pushes on the optic nerve and causes thinning of the optic nerve,” explains Ertel, who likens the optic nerve to a computer cable that’s connected to a power source.

“If you bend that cable over and over and put constant pressure on it, the cable will wear, and you’ll lose power. The same thing is happening with glaucoma,” she continues. “If there's high eye pressure and there's constant pressure on the cells in the back of the eye, it damages those nerves. And then, even if the eye is still there and it looks okay, that damage to the optic nerve means there's not a connection between the eye and the brain, so you can't perceive vision.”

The childhood glaucoma clinic works with patients and their families to preserve vision and keep young eyes developing healthily. Here, Ertel answers some of the most common questions about childhood glaucoma and the symptoms parents should be aware of for their young children.

What makes pediatric cases different from adults?

Glaucoma in children is usually a congenital issue, although there can be secondary causes, too. Because these patients are so young, everything is still growing and forming.

Some of the consequences of the high eye pressure for children specifically include the eye growing longer, which can affect their prescription and affect their ability to develop normal vision. It’s important to detect glaucoma as early as possible in patients of all ages, but it’s especially true with kids because it can have a long-term impact on their ability to develop normal vision.

Is diagnosis different for children?

It can be more difficult to diagnose children because most of the time they’re so young that they can’t share with us what they’re experiencing. We look for signs as opposed to asking the patient about their symptoms.

Parents will often notice symptoms such as excessive tearing, light sensitivity, and sometimes a cloudy cornea. The eye may also be enlarged. Glaucoma is not always obvious. I’ve had several parents who have said they just felt that something wasn’t right about their child’s eye, and because they trusted their instinct and were persistent, they got an early diagnosis, and that can improve outcomes.

How do secondary causes of childhood glaucoma differ from the congenital cases?

We can see high pressure from trauma. We can see high pressure in kids who have inflammation inside of the eye. We can see high eye pressure from kids who have cataracts, who are born with cataracts and have cataract removal. There are a number of other eye issues, either primary eye diagnosis, like cataract or inflammation side of the eye, or secondary things that can just happen, like trauma, that can cause high eye pressure.

We see kids who have trauma to the eye and develop pressure elevations, so that's an important thing for parents to know could happen after trauma to the eye. It's important to get regular follow up to ensure they don't develop a secondary glaucoma.

What does treatment for childhood glaucoma look like?

One of the hardest things for families to process is that there's no cure for glaucoma and there's no cure for pediatric glaucoma, so for the rest of that kid's life, they're going to have to see an ophthalmologist.

We can treat high eye pressure with medications, eye drops, surgeries and lasers. The goal of all our treatments is to lower the eye pressure. However, there's nothing that cures the problem, and so it's something we must monitor for the rest of the child's life.

For children and adults, there are some surgeries that are similar, but children require modifications to how we surgically approach the disease. It’s a lot of the same surgeries, but I do modify my surgical technique slightly when I’m operating on a child to take into consideration how they heal and to accommodate their smaller eyes.

We also use a lot of the same medications, although there are a few that are not safe for children to use. It’s more likely in adults that we can manage the disease with medications and eye drops. We typically manage childhood glaucoma with surgery sooner than we do with an adult.

You’ve talked about symptoms. What advice do you have for parents who think their child may have glaucoma?

Talk to an ophthalmologist. I'm always amazed at the parents of those kids who are persistent and who end up getting a diagnosis and doing what's right for their kids. As a parent, you have instincts. If you feel like something is wrong and you think your kid needs an eye exam, trust your gut, make an appointment, and have them assessed.