Chat Highlights
Pediatric Glaucoma
October 24, 2001

Norma Devine, Editor

On Wednesday, October 24, 2001, Dr. Rick Wilson, a glaucoma specialist at Wills, and the glaucoma chat group discussed "Pediatric Glaucoma." 

Moderator:  Our topic tonight is "Pediatric Glaucoma."

Dr. Rick Wilson:  I worked since 4:00 a.m. on a pediatric glaucoma article and just finished it.  So I feel good to have most of the work behind me.  Only the illustrations remain to be done. 

P:  Where will it be published, Dr. Rick? 

Dr. Rick Wilson:  In "Review of Ophthalmology."  I'll try to write a synopsis of it for this group and for the web page. 

P:  How common is pediatric glaucoma?

Dr. Rick Wilson:  One study said 1 in 10,000 births.  

P:  I had no idea glaucoma affected that many children.

P:  Is pediatric glaucoma always genetic?

Dr. Rick Wilson:  No.  It could be caused by trauma, inflammation, the use of steroids after muscle surgery on the eye, etc.

P:  Which procedure is best for children who have had several procedures and still have high IOP's?

Dr. Rick Wilson:  Probably an aqueous shunt, or a revision of an existing one.

P:  Is there a chance of  blindness from multiple surgeries?  And at what point does the formation of scar tissue make it pointless to perform more surgery?  

Dr. Rick Wilson:  The blindness is most often caused by the uncontrolled IOP (intraocular pressure), not the number of surgeries.  Cyclodestructive procedures, which deaden the part of the eye that makes the fluid, can be performed regardless of the amount of scar tissue.  

P:  How is pediatric glaucoma usually discovered?  Through normal eye exams?

Dr. Rick Wilson:  Congenital (at or near birth) and infantile glaucoma are usually discovered by the parents, because the eye looks unusual (often with large corneas), or by the pediatrician.

P:  My two-and-a half-year-old daughter had a successful trabeculotomy two years ago.  Her IOP is still good, but should we be discouraging her from trying to do headstands?  She likes to do that sort of thing.

Dr. Rick Wilson:  Headstands for more that 5 to 10 seconds should probably be discouraged on theoretical grounds.

P:  What other activities besides headstands should be curtailed in a four-year-old child with severe glaucoma?

Dr. Rick Wilson:  If there are no trabeculectomy blebs, I would not inhibit them unless they had only one eye.  Then I would have them wear safety glasses.

P:  How was your daughter's glaucoma discovered?  

P:  She developed a bulging cornea a few months after cataract surgery.  

P:  When my daughter was small, the eye doctor said her pupils were oval, not round.

Moderator:  What is the difference between congenital and pediatric glaucoma? 

Dr. Rick Wilson:  Congenital is one part of the pediatric glaucomas.  Juvenile is from ages 3 to 21 or more.

P:  Do the eyes of adults with glaucoma ever have that unusual appearance?

Dr. Rick Wilson:  Adults' eyes are less elastic and don't change shape like a child's.  But the lens in the eye continues to grow your entire life unless removed.  Since there is little space in the eye, the lens mostly compacts, although it gets slightly thicker.  This leads to no longer being able to focus at near, and later to cataracts.

P:  How is the IOP of a toddler taken?

Dr. Rick Wilson:  It can be taken if the child is asleep.  The IOP is often taken with the child sedated.  The Perkins kind of Goldmann tonometer can be used on recumbent patients to check their pressure.

P:  When I was little, I hated to have my pressure checked and had to be sedated.

Moderator:  Is it true that our eyes are fully developed when we are born and do not grow as we age?  

Dr. Rick Wilson:  The eye reaches full adult size between one and one-and-a-half years of age. 

Moderator:  In most cases of pediatric glaucoma, is the angle open or closed or does it vary?  

Dr. Rick Wilson:  Most have an abnormality of their angle.  Children who have had previous cataract surgery often have angle-closure glaucoma.

P:  What causes cataracts to form after trabeculectomies?  Does that procedure squeeze the lens?

Dr. Rick Wilson:  No, it diverts aqueous fluid from the eye out the bypass drain.  That fluid has oxygen and nutrients in it.  If too much is diverted, or the eye goes into shock and doesn't make enough fluid in the early stages after surgery, the lens doesn't get enough of what it needs and a cataract forms.

P:  What is the difference between open-angle and closed-angle glaucoma?

Dr. Rick Wilson:  The fluid from the eye exits where the clear cornea and the colored iris come together, at the junction with the white of the eye.  In closed-angle glaucoma, the iris has become stuck in the trabecular meshwork (drain) of the eye, preventing fluid from leaving the eye and leading to a buildup of pressure.  In open-angle glaucoma, there is no visible blockage to the fluid leaving the eye.

P:  Have you seen children who have strabismus as well as glaucoma? 

Dr. Rick Wilson:  Yes, in fact, I saw one yesterday.

P:  I have strabismus and my father had it,  but he had no sign of glaucoma.  My son, who is 40 years old, had two unsuccessful eye-muscle surgeries for strabismus as a child.  Does that make him a prime glaucoma suspect?

Dr. Rick Wilson:  No.  Strabismus and glaucoma are totally different entities. 

P:  After tonight's chat, I won't complain about the quality of my sight, surgery, or treatments for glaucoma.  I cannot bear to think of children with all of these problems for the rest of their lives!

Moderator:  Fortunately, better treatment options and medications will be available.

Dr. Rick Wilson:  Time for me to leave.  See you in three weeks.  Enjoy the other doctors.

End of highlights for October 24, 2001.

On October 31, Dr. Werner discussed "Hypotony - Low Eye Pressure" in the Chat room. Click here for highlights of that meeting.

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