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Congenital glaucoma is most commonly treated with surgery, either through traditional surgery or laser surgery. (Learn More)
Medications like eye drops help to regulate eye pressure leading up to surgery. (Learn More) Both medications and surgeries have some additional complications and risk factors when applied to children rather than adults. (Learn More)
Glaucoma involves damage to the optic nerve, which can create vision problems and lead to blindness without treatment. The pressure in the eye needs to be managed in order to preserve sight and treat glaucoma. Because of this, treatment is essential.
The earlier glaucoma is diagnosed and treated, the better. Your child’s doctor can help you decide on the best treatment method to address congenital glaucoma.
Why Is Treatment Necessary?
The most common treatment for primary congenital glaucoma is surgery. Primary means that the glaucoma was present at birth and not directly caused by something else, such as medications or another condition. Other forms of glaucoma in children are called secondary glaucoma, as they often result from some additional trigger.
Congenital glaucoma is most often diagnosed within the first year after birth. The earlier it is diagnosed, the better the available treatment outcomes.
Typically, congenital glaucoma is the result of a defect in the drainage angle that prevents the aqueous humor (fluid) in the eye from draining properly. This then leads to a buildup of intraocular pressure (IOP). Increased eye pressure can damage the optic nerve, which is what causes vision loss from glaucoma.
Primary congenital glaucoma is rare, occurring in only 1 out of 10,000 births. Treatment for congenital glaucoma differs from traditional treatment methods as it is necessary at a much younger age.
Surgery to Treat Congenital Glaucoma
Surgery for congenital glaucoma is designed to correct this angle defect and allow the fluid to drain better. This then lowers IOP and protects the optic nerve. The most common surgeries for treating congenital glaucoma are trabeculotomy and goniotomy.
These are the available surgical options for congenital glaucoma:
- Trabeculotomy: Part of the trabecular meshwork in the eye is cut, and a small amount of tissue is removed to allow for better fluid drainage. If the cornea is opaque or cloudy, this is the better option.The success rate for this procedure is high, around 80 percent. It has the best results when it is done as early as possible. Often, additional surgeries are needed. The drainage channel can close up again as the child grows and ages.
- Goniotomy: This is similar to trabeculotomy, but a goniolens is used to visualize the surgical site. The cornea needs to be clear for this to be effective. This procedure has a high rate of success initially, but it can also require multiple additional surgeries down the line.
- Laser surgery: A specialized laser is used for the incisions, making this option less invasive. A high-powered beam of light makes an opening in the tissue of the eye to allow for better drainage of fluid.Laser eye surgeries can be less effective in children than adults. They are often used as a secondary method if other options are not helpful or have failed.
- Tube implant: Additional surgical options involve placing a tube shunt in the eye to allow the fluid to drain properly. This type of procedure is done when other surgical procedures have not worked, or there are additional complications.
Medications for Congenital Glaucoma
For adults with glaucoma, prescription eye drops are considered the first treatment method. However, most children with congenital glaucoma will need surgery.
Medications, including topical eye drops and oral medications, can still be beneficial in helping to control pressure in the eyes. They are often used prior to surgery to keep IOP regulated. They are used again after surgery.
Medications for glaucoma help to reduce IOP by either increasing the drainage of fluid or decreasing the amount of fluid the eyes produce. Both methods help to regulate pressure and protect the optic nerve from further damage.
During the consultation, we will ask you about your eye health history and your medications, and perform some tests. You will then be examined by the surgeon who will discuss your treatment options. Your personal Patient Counselor will help you throughout the process.
Your Counselor can review payment options and schedule you for surgery and related appointments, such as pre- and post-operative exams. Prior to your procedure you will have a dilated eye exam, and you should discontinue wearing your contact lenses and begin taking eye drops as instructed.
Plan to be at the center for two to three hours the day of your procedure. ICL eye surgery is a fairly brief outpatient procedure. Your surgeon dilates your eyes, and gives you a local anesthetic to numb the area. A tiny incision is made, and the clear lens is slipped between your iris and your eye’s natural lens. The day of your procedure should be a day of rest.
Your Patient Counselor will give you detailed post-operative instructions and eye drop regimen for your recovery. After ICL surgery, you’ll need several follow-ups with your eye doctor. Visual recovery is rapid, and you can expect noticeable improvement within a day or two. Most patients are generally able to return to their normal activities within two or three days following their procedure.
Risks & Benefits of Treatment Methods
Treatment for congenital glaucoma is most effective when done as early as possible. Usually, surgery is required to successfully lower the pressure in the eyes, and often, a combination of medications and surgery can keep glaucoma from progressing. The goal of any treatment for congenital glaucoma is to preserve and protect a child’s vision.
There are risks associated with surgery. Possible complications include the following:
- Hypotony (eye pressure becoming too low)
- Complications with a tube implant, including migration, infection, and endophthalmitis
Since children’s eyes are smaller and less developed, and their corneas are thinner, there are more possible complications with glaucoma surgery than with adults. Multiple surgeries are often needed as well. Surgery can help to save a child’s vision and stop the progression of glaucoma, however.
Medications for glaucoma are not often rated safe for children. In addition, it can be difficult to apply eye drops multiple times per day to a small child. As a result, eye drops are typically used as a secondary or adjunct treatment method after surgery.
Side effects from glaucoma medications can include the following:
- Eye irritation
- Blurry vision
- Changes in blood pressure and pulse rate
- Respiratory issues
- Dry mouth and nose
- Allergic reaction
Your child’s doctor can discuss all of the options of congenital glaucoma treatment with you. Ultimately, treatments for congenital glaucoma aim to save your child’s vision in the safest and most effective way possible.
Don’t Let Glaucoma Steal Your Sight! (December 2018). Centers for Disease Control and Prevention (CDC).
Glaucoma for Children. (September 2018). American Association for Pediatric Ophthalmology & Strabismus (AAPOS).
Childhood Glaucoma. (October 2019). Glaucoma Research Foundation.
Surgical Outcomes in Children With Primary Congenital Glaucoma: A 20-Year Experience. (November 2016). European Journal of Ophthalmology.
Current Surgical Options for the Management of Pediatric Glaucoma. (April 2013). Journal of Ophthalmology.
Glaucoma Implant Surgery. (October 2017). Glaucoma Research Foundation.
Complications of Glaucoma Surgery in Children. (March 2017). American Academy of Ophthalmology (AAO).
Diagnosis and Treatment of Primary Congenital Glaucoma. (March 2010). EyeNet Magazine.