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by Dr. Irene R. Felarca and Dr. Edgar U. Leuenberger
Congenital glaucoma occurs less frequently than adult glaucoma. It is seen in 1 in 10,000 births. This condition results from developmental defects of the eye’s internal drainage system leading to increase in eye pressures. This disease entity is seen at birth or early childhood. High eye pressures can also be seen in older children and young adults but they do not have enlarged eyes. Their condition is called juvenile glaucoma. Since young children or infant’s eyes have elastic eyeballs, increased intraocular pressure leads to enlargement of the eyes. Elevated eye pressure leads to swelling and haziness of the cornea or the front part of the eye, causing blurred vision, tearing, light sensitivity and eyelid spasm. If high eye pressure persists, the eye would further enlarge accompanied by optic nerve damage and ultimately permanent blindness.
The mainstay for treatment of congenital glaucoma is surgery. This is done by making an incision on the abnormal tissue of the eye’s internal drainage system (goniotomy). For complicated cases, an alternate drainage or canal is created (trabeculectomy). There are some instances where pressure is still uncontrolled and a small tube is placed inside the eye to drain the internal fluid (glaucoma drainage device surgery). In resistant cases, laser surgery (cycloablation) is done to shrink the structure that produces the internal fluid of the eye. Nevertheless, the patient and the family should be aware that high pressures might return at any age hence follow-up is warranted throughout their life. Early recognition is essential to preserve vision, maximize visual potential, and help the child become a useful member of society.