Congenital Glaucoma

History

XY

5/M

CC: Eye enlargement, bilateral

Since birth -> patient was noted to

hae ha!y cornea with eye
enlargement, "#

$%&' -> he was hit in the eye,

bro(ght to a hospital and was
diagnosed with hyphema and
gla(coma

)e was then lost to *ollow-(p and

was bro(ght to +,)
Eye Examination

-is(al .c(ity

,ross Eye E/amination

"0 "S
1+ at $%*t 1+ at $%*t
+(pils $mm 234 +(pils $mm 234
5-6 2.+0
Eye Examination

3onometry

E"MS 7 *(ll and e8(al

1(ndoscopy
"0 "S
9rm 9rm
"0 "S
5:6 2"2, ha!y
media
5:6 2"2, ha!y
media
Assessment

Congenital ,la(coma, "#

Discussion

,la(coma

,ro(p o* disorders that are mainly b(t

not always characteri!ed by an
increased intraoc(lar press(re

3hose that occ(r early in li*e are mainly

secondary to abnormalities o* the
anterior segment o* the eye and are
considered deelopmental or congenital
gla(coma
Congenital Glaucoma

.;ected in*ants may be born with a high

intraoc(lar press(re or may deelop an
increased <"+ within the =9rst wee>s o* li*e?@

Aoth eyes are (s(ally inoled, b(t to arying

seerity

&:&%,%%% births, B5C boys

Most sporadic - &%C a(tosomal recessie

.bsence o* angle recess with iris inserted

directly into trabec(l(m

3he <"+ eleation is ca(sed by the *ail(re

o* the anterior chamber angle and the
trabec(lar meshwor> to deelop
appropriately d(ring intra(terine
deelopment@
Consequences of an Increased IOP during
Infancy

0epending on the <"+ leel,

gla(comato(s damage is ineitable
a*ter wee>s, months or een years@

occ(rs ia the same mechanisms as

in the ad(lt

<n addition to optic nere damage,

the globe 5eyeball6 enlarges beca(se
the sclera is distensible

Enlargement o* the globe 5b(phthalmos6 is a

res(lt o* eleated intraoc(lar press(re@

3he anatomic landmar>s are displaced@

3he anterior chamber is deep

.ll segments o* the o(ter eye, b(t especially the

cornea and sclera, e/pand@

+rincipally at the corneoscleral D(nction

CLINICAL APPEARANCE

)oweer, certain layers o* the cornea are

not ery elastic, and stretching may res(lt
in small tears 5)aabs striae6 that ca(se a
certain degree o* corneal opaci9cation@
)aabs striae )aabs striae

Corneal epithelial edema ca(sed by

eleated intraoc(lar press(re and *ail(re
o* the corneal endothelial p(mp
mechanism@

Epiphora, photophobia and

blepharospasm

<* the <"+ is lowered, this

opacity is partially reersible@

.s a res(lt o* the optic nere

damage and/or corneal
opacity, children with
congenital gla(coma may be
permanently is(ally impaired
DIAGNOI O!
CONGENI"AL GLA#CO$A

Clinical cl(es

Enlarged eyesE tearing, and photophobia

5aoidance o* light6@

"*ten, babies also r(b their eyes@

E+<+)"2.
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"G ,"G<"SC"+Y
"reatment

3he treatment is primarily s(rgical@

0i;erent s(rgical proced(res

5according to the degree o* the
maldeelopment and the
clarity o* the cornea6

Goniotomy

"ra%eculotomy

"ra%eculotomy & tra%eculectomy

32.AEC#4"3"MY
,"G<"3"MY
Goniotomy
"ra%eculotomy