What Are the Signs and Symptoms of Childhood Glaucoma?

Childhood glaucoma is a rare condition that affects roughly one in 10,000 births. Fortunately, it’s also a very treatable condition.

Recognizing early signs and acting swiftly can protect a child's vision and quality of life for the long term. Here’s everything you need to know about childhood glaucoma.

What is Childhood Glaucoma?

Childhood glaucoma includes several rare conditions that cause elevated eye pressure, known medically as intraocular pressure (IOP), in infants and children.

The most common form of childhood glaucoma is primary congenital glaucoma (PCG). It appears within a child’s first year and requires prompt treatment, usually surgery.

Early months matter because a baby’s eye tissues are still developing and are more flexible. Fortunately, over 80% of children maintain healthy vision when diagnosed early.

What Are the Different Types of Childhood Glaucoma?

Unlike adults, children with glaucoma often have developmental abnormalities present from birth, creating different challenges and responses. Childhood glaucoma includes three main types:

• Primary Congenital Glaucoma (PCG)
• Juvenile Open-Angle Glaucoma (JOAG)
• Secondary Glaucoma

What Causes Eye Pressure to Rise in Children?

Primary glaucoma develops when fluid (aqueous humor) that circulates inside the eye can’t drain properly, causing a buildup of pressure.

Meanwhile, secondary childhood glaucoma occurs when an underlying medical condition causes an increase in IOP. Medical conditions linked to childhood glaucoma include:

• Axenfeld-Rieger Syndrome. A group of eye and other developmental disorders
• Aniridia. Absence or severe underdevelopment of the iris (colored part of the eye)
• Sturge-Weber Syndrome. A rare vascular disorder in the brain and eye
• Neurofibromatosis. Nervous system tumor growths
• Chronic steroid use. Often associated with elevated intraocular pressure
• Eye injury. Blunt trauma and any type of eye injury can affect IOP
• Previous eye surgery. Complications with procedures such as congenital cataract surgery

What are the Signs of Childhood Glaucoma?

It’s important to know what to look out for regarding childhood glaucoma. Here are a few symptoms that could indicate glaucoma:

• Excessive tearing (epiphora)
• Light sensitivity (photophobia)
• Squinting or eyelid squeezing (blepharospasm)
• Large eyes (buphthalmos)
• Cloudy or hazy corneas
• Fine horizontal lines may indicate stretching of the cornea.

If you notice these signs, contact a pediatric ophthalmologist within 24 to 48 hours.

How is Childhood Glaucoma Treated?

Surgery is the best way to treat primary congenital glaucoma. Treatment involves opening up the drainage system to lower intraocular pressure.

Surgical procedures for congenital glaucoma include:

• Goniotomy. Makes a controlled incision in the abnormal trabecular meshwork to open the drainage angle and lower intraocular pressure
• Trabeculectomy. Creates a bleb (reservoir) to capture fluid and decrease IOP
• Tube shunt surgery. Implants a hollow tube called a shunt to divert fluid into a reservoir and away from the eye
• Iridotomy. Creates a small hole in the iris to relieve pupillary-block angle-closure; it is not a standard treatment for primary congenital glaucoma
• Cyclophotocoagulation. A laser surgery that reduces fluid production

Medicated eye drops are routinely used to lower fluid pressure inside the eye. They are used both before and after glaucoma surgery.

Medicines That Help After Surgery

Medication alone rarely solves childhood glaucoma because the underlying problem is structural. However, medicines often supplement surgery to maintain healthy pressures. Common choices include:

• Beta-blockers (like timolol).  These lower eye pressure by reducing fluid production, but they must be used cautiously, especially in infants, due to potential breathing issues.
• Carbonic Anhydrase Inhibitors (CAIs). They can effectively reduce pressure, but may cause side effects like metabolic imbalances.
• Prostaglandin analogues. These are often used in older children and teens, but are less predictable in infants.

Parents must understand medication side effects and proper application to maximize safety and effectiveness.

Factors that Affect Childhood Glaucoma Treatment

Various factors affect the treatment plan for your child’s glaucoma. This mainly includes their age, medical history, and tolerance to medical procedures and medication.

The goal of treatment for secondary glaucoma is to reduce eye pressure and address the underlying medical condition.

How Is Childhood Glaucoma Diagnosed?

Because young children can't communicate their symptoms clearly, doctors use specific methods to diagnose childhood glaucoma accurately. These include:

• Tonometry. A test that pediatric ophthalmologists often use to measure intraocular pressure (IOP)
• Examination Under Anesthesia (EUA). A detailed eye examination performed under general anesthesia
• Gonioscopy. Uses special lenses to directly view the eye's drainage angle to detect abnormalities
• Axial length measurement. Uses A-scan ultrasound or optical biometry to measure how much the eye has enlarged

Doctors follow specific criteria set by the Childhood Glaucoma Research Network (CGRN), ensuring reliable diagnosis. Early diagnosis means early treatment, dramatically improving outcomes for your child.

Can Childhood Glaucoma Be Prevented?

No, childhood glaucoma itself cannot be prevented. However, early detection and treatment can prevent pediatric glaucoma from progressing to blindness.

Congenital glaucoma typically has visual warning signs shortly after birth. However, other types of childhood glaucoma are usually asymptomatic until the disease progresses into permanent optic nerve damage and vision loss.

If your child is at risk for infantile or juvenile glaucoma, they should be monitored regularly by a pediatric ophthalmologist at intervals the specialist recommends (often at least annually, and sometimes more frequently). They will check eye pressure and look for signs of optic nerve damage.