Clinical Evaluation of Glaucoma in Children

Abstract

Glaucoma in children is a potentially blinding condition. The suspicion of glaucoma in a child should be taken seriously and with a degree of urgency as early diagnosis and treatment can minimise visual loss. However, the clinical evaluation of children with glaucoma or suspected glaucoma can be challenging. Whilst a neonate may be examined in the clinic whilst sleeping or immediately following feeding, detailed examination to establish a diagnosis of glaucoma in infants or young children (or indeed to monitor once treatment has been instigated) may require examination under general anesthetic. Intraocular pressure (IOP) measurement needs particular care due to the variability of tonometry devices and the fact that IOP may be influenced by a number of factors. Optic disc assessment is critical in the diagnosis and monitoring of glaucoma in children and requires detailed dilated fundoscopic examination. Other examinations such as automated visual field testing and optic disc imaging, taken for granted in adult glaucoma patients, are highly dependent on patient cooperation. As such, they may not be possible in children until after the age of 6–7 years.