The history of tearing, photophobia, and blepharospasm in both eyes with bilateral large corneas, corneal edema, Haab's striae, elevated intraocular pressures, prominent cupping, buphthalmos, and secondary myopia are strongly suggestive of glaucoma.
The normal horizontal corneal diameter is 9.5-10.5 mm in full-term newborns. Patients with congenital glaucoma typically have corneal diameters that are > 12 mm.
In children, cupping of the optic disc is reversible with improved control of intraocular pressure; however, it is not reversible in adults.
Secondary congenital glaucoma is glaucoma associated with other intraocular abnormalities, including anterior segment dysgenesis syndromes, aniridia, oculocerebrorenal syndrome, Sturge-Weber syndrome, rubella, juvenile xanthogranuloma, retinoblastoma, trauma, and a variety of genetic diseases.
Definitive management of primary congenital glaucoma is surgical.
Starting the patient on a topical glaucoma medication until surgical intervention can be arranged may improve intraocular pressure, corneal edema, and visualization during surgery.
Most clinicians recommend a carbonic anhydrase inhibitor and/or beta blocker as first-line therapy on the basis of side effect profiles and efficacy. However, parents should still perform punctal occlusion when administering these drops to limit systemic absorption.
Alpha agonists can cause central nervous system depression and are contraindicated in children. Prostaglandin analogs have little effect in the pediatric population.
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