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A Parent's Guide to Congenital Glaucoma in Infants

Receiving a serious diagnosis for your newborn is one of the most frightening experiences a parent can face.

When you hear the words “congenital glaucoma,” your world may feel like it has been turned upside down.

It’s natural to feel overwhelmed with questions, fear, and uncertainty about what this means for your baby’s future.

This condition, though rare, requires immediate attention. Understanding the signs, the causes, and the treatment options is the first step toward managing your child’s health effectively.

We are here to walk you through this complex topic with clear, reliable information.

This comprehensive guide will explain congenital glaucoma in simple terms.

We will cover what it is, how to spot the early signs, the diagnostic process, available treatments, and what you can expect for your child’s long-term vision. Our goal is to empower you with the knowledge you need to navigate this journey with confidence.

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Ophthalmologist/ Eye Surgeon 13+ Years Exp

MBBS, MS – Ophthalmology

TSMC- TSMC/FMR/05251 (2018)

CONDITION

Glaucoma

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What is Congenital Glaucoma?

Congenital glaucoma, also known as infantile glaucoma, is a rare but serious eye condition that occurs in infants and young children.

It develops when the eye’s drainage system does not form correctly before birth, leading to increased pressure inside the eye. This high intraocular pressure (IOP) can damage the optic nerve, which is vital for sending visual information from the eye to the brain.

Unlike adult glaucoma, which usually develops slowly over many years, congenital glaucoma can cause rapid and irreversible vision loss if not treated promptly.

It typically appears within the first year of life. The term “primary congenital glaucoma” is used when the condition is not caused by another medical issue or syndrome.

How Does Congenital Glaucoma Develop?

The eye constantly produces a clear fluid called aqueous humour, which nourishes the eye and maintains its shape. This fluid normally flows out through a spongy meshwork. In congenital glaucoma, this drainage system is blocked or poorly developed.

Because fluid cannot drain properly, it builds up inside the eye, causing the pressure to rise. An infant’s eye is still soft and flexible, so this high pressure can cause the eyeball (specifically the cornea) to stretch and enlarge, a key sign of the condition.

What Are the Signs and Symptoms of Congenital Glaucoma?

The signs of congenital glaucoma can be noticeable, especially if you know what to look for. Parents are often the first to spot that something is not right with their baby’s eyes.

⇒The classic triad of symptoms includes:

Epiphora (Excessive Tearing): Your baby may seem to be crying without making any sound, with constant watery eyes.
Photophobia (Light Sensitivity): Your infant may shut their eyes tightly, squint, or turn away from bright light, both indoors and outdoors.
Blepharospasm (Eyelid Spasms): Involuntary, forceful squeezing or twitching of the eyelids is common.

⇒Other important signs to watch for are:

Cloudy Corneas: The normally clear front part of the eye may look hazy, cloudy, or milky white. This is due to swelling caused by high pressure.
Enlarged Eyes (Buphthalmos): One or both of your baby’s eyes may appear unusually large or seem to be bulging. This happens because the high pressure stretches the soft tissues of the infant eye.
Redness: The eye may look persistently red or irritated.
Vision Problems: Your baby might seem to have trouble focusing or tracking objects.

If you notice any of these symptoms, it is crucial to see a paediatric ophthalmologist immediately. Early detection is the most important factor in preserving your child’s vision.

How is Congenital Glaucoma Diagnosed?

Diagnosing congenital glaucoma involves a thorough eye examination by a specialist, which often needs to be performed under general anaesthesia. This allows the ophthalmologist to conduct a detailed and accurate assessment without causing distress to the infant.

⇒The diagnostic process typically includes several tests:

Intraocular Pressure (IOP) Measurement: The doctor uses a special instrument called a tonometer to measure the pressure inside the eye.
Corneal Examination: The ophthalmologist measures the diameter of the cornea and examines it for cloudiness and swelling.
Goniocopy: This test involves using a special lens to inspect the eye’s drainage angle to see if it is blocked or improperly formed.
Optic Nerve Examination: The doctor examines the optic nerve at the back of the eye to check for any signs of damage or cupping, which is a hollowing of the nerve head caused by high pressure.
Refraction: This test checks for nearsightedness (myopia), which is common in children with congenital glaucoma.

These tests help confirm the diagnosis, assess the severity of the condition, and plan the most effective treatment.

What Are the Treatment Options for Congenital Glaucoma?

The primary goal of treatment is to lower the intraocular pressure to a safe level, thereby protecting the optic nerve and preserving vision. Unlike adult glaucoma, medication is not the primary long-term solution. Surgery is almost always necessary to correct the underlying drainage problem.

⇒Surgical Procedures

Surgery for congenital glaucoma aims to create a new channel for the aqueous humour to drain from the eye. The two most common procedures are:

Goniotomy: The surgeon uses a special lens and instruments to make a small incision in the trabecular meshwork (the eye’s drainage tissue) to allow fluid to flow out more easily. This is often the first choice if the cornea is clear enough for the surgeon to see the drainage angle.
Trabeculotomy: If the cornea is too cloudy for a goniotomy, the surgeon makes an incision from the outside of the eye to bypass the blockage in the drainage canals. This procedure achieves the same goal of improving fluid outflow.

Both surgeries have a high success rate, but sometimes more than one operation is needed to control the eye pressure effectively.

⇒Medications

Eye drops and oral medications may be used as a temporary measure to lower eye pressure before surgery or if surgery does not fully control the IOP. However, they are generally not considered a standalone, long-term treatment for congenital glaucoma.

Life After a Congenital Glaucoma Diagnosis

A diagnosis of congenital glaucoma means your child will require lifelong monitoring by an ophthalmologist. Regular follow-up appointments are essential to check their eye pressure, optic nerve health, and overall vision.

Here’s what you can expect:

Frequent Eye Exams: Especially in the first few years, your child will need frequent check-ups, which may initially be done under anaesthesia.
Glasses or Contact Lenses: Many children with congenital glaucoma develop nearsightedness or astigmatism and will need corrective lenses to see clearly.
Patching for Amblyopia (Lazy Eye): If one eye has better vision than the other, the doctor may recommend patching the stronger eye to encourage the weaker eye to develop properly.
Low Vision Aids: If vision loss has occurred, low vision aids and support services can help your child adapt and thrive in school and daily life.

With timely surgery and diligent follow-up care, the prognosis for children with congenital glaucoma is generally good. Many children go on to have useful vision throughout their lives.

At Saijyothi Eye Hospital in Hyderabad, our pediatric ophthalmology team provides expert care and lifelong support for children with congenital glaucoma. Book a consultation today to protect your child’s vision for the future.

Key Takeaways

Congenital glaucoma is a rare but serious eye condition in infants caused by a poorly developed eye drainage system.
Key symptoms include excessive tearing, light sensitivity, and cloudy or enlarged eyes.
Immediate medical attention is critical. See a paediatric ophthalmologist if you notice any signs.
Diagnosis requires a specialized eye exam, often under anaesthesia.
Surgery is the primary treatment to lower eye pressure and prevent vision loss.
Children with congenital glaucoma need lifelong monitoring to protect their vision.

Frequently Asked Questions (FAQ)

Q1: Is congenital glaucoma hereditary?
A1: In about 10% of cases, congenital glaucoma is inherited. If you have a family history of the condition, there is a higher risk. However, most cases occur randomly in families with no prior history.

Q2: Can my baby go blind from congenital glaucoma?
A2: While congenital glaucoma can lead to blindness if left untreated, early diagnosis and surgical intervention significantly reduce this risk. The majority of children who receive timely treatment retain useful vision.

Q3: How successful is the surgery for congenital glaucoma?
A3: Surgical procedures like goniotomy and trabeculotomy have a high success rate, often over 80-90%. However, some children may require more than one surgery or additional treatments to keep their eye pressure under control.

Q4: Will my child have a normal life?
A4: Yes. With proper medical care and support, children with congenital glaucoma can lead full, active, and normal lives. They can attend school, play sports, and pursue their dreams just like any other child. Regular eye appointments will be a permanent part of their healthcare routine.

Q5: What is the difference between congenital glaucoma and juvenile glaucoma?
A5: The main difference is the age of onset. Congenital glaucoma is present at birth or develops within the first year. Juvenile glaucoma is diagnosed in older children, teenagers, or young adults (typically after the age of 4). The underlying causes and treatment approaches can also differ.

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