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RECOGNIZINGCHILDHO OD GLAUCOMAT H E P R IM R Y P E D I T R IC S E T T I N GHELEN H Y E UNG MD AND DAV I D SWALTO N MD
Pdiatrie glaucom a, if not diagnosed early and treated prom ptly, canlead to significant corneal and optic nerve damage and loss of visionin infants and young children. Know how to recognize the signs andthe primary and secondary causes of childhood glaucomas so you canmake the quick diagnosis necessary to save child s sight.A 6-month-old baby girl is brought to a pri-ma ry care clinic for a routin e physical exam-ination. The parents express their concernfor an enlargement of the right eye compared withthe left eye over the last m onth (Figure 1). They alsoreport excessive tearing from the right eye. On physi-cal exam, the clinician sees asymmetry in the sizesof the eyes. No conjunctival discharge is present, andthe extraocular movements and pupils are normallyreactive bilaterally. The rest ofthe baby girl s physicalexam is norm al. Wh at is your clinical impression?Unilateral eye enlargementin an infantThe infant in this case has buphthalmos. This termdescribes the enlargement of the globe of the eye andusually appears in the infancy period up to the firstyear oflife,
Buphthalmos is pathognomonic for glaucoma sec-ondary to abnormal drainage of aqueous humor thatinevitably causes the responsible increased intraocu-lar pressure. The differential diagnosis of buphthal-mos includes either megalocornea (nonprogressiveenlargement of the cornea with normal eye pres-sures) or glaucoma. In rare cases, retinoblastomacan be considered and is the cause of the glaucoma.
The presence of leukocoria (white reflex), iris neo-vascularization, and buphthalmos (because of long-standing glaucoma causing enlargement of the eye)related to an advanced retinoblastoma may necessi-tate immediate removal of the eye because of the riskof extraocular spread ofthe cancer.
The baby s pediatrician referred her im mediately toan ophthalmologist. Increased intraocular pressure ofthe right eye was measured associated with no otherocular abnormalities, thus confirming the diagnosisof glaucoma.
D R Y E U N G is a third-year resident, De partment of Pediatrics, Massachu setts General Hospital, Harvard Medical School, Boston,Massachusetts. D R W A L T O N is clinical professor of ophthalmology, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary,Harvard Medical School, Boston, and pediatrician, Massachusetts General Hospital and Harvard Medical School, Boston. The authors have nothingto disclose in regard to affiliation s vi/ith or financial interes ts in any organization that may have an interest in any part of this art icle.
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CH ILDH OO D GL UCOM S
Sinous venosus of scieraCanal of Schlemm)
Anter iorcil iary vein
Trabecularmeshworl
