Pediatric Traumatic Glaucoma

Pediatric Traumatic GlaucomaEye complaints are commonly encountered when caring for kids in the ED. Often, they are due to a simple issue, like conjunctivitis (although even “simple” deserves vigilance – Conjunctivitis-Otitis-Syndrome), but there are other times when the “red eye” warrants greater concern. This is particularly true in the setting of trauma. We have considered some eye-related trauma before (ex, Hyphema, Eyelid Lacerations), but now let us look at another potential cause of eye pain after trauma – Traumatic Glaucoma:

 

Pediatric Glaucoma: Basics

  • Worldwide, glaucoma is the 2nd leading cause of vision loss in people of all ages. [Fung, 2013]
  • Glaucoma is rare in childhood, but it is not just an adult condition!
    • Incidence of childhood glaucoma found to be 2.29 per 100,000 people <20 years of age. [Aponte, 2010]
    • Similar to PE, cholelithiasis, and renal stones – not common, but not impossible.
    • Vigilance is required!
  • Glaucoma is characterized by:
    • Increased intraocular pressures
    • Optic disc cupping
    • Progressive visual field loss
  • Early detection is vital to prevent corneal damage, optic nerve damage, and amblyopia (AKA, vision loss). [Fung, 2013]
  • Childhood glaucoma leads to a significant economic burden. [Liu, 2016]

 

Pediatric Glaucoma: Classifications

Pediatric Glaucoma can be classified as Primary or Secondary.

Below is a basic and abridged list to consider: [Fung, 2013; Yeung, 2010]

  • Primary (Developmental):
    • Congenital causes
      • Don’t worry… I won’t torture you with this extensive list!
      • Obviously, patients tend to be younger at presentation (<2 years of age).
    • Associated with systemic disorders- examples:
  • Secondary (Acquired)
    • Trauma
      • In the US, this is the leading cause of 2ndary pediatric glaucoma. [Fung, 2013]
      • Typically older (10-15 years of age) and male (again… boys have issues with a high testosterone to grey matter ratio).
      • Hyphema is a significant risk factor for development of Glaucoma!
      • Penetrating trauma can lead to glaucoma also. [Girkin, 2005]
      • May develop over time… so needs to be monitored for after initial trauma.
    • Post-operative [Sahin, 2013]
    • Intraocular neoplasms
    • Lens related disorders (like dislocation)
    • Uveitis
    • Sturge-Weber syndrome is a notable cause

 

Pediatric Eye Injuries: Prevention

  • Eye injuries are common among our pediatric patients!
  • Sporting activities are often associated with these events. [Haavisto, 2016]
  • Other activities that are associated:
  • Ocular contusion is a leading diagnosis after trauma. [Haavisto, 2016]
    • Often requires prolonged follow-up for glaucoma monitoring.
  • Advocate for protective eyewear whenever possible! [Haavisto, 2016]

 

Moral of the Morsel

  • Kids might be smaller, but they still get big problems. Glaucoma does occur in children.
  • Check that pressure! Trauma is the leading cause of secondary glaucoma. Check that IOP (after your are sure it isn’t an open globe!).
  • Keep an eye out for it even after discharge! Kids with a history of eye trauma deserve close outpatient follow up to ensure glaucoma has not developed.
  • An Ounce of Prevention… is much better than trying to fix a dysfunctional eye! Promote protective eyewear!!

 

References

Liu D1, Huang L, Mukkamala L, Khouri AS. The Economic Burden of Childhood Glaucoma. J Glaucoma. 2016 Oct;25(10):790-797. PMID: 26950576. [PubMed] [Read by QxMD]

Haavisto AK1, Sahraravand A1, Holopainen JM1, Leivo T1. Paediatric eye injuries in Finland – Helsinki eye trauma study. Acta Ophthalmol. 2017 Jun;95(4):392-399. PMID: 27966829. [PubMed] [Read by QxMD]

Ophthalmologe. 2014 Dec;111(12):1204-6. PMID: 24938368. [PubMed] [Read by QxMD]

Keles S1, Ondas O2, Ekinci M3, Sener MT4, Erhan E5, Sirinkan A5, Akyol Salman I1, Kocer I1, Baykal O1. Paintball-related ocular trauma: Paintball or Painball? Med Sci Monit. 2014 Apr 5;20:564-8. PMID: 24704783. [PubMed] [Read by QxMD]

Fung DS1, Roensch MA, Kooner KS, Cavanagh HD, Whitson JT. Epidemiology and characteristics of childhood glaucoma: results from the Dallas Glaucoma Registry. Clin Ophthalmol. 2013;7:1739-46. PMID: 24039394. [PubMed] [Read by QxMD]

Sahin A1, Caça I, Cingü AK, Türkcü FM, Yüksel H, Sahin M, Cinar Y, Ari S. Secondary glaucoma after pediatric cataract surgery. Int J Ophthalmol. 2013 Apr 18;6(2):216-20. PMID: 23638427. [PubMed] [Read by QxMD]

Yeung HH1, Walton DS. Clinical classification of childhood glaucomas. Arch Ophthalmol. 2010 Jun;128(6):680-4. PMID: 20547943. [PubMed] [Read by QxMD]

Aponte EP1, Diehl N, Mohney BG. Incidence and clinical characteristics of childhood glaucoma: a population-based study. Arch Ophthalmol. 2010 Apr;128(4):478-82. PMID: 20385945. [PubMed] [Read by QxMD]

Papadopoulos M1, Cable N, Rahi J, Khaw PT; BIG Eye Study Investigators. The British Infantile and Childhood Glaucoma (BIG) Eye Study. Invest Ophthalmol Vis Sci. 2007 Sep;48(9):4100-6. PMID: 17724193. [PubMed] [Read by QxMD]

Klin Monbl Augenheilkd. 2005 Oct;222(10):772-82. PMID: 16240269. [PubMed] [Read by QxMD]

Girkin CA1, McGwin G Jr, Morris R, Kuhn F. Glaucoma following penetrating ocular trauma: a cohort study of the United States Eye Injury Registry. Am J Ophthalmol. 2005 Jan;139(1):100-5. PMID: 15652833. [PubMed] [Read by QxMD]

Cavallerano AA, Alexander LJ. The secondary glaucomas. Optom Clin. 1991;1(1):127-64. PMID: 1686843. [PubMed] [Read by QxMD]

Sean Fox

I enjoy taking care of patients and I finding it endlessly rewarding to help train others to do the same. I trained at the Combined Emergency Medicine and Pediatrics residency program at University of Maryland, where I had the tremendous fortune of learning from world renown educators and clinicians. Now I have the unbelievable honor of working with an unbelievably gifted group of practitioners at Carolinas Medical Center. I strive every day to inspire my residents as much as they inspire me.

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