Pediatric Traumatic Glaucoma
Eye 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:
- Marfan Syndrome
- Down Syndrome
- Trisomy 13
- Congenital causes
- Secondary (Acquired)
- 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)
- 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!!
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