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!!



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Sean M. Fox
Sean M. Fox
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