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:
    • Neurofibromatosis
    • Marfan Syndrome
    • Down Syndrome
    • Trisomy 13
• 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
    • Retinoblastoma
    • Leukemia
  • 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:
  • Guns
  • Pellet-guns
  • Paintball guns [Keles, 2014]
  • Fireworks
  • Tools
• 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