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TAS Opthalmology > Childhood Glaucoma ✅ > Flashcards

Childhood Glaucoma ✅ Flashcards

1
Q

Is childhood glaucoma common?

A

No, it is rare

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2
Q

Why is childhood glaucoma significant?

A

It is a potentially blinding condition

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3
Q

What is childhood glaucoma characterised by?

A

Raised IOP and optic disc cupping

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4
Q

What is the optic cup?

A

The pale central area of the optic disc

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5
Q

What produces the optic cup?

A

In the normal optic nerve head, the retinal ganglion cell (RGC) axons are concentrated around the circumference of the optic disc, leaving a pale central area relatively devoid of axons

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6
Q

What happens to the optic cup in glaucoma?

A

The relative size of the optic cup (cup:disc ratio) gradually enlarges

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7
Q

Why does the cup:disc ratio enlarge in glaucoma?

A

The raised IOP causes retinal ganglion cell death, so the number of axons passing through the optic nerve head opening reduces

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8
Q

What will uncontrolled glaucoma lead to clinically?

A

Peripheral visual field loss

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9
Q

What is the problem with the presentation of uncontrolled glaucoma?

A

Peripheral visual field loss is difficult to detect in children

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10
Q

How does the presentation of glaucoma differ to that of optic neuritis or optic atrophy?

A

The optic neuropathy of glaucoma is not characterised by the early loss of visual acuity or colour vision that is seen with optic neuritis or optic atrophy

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11
Q

Why do you not get early loss of visual acuity or colour vision in glaucoma?

A

Because the RGCs serving the macula are the last to be damaged

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12
Q

What is the normal intra-ocular pressure in children?

A

6-18mmHg

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13
Q

In what setting can intra-ocular pressure in children be measured?

A

In eye clinic

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14
Q

What causes raised IOP?

A

Impaired aqueous outflow through the trabecular meshwork

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15
Q

What will happen with raised IOP in children under 3?

A

It will result in globe expansion (buphthalmos)

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16
Q

Why will raised IOP lead to globe expansion in children under 3?

A

Because they have low scleral rigidity

17
Q

What does the increase in axial length in globe expansion caused by raised IOP in under 3’s lead to?

A

A shift towards myopia (or loss of hypermetropia) and an increasing corneal diameter

18
Q

What is the normal corneal diameter?

A

11mm

19
Q

Why does primary congenital glaucoma present?

A

Within the first year of life

20
Q

Is primary congenital glaucoma unilateral or bilateral?

A

Usually bilateral

21
Q

What does primary congenital glaucoma result from?

A

Abnormal development of the drainage angle

22
Q

What is the incidence of primary congenital glaucoma?

A

1/10,000 live births

23
Q

What are the majority of causes of primary congenital glaucoma due to?

A

A gene mutation in the CYP1B1 gene

24
Q

What happens in primary congenital glaucoma?

A

The globe enlarges due to the raised pressure, and splits occur in the deeper layers of the cornea, leading to photophobia and corneal opacification

25
Q

What are the splits in the deeper layers of the cornea in primary congenital glaucoma called?

A

Haab’s striae

26
Q

What is the treatment for primary congenital glaucoma?

A

Early surgical division of the abnormal ‘Balkan membrane’ (which obstructs fluid flow to the drainage angle)

27
Q

What are the causes of secondary glaucoma?

A
  • Anomalies of the anterior segment
  • Sturge-Weber syndrome
  • Following congenital cataract surgery
  • Topical, inhaled, or oral steroid therapy
28
Q

Give an example of an anomaly of the anterior segment?

A

Aniridia

29
Q

How can Sturge-Weber syndrome lead to secondary glaucoma?

A

If the capillary malformation involves the eyelids, the episcleral venous pressure may be raised, reducing aqueous outflow and causing glaucoma in 50% of cases

30
Q

What is the lifetime risk of secondary glaucoma following cataract surgery?

A

30%

31
Q

Why can glaucoma develop following cataract surgery?

A

Possibly due to the release of vitreous derived factors or inflammatory cells into the drainage angle in infancy

32
Q

How can topical, inhaled, or oral steroid therapy lead to glaucoma?

A

Due to the increased accumulation of glycosaminoglycans or trabecular meshwork-induce bile glucocorticoid response protein (TIGR) in the trabecular meshwork

TAS Opthalmology (9 decks)

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