Congenital Glaucoma

Congenital glaucoma is a potentially blinding condition with an incidence of 1 per 10,000 births. It is often confused with chronic dacryocystitis. About two thirds of these cases are bilateral. These patients, similar to those with dacryo-cystitis, present with excessive tearing. The infants usually are light sensitive (photophobic) and frequently bury their head in a pillow or blanket. These infants often have intense

Figure 41-5 Congenital glaucoma in a 2-month-old infant who presented with a cloudy cornea involving the right eye. Intraocular pressure was elevated. The diagnosis was congenital glaucoma.

blinking or lid spasm (blepharospasm). An enlarged cornea or corneal clouding can be detected clinically and measured with a plastic ruler (normal, <12 mm) (Fig. 41-5). Corneal edema is the result of elevated IOP, which causes breaks in the inner corneal layers (Descemet's membrane) and intrusion of anterior chamber fluid into the corneal stroma. Increased IOP causes significant optic nerve damage, which can lead to blindness. Whenever glaucoma is suspected, immediate consultation is indicated. Surgical treatment of congenital glaucoma is successful in approximately 90% of cases. These patients must be followed by an ophthalmologist for life as a precaution against recurrent IOP elevation and amblyopia.

KEY TREATMENT

Newborns should be prophylactically treated with erythromycin 0.5% or tetracycline 1% ophthalmic ointment to reduce the risk of ophthalmia neonatorum (CDC, 2002) (SOR: A). Ciprofloxacin 0.3% ophthalmic solution is effective empiric treatment of bacterial conjunctivitis (Leibowitz, 1991) (SOR: A). A broad-spectrum antibiotic for 5 to 7 days is generally effective for most cases of bacterial conjunctivitis (American Academy of Ophthalmology [AAO], 2008) (SOR: A).

Children with nasolacrimal duct obstruction may undergo nasolacrimal duct surgery between 6 and 12 months of age, or sooner if clinically indicated (Katowitz et al., 1987) (SOR: C). Children with congenital glaucoma should be promptly referred to a pediatric ophthalmologist or glaucoma specialist (AAO, 2008) (SOR: A).

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