Pediatric Glaucoma

Congenital & Childhood Glaucoma

Glaucoma is a group of eye diseases that can damage the optic nerve, the structure that carries visual information from the eye to the brain.

Although glaucoma is much more common in adults, babies and children can develop glaucoma too.

Pediatric glaucoma is rare, but it can be serious. In young children, elevated eye pressure can damage the optic nerve and may also physically stretch the developing eye, causing the cornea to enlarge or become cloudy. The signs can look very different from adult glaucoma.

At Children’s Eye Care, our pediatric ophthalmologists have extensive experience diagnosing, surgically treating and providing long-term care for children with primary congenital glaucoma, juvenile glaucoma and secondary forms of childhood glaucoma.

Pediatric glaucoma care requires specialized expertise because children are not simply small adults. The disease itself behaves differently, the examination can be more challenging, surgical treatment often differs and preserving vision may also require treatment for amblyopia, refractive error or strabismus.

Pediatric Glaucoma Specialists in Metro Detroit

Children’s Eye Care has specialized in pediatric ophthalmology in Metro Detroit since 1973.

Our physicians care for babies born with glaucoma, children who develop glaucoma later, and children at increased risk because of another eye disorder, medical condition, medication, trauma or previous eye surgery.

That includes glaucoma associated with conditions such as:

• Congenital abnormalities of the front of the eye
• Aniridia
• Axenfeld-Rieger syndrome
• Sturge-Weber syndrome
• Neurofibromatosis
• Uveitis
• Eye trauma
• Steroid use
• Previous pediatric cataract surgery

Not every child with one of these conditions will develop glaucoma, but some require lifelong surveillance because the risk can remain even when the eye initially appears healthy.

Our role is not simply to obtain an eye-pressure number.

We evaluate pressure, corneal size and clarity, the drainage angle, optic nerve appearance, eye growth, refractive error and visual development together to determine whether glaucoma is present, whether it is progressing and how aggressively it needs to be treated.

What Is Pediatric Glaucoma?

Inside the eye, clear fluid is constantly produced and drained.

When that fluid does not drain properly, pressure inside the eye can rise. Elevated pressure can damage the optic nerve and cause permanent vision loss.

But pediatric glaucoma is more complicated than simply having “high eye pressure.”

A child’s diagnosis is based on the entire examination, including:

• Intraocular pressure
• Optic nerve appearance
• Corneal findings
• Eye size and growth
• Changes in refractive error
• Drainage-angle anatomy
• Visual field testing when age appropriate
• Imaging such as OCT when the child is able to participate

Young eyes can physically stretch under elevated pressure in a way adult eyes generally do not. That is why babies with congenital glaucoma may develop larger eyes, enlarged corneas or cloudy corneas.

What Is Primary Congenital Glaucoma?

Primary congenital glaucoma is a form of glaucoma caused by abnormal development of the eye’s drainage system.

It may be present at birth or become apparent during infancy or early childhood.

The drainage structures do not allow fluid to leave the eye normally, causing pressure to rise.

Primary congenital glaucoma usually occurs without another eye or systemic developmental abnormality. It is the most common form of primary childhood glaucoma.

Some cases occur in families or have an identifiable genetic component, while others occur without a known family history.

What Are the Symptoms of Congenital Glaucoma in a Baby?

Congenital glaucoma often looks very different from glaucoma in an adult.

The classic symptoms include:

• Excessive tearing
• Sensitivity to light
• Frequent squeezing or closing of the eyelids
• A cloudy or hazy cornea
• An eye or cornea that appears unusually large

The combination of tearing, light sensitivity and eyelid squeezing is particularly characteristic of congenital glaucoma.

Parents may describe a baby who constantly waters, dislikes bright light or keeps the eyes closed.

These symptoms should not automatically be assumed to be a blocked tear duct.

Is Constant Tearing in a Baby Always a Blocked Tear Duct?

No.

A blocked tear duct is a much more common cause of tearing in infancy and usually does not cause significant light sensitivity or an enlarged or cloudy cornea.

Congenital glaucoma can also cause excessive tearing, but the overall picture is different.

A baby with tearing plus significant light sensitivity, frequent eyelid squeezing, a cloudy cornea or an unusually large eye should be evaluated promptly.

Related: Blocked Tear Ducts in Babies & Children

Why Can an Eye Become Larger With Congenital Glaucoma?

A baby’s eye is still developing and its tissues are more flexible than an adult eye.

When eye pressure remains elevated, the eye can physically stretch.

This enlargement is sometimes called buphthalmos.

The cornea may become larger, and pressure can also create small breaks within one of the deeper corneal layers called Haab striae. Corneal swelling can make the normally clear front of the eye appear hazy or cloudy.

An unusually large or cloudy eye in a baby is therefore not simply an appearance issue.

It can be a sign of elevated pressure and requires pediatric ophthalmic evaluation.

What Is Juvenile Glaucoma?

Glaucoma can also develop later in childhood or adolescence.

Juvenile open-angle glaucoma is generally more similar to adult open-angle glaucoma than congenital glaucoma.

Unlike babies with congenital glaucoma, older children may have few or no symptoms.

Some are diagnosed because they fail a vision screening, develop blurry vision or are found to have elevated pressure or optic nerve changes during an examination.

Juvenile glaucoma can also be associated with a family history of glaucoma.

Because children may not notice gradual peripheral vision loss, the absence of complaints does not necessarily mean the disease is absent.

What Is Secondary Pediatric Glaucoma?

Not all childhood glaucoma is primary congenital glaucoma.

Secondary glaucoma develops because of another eye condition, medical condition, injury, medication or previous surgery.

Examples include glaucoma associated with:

• Uveitis
• Previous cataract surgery
• Eye trauma
• Steroid treatment
• Aniridia
• Axenfeld-Rieger syndrome
• Sturge-Weber syndrome
• Other congenital or developmental abnormalities of the eye

The underlying cause matters because it can influence both the behavior of the glaucoma and the treatment that is most appropriate.

Glaucoma After Pediatric Cataract Surgery

Children who undergo cataract surgery—especially surgery during infancy—have an increased lifelong risk of glaucoma.

Importantly, glaucoma may develop months or years after an otherwise successful cataract operation.

AAPOS notes that roughly one in five babies undergoing cataract surgery during the first six months of life may develop glaucoma within 10 years.

That is why Children’s Eye Care continues monitoring children after pediatric cataract surgery long after the cataract itself has been treated.

Related: Pediatric Cataracts

Can Steroids Cause Glaucoma in Children?

Yes.

Steroid medications can cause eye pressure to rise in susceptible children.

This can occur with several forms of steroid treatment, including some eye drops and systemic medications. AAPOS also notes that steroid exposure can be associated with childhood glaucoma.

This does not mean children should avoid medically necessary steroids.

It means that children requiring prolonged steroid treatment—particularly those with eye inflammation—may need appropriate pressure monitoring.

Related: Uveitis

How Is Pediatric Glaucoma Diagnosed?

Diagnosing glaucoma in children requires a comprehensive pediatric eye examination.

Depending on the child’s age and ability to cooperate, evaluation may include:

• Measurement of eye pressure
• Measurement of corneal diameter
• Evaluation of corneal clarity and thickness
• Examination of the drainage angle
• Measurement of eye length
• Refraction
• Careful examination of the optic nerve
• Optic nerve photography
• OCT imaging
• Visual-field testing in older children

Does My Child Need Anesthesia Just to Diagnose Glaucoma?

Sometimes.

We can obtain useful measurements in the office for many children, especially as they become older and more cooperative.

But glaucoma diagnosis depends on accurate information.

A baby cannot reliably sit at an adult slit lamp, stare into a machine or complete a visual-field test on command.

When important measurements cannot be obtained safely and accurately in the office, our pediatric ophthalmologists may recommend an examination under anesthesia, often called an EUA.

During an EUA, the physician can perform measurements that may include eye pressure, corneal size, drainage-angle examination, optic nerve evaluation, refraction and other testing.

An EUA is not simply done because a child “won’t cooperate.”

It is a specialized diagnostic tool used when the information needed to protect the child’s vision cannot otherwise be obtained reliably.

Is Eye Pressure the Only Test for Glaucoma?

No.

This is an important misconception.

A single pressure measurement does not tell the whole story.

Eye pressure can vary, and measurements can be influenced by the child’s behavior, corneal characteristics and sometimes anesthesia.

Pediatric glaucoma specialists look at patterns over time.

We may compare:

• Pressure measurements
• Corneal diameter
• Eye length
• Optic nerve cupping
• Corneal changes
• Refraction
• OCT measurements
• Visual fields in older children

For a growing child, it is often the combination of findings and how they change over time that gives the clearest picture.

What Does the Optic Nerve Have to Do With Glaucoma?

The optic nerve carries visual information from the eye to the brain.

Glaucoma damages the optic nerve, often producing progressive enlargement of the central depression of the nerve called cupping.

Our pediatric ophthalmologists monitor the optic nerve carefully during follow-up.

In older children, OCT imaging and visual-field testing can provide additional information about whether glaucoma is stable or progressing.

Related: Optic Nerve Conditions in Children

How Is Congenital Glaucoma Treated?

Unlike many forms of adult glaucoma, primary congenital glaucoma is primarily a surgical disease.

Medication can sometimes temporarily lower pressure or supplement surgical treatment, but surgery is usually the main treatment because the underlying problem is abnormal drainage anatomy.

The goal is to improve the eye’s ability to drain fluid and lower pressure enough to protect the optic nerve and developing visual system.

What Surgery Is Used for Pediatric Glaucoma?

The appropriate operation depends on the type of glaucoma, the anatomy of the child’s eye, previous treatment and how well pressure is controlled.

For primary congenital glaucoma, initial surgery often focuses on the eye’s natural drainage angle.

Goniotomy

A goniotomy is performed from inside the eye.

The surgeon uses a specialized view of the drainage angle and creates an opening within the abnormal drainage tissue to improve fluid outflow.

Trabeculotomy

A trabeculotomy also opens the eye’s natural drainage pathway but approaches the drainage system differently.

Both goniotomy and trabeculotomy are established angle surgeries for primary congenital glaucoma.

Glaucoma Drainage Devices and Other Surgery

If angle surgery does not provide adequate pressure control—or if the child’s glaucoma has a different underlying cause—other procedures may be required.

These can include:

• Glaucoma drainage implants or tube shunts
• Trabeculectomy in selected cases
• Cyclophotocoagulation or other procedures that reduce fluid production

Some children require more than one glaucoma procedure over the course of treatment.

This is why pediatric glaucoma care requires experience not just with one operation, but with long-term surgical decision-making as the child’s disease and eye change over time.

Will Eye Drops Treat Congenital Glaucoma?

Eye-pressure-lowering medication can be useful, but it often plays a different role in babies with primary congenital glaucoma than it does in adults.

Drops may be used:

• Before surgery
• While surgery is being planned
• After surgery if additional pressure lowering is needed
• As part of treatment for secondary or juvenile glaucoma

Some medications used commonly in adults require special consideration in young children because of their potential systemic effects.

Medication choice and dosing therefore need to be specifically managed for the child.

Why Might My Child Need More Than One Glaucoma Surgery?

Pediatric glaucoma can be a lifelong disease.

Some children obtain excellent pressure control after one operation.

Others require additional surgery because the first procedure does not lower pressure enough, pressure rises again as the eye changes or another drainage approach becomes necessary.

That does not necessarily mean that an earlier procedure “failed” in the ordinary sense.

Sometimes a procedure successfully controls pressure for years before the disease changes.

The treatment goal is always the same:

maintain pressure at a level that protects the optic nerve and gives the child the best opportunity to preserve vision.

Does Glaucoma Surgery Restore Vision That Has Already Been Lost?

Glaucoma treatment is primarily designed to prevent additional damage.

Once optic nerve tissue has been permanently damaged, surgery or medication cannot recreate it.

That is one reason early diagnosis and pressure control matter.

But visual outcome in children depends on more than glaucoma alone.

A child may also have:

• Corneal scarring
• Refractive error
• Amblyopia
• Strabismus
• Nystagmus
• Other congenital abnormalities

Those conditions may require their own treatment even after eye pressure is controlled.

Pediatric Glaucoma and Amblyopia

Controlling eye pressure is only one part of protecting a child’s vision.

Glaucoma can create significant differences in vision between the eyes through optic nerve damage, corneal clouding, myopia, astigmatism or other changes.

If the brain begins favoring one eye, amblyopia may develop.

Glasses, patching or other amblyopia treatment may therefore be necessary alongside glaucoma care.

Glaucoma treatment protects the eye from pressure-related damage. Amblyopia treatment helps the developing brain use the vision that remains available.

Related: Amblyopia | Patching Help for Parents

Pediatric Glaucoma and Refractive Error

Children with congenital glaucoma can develop substantial refractive errors.

As an infant’s eye stretches from elevated pressure, the child may become increasingly nearsighted or develop astigmatism.

These prescriptions can change as the eye grows and glaucoma is treated.

Accurate glasses correction is an important part of visual rehabilitation, particularly when the two eyes are affected differently.

Related: Refractive Errors in Children

Pediatric Glaucoma and Strabismus

Some children with glaucoma also develop strabismus, or misalignment of the eyes.

This may occur because one eye sees significantly less well than the other or because of associated developmental eye abnormalities.

Our pediatric ophthalmologists and orthoptists monitor eye alignment as part of the child’s ongoing visual care.

Related: Strabismus

Can Pediatric Glaucoma Be Inherited?

Some forms can.

Primary congenital glaucoma and juvenile glaucoma may have a genetic basis, and certain syndromes associated with childhood glaucoma can also be inherited.

Not every child with glaucoma has an affected parent or sibling.

When the clinical picture suggests an inherited disorder, genetic evaluation and counseling may be appropriate. AAPOS specifically identifies congenital and juvenile glaucoma among childhood conditions that may warrant consideration of genetic evaluation.

Does a Sibling Need to Be Checked?

That depends on the child’s specific diagnosis and family history.

Because some forms of childhood glaucoma can be inherited, the pediatric ophthalmologist may recommend examination of siblings or genetic counseling in selected families.

We would make that recommendation based on the type of glaucoma and the child’s individual findings, rather than applying a universal rule to every family.

Is Pediatric Glaucoma Curable?

I would be careful with the word cure.

Some children with congenital glaucoma achieve excellent long-term pressure control after surgery.

But a child who has had glaucoma remains someone we continue to monitor.

Pressure can rise again, visual needs change as the eye grows and other consequences of the disease may require treatment.

For that reason, pediatric glaucoma is best thought of as a condition requiring long-term surveillance even when pressure is doing very well.

Why Does My Child Need Lifelong Follow-Up?

Because successful glaucoma treatment today does not guarantee that the disease can never change.

As children grow:

• Eye anatomy changes
• Pressure can change
• Glasses prescriptions change
• Optic nerve testing becomes more sophisticated
• Visual-field testing becomes possible
• Previous surgery may require continued monitoring
• New treatment may occasionally become necessary

Follow-up may become less frequent when glaucoma is stable, but ongoing surveillance remains important.

Pediatric glaucoma care is measured in years, not simply in the weeks surrounding an operation.

What Is the Long-Term Outlook for a Child With Glaucoma?

The outlook varies widely.

Some children with congenital glaucoma who are diagnosed and treated early develop very useful vision.

Others have permanent visual limitations because of optic nerve damage, corneal scarring, amblyopia or associated eye abnormalities.

Factors that influence outcome include:

• Severity at diagnosis
• Age of onset
• How much optic nerve damage has occurred
• Whether the cornea remains clear
• How well eye pressure can be controlled
• Whether one or both eyes are affected
• Associated eye or systemic abnormalities
• Amblyopia and refractive treatment
• Long-term adherence to follow-up

Our responsibility is both to treat the glaucoma aggressively enough to protect vision and to give families a realistic understanding of their child’s individual visual potential.

When Should a Baby Be Evaluated for Possible Glaucoma?

Prompt pediatric ophthalmology evaluation is especially important when an infant has:

• Persistent excessive tearing accompanied by significant light sensitivity
• Frequent forceful eyelid squeezing
• A cloudy or hazy cornea
• An eye that appears unusually large
• An enlarging cornea
• A known congenital eye disorder associated with glaucoma
• A strong family history of congenital glaucoma

Most babies with watery eyes do not have glaucoma.

But congenital glaucoma is too important to miss when the characteristic signs are present.

Pediatric Glaucoma Expertise at Children’s Eye Care

Pediatric glaucoma is one of the conditions in which experience specifically caring for children’s eyes matters enormously.

Children’s Eye Care has specialized in pediatric ophthalmology in Metro Detroit since 1973, providing care for children with congenital and complex eye disease from infancy through adolescence and beyond.

Our pediatric ophthalmologists diagnose and treat the full spectrum of childhood glaucoma, including:

primary congenital glaucoma, juvenile glaucoma, glaucoma following pediatric cataract surgery, inflammatory glaucoma, traumatic glaucoma and glaucoma associated with developmental and systemic disorders.

Our expertise extends through every stage of care:

recognizing glaucoma in babies who cannot describe their symptoms → obtaining accurate pressure and structural measurements → performing examinations under anesthesia when necessary → evaluating the drainage angle and optic nerve → selecting and performing pediatric glaucoma surgery → managing medications → treating associated refractive error and amblyopia → monitoring children over the long term for recurrent or progressive disease.

That continuum is particularly important in children.

A pediatric glaucoma surgeon cannot focus solely on pressure.

We must also ask:

Is the cornea staying clear?
Is the eye continuing to enlarge?
Is the optic nerve stable?
Is the child’s prescription changing?
Is amblyopia developing?
Are the eyes aligned?
And is the child actually developing useful vision?

Children’s Eye Care’s pediatric ophthalmologists work alongside orthoptists with specialized expertise in childhood visual development, amblyopia, strabismus and pediatric vision testing.

Our academic team also participates in the education of ophthalmology residents and pediatric ophthalmology fellows, helping train the next generation of professionals who care for children with complex eye disease.

Treating pediatric glaucoma is not simply about lowering a pressure number. It is about protecting an eye—and a visual system—that may still have a lifetime of seeing ahead of it.

Frequently Asked Questions About Pediatric Glaucoma

Can babies really have glaucoma?

Yes. Primary congenital glaucoma may be present at birth or develop during infancy or early childhood. It results from abnormal development of the eye’s drainage system.

How rare is congenital glaucoma?

It is rare. AAPOS and the National Eye Institute estimate that primary congenital glaucoma occurs in roughly 1 in 10,000 births in Western populations/the United States.

What are the warning signs of glaucoma in a baby?

The classic warning signs are excessive tearing, strong sensitivity to light and frequent eyelid squeezing. The cornea may also appear enlarged or cloudy.

My baby’s eye waters constantly. Does that mean glaucoma?

Usually not. Blocked tear ducts are much more common. Tearing accompanied by significant light sensitivity, a cloudy cornea or an unusually large eye is more concerning for glaucoma and should be evaluated.

Can glaucoma make a baby’s eye bigger?

Yes. Elevated pressure can stretch the flexible tissues of a young eye, causing enlargement of the eye and cornea.

Is pediatric glaucoma treated with eye drops?

Sometimes, but primary congenital glaucoma usually requires surgery. Drops can be used before or after surgery and are also important in some forms of juvenile and secondary glaucoma.

What surgery is used for congenital glaucoma?

Angle procedures such as goniotomy or trabeculotomy are commonly used as initial surgery for primary congenital glaucoma. More complex cases may require additional procedures, including glaucoma drainage devices.

Why does my child need an exam under anesthesia?

Babies and young children sometimes cannot provide sufficiently accurate measurements in the office. An examination under anesthesia allows the ophthalmologist to carefully measure pressure and evaluate structures such as the cornea, drainage angle and optic nerve.

Can childhood glaucoma be cured?

Some children achieve excellent long-term pressure control, but continued surveillance is still important because pressure and other findings can change as the child grows.

Can glaucoma come back after surgery?

Pressure can rise again after previously successful treatment. Some children require additional medication or surgery later in childhood.

Can children develop glaucoma after cataract surgery?

Yes. Glaucoma is an important long-term complication after pediatric cataract surgery, particularly when surgery occurs during infancy. These children require ongoing monitoring.

Can steroids cause glaucoma in a child?

Yes. Some children experience increased eye pressure with steroid medication. Children requiring prolonged steroid treatment may need appropriate eye-pressure monitoring.

Is pediatric glaucoma hereditary?

Some forms can be inherited, including some cases of primary congenital and juvenile glaucoma. Genetic evaluation may be recommended depending on the diagnosis and family history.

Does glaucoma cause amblyopia?

Glaucoma can contribute to amblyopia by causing unequal vision, corneal clouding or significant refractive differences between the eyes. Some children need glasses or patching in addition to glaucoma treatment.

Does pediatric glaucoma cause blindness?

Severe or untreated glaucoma can cause permanent vision loss. Early diagnosis, appropriate pressure control and long-term follow-up provide the best opportunity to preserve vision.

Trusted Resources & Family Support

Pediatric Glaucoma & Cataract Family Association
A parent-and-professional organization focused specifically on children with glaucoma and cataracts. It provides education, family resources and peer support for families managing these uncommon childhood eye conditions.
Pediatric Glaucoma & Cataract Family Association

Children’s Glaucoma Foundation
A nonprofit dedicated specifically to childhood glaucoma, with information for families as well as support for research, physician education and programs benefiting children with glaucoma.
Children’s Glaucoma Foundation

Childhood Glaucoma Research Network
An international network of physicians and scientists focused specifically on pediatric glaucoma research, education and improving treatment. It also provides information about childhood glaucoma and the specialists and research community working in this area.
Childhood Glaucoma Research Network

Glaucoma Research Foundation – Childhood Glaucoma
Provides parent-friendly information about congenital and childhood glaucoma, including symptoms, causes and treatment.
Childhood Glaucoma Information

Connecting With Other Families

Families dealing with a rare condition such as congenital glaucoma often find it helpful to connect with parents who have faced similar surgeries, medications and long-term follow-up.

The Pediatric Glaucoma & Cataract Family Association offers family support and maintains social-media communities for parents and caregivers.