2020–2021 BCSC Basic and Clinical Science Course™
Chapter 11: Glaucoma in Children and Adolescents
Evaluating the Pediatric Glaucoma Patient
Evaluation of a pediatric glaucoma patient differs from examination of an adult glaucoma patient. Ophthalmologists should proceed with an orderly system of examination and have the appropriate equipment for evaluating infants and young children in both the office and the operating room (Table 11-10). For examinations under anesthesia (EUAs), efficiency in measuring and recording data in the operating room is optimized by having all necessary equipment ready and gathered in a single place (Fig 7-11). Time under anesthesia should be minimized as much as possible. The effects of general anesthesia on the developing brain are unclear but are currently under study in a number of multicenter randomized studies.
Table 11-10 Supplies Needed for Examining Children Under Anesthesia
Figure 11-7 Photograph of a cart prepared for an examination under anesthesia (EUA) that contains all handheld instruments needed to perform a complete pediatric glaucoma examination in one place.
(Courtesy of JoAnn A. Giaconi, MD.)
When evaluating an infant, the ophthalmologist should ask the caregiver whether the baby is fussy or irritable, whether the child is not feeding well or is losing weight, and whether the baby cries when taken outside into sunshine. It is important to elicit the caregiver’s observations regarding any corneal clouding, specifically as to whether the clouding is intermittent or constant.
For evaluation of school-aged children, the ophthalmologist should inquire about the results of school vision screenings, changes in academic performance, and complaints about trouble seeing in the classroom. A complete record of the patient’s history includes the names of any previous physicians who have been consulted; all prior ocular and systemic medical and surgical treatments; any family history of congenital glaucoma and other ocular and systemic disorders; medication use (with particular attention to all forms of steroids); and allergies.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.