JAN 28, 2016
By Beth Edmunds, MD, PhD; Allison Loh, MD; Cecilia Fenerty, MD, FRCS, FRCOphth; Maria Papadopoulos, MD
Secondary childhood glaucoma refers to glaucoma developing as a result of another ocular or systemic anomaly. These anomalies may be present at birth, which places them in the “non-acquired ocular anomalies” section of the childhood glaucoma classification (see Glaucoma: Definitions and Classification), or develop later in childhood, in which case they are referred to as “acquired.” Elevated intraocular pressure (IOP) in this context is referred to as secondary ocular hypertension (OHT), unless there is evidence of end-organ damage (disc cupping, visual field [VF] defects, or enlargement of the globe in younger children), in which case it becomes secondary glaucoma. The term glaucoma is used somewhat loosely in the secondary glaucoma section and refers to OHT as much as glaucoma, since they form a continuum resulting from the same underlying condition. These glaucomas can be further classified into open angle (> 50% angle open) or angle closure (<50% open or acute angle closure). There are many underlying mechanisms leading to open-angle or angle-closure glaucoma in these conditions, and more than one mechanism may contribute to the development of glaucoma or to its progression.
In general, consistently elevated intraocular pressure (IOP) should be treated. Medications are usually the initial treatment, followed by surgery. Clinicians should consider spectacle correction and amblyopia therapy when indicated. Children with conditions known to have systemic associations should be referred to a pediatrician or relevant specialist for assessment. Family screening is important for conditions with autosomal dominant inheritance.