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MR SHOJA.MD
Shahid sadoughi
Medical School
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INTERNATIONAL CENTRE FOR EYE HEALTH
TEACHING SET NO.4 PREVENTION OFCHILDHOOD BLINDNESS
. Causes of Childhood Blindness
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Cloudy Cornea in infancy
Gonococcal keratitis.
Congenital Corneal Diseases.
Obstetrical Forceps Trauma.
Congenital Gluacoma.
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Birth Trauma :
(Forceps injury )
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Horizontal Tear in Descemet M in Congenital Glaucoma
Sclero Cornea
Corneal Dermoid
Aniridia
Congenital
Rubella
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MUCOPOLYSACCHARIDOSE
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CYSTINOSIS
KAYSER FLEISHER
RING
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Peter,s anomaly
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Congenital Hereditary
Endothelial Dystrophy (CHED)
Endothelial dysfunction .
Increased cornea thickness.
Cornea is edematous & bluish.
IOP is normal .
Primary treatment is
keratoplasty
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Macro Cornea
13 mm horizontal diameter
X-linked reccessive pattern
90% patients are male
No Cornea clouding , photophobia
Microcornea
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Keratoglobus
Cornea is thinner
Deep anterior chamber
Spontaneous break in descemet,s M
Cornea easily ruptured by truma.
Part of Ehlers-Danols type 6 syndrome
Paitient should wear protective lens.
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Keratoconus
Bilateral , twice in female
Central , paracentral thining.
Irregular myopic astigmatism.
Chronic eye rubbing is a factor
VKC is a risk factor .
Common in Down ,Osteogenesis imperfecta
Rapid progression occur in teanager
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Acute keratoconus
(Hydrops)
Common in Down, s syndrome
Result from ocular message
Often at night,extremely painful
Rupture in Descemet,s membrane
Deep opacity at apex of cone
If hydrops happens, don’t lose
heart
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Cloboma
of Iris
Occur in inferonasal Iris.
Microphthalmia is common.
Cloboma of retina & choroid .
VA ranges is low.
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Stromal Dystrophies
Granular
Macular
Lattice
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Primary Congenital
Glaucoma
Incidence in USA is 1:10000
Incidence in Saudia Arabic is 1:2500
75% have bilateral involvement
Occurs in 65% of male ,reccessive pattern
60% occur before 6 months
80% by 1 year of age
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INTERNATIONAL CENTRE FOR EYE HEALTH
TEACHING SET NO.4 PREVENTION OFCHILDHOOD BLINDNESS
Congenital Glaucoma
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Clinical Triad
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- Epiphora
- Photophobia
3 – Blepharospasm
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Signs :
Elevated IOP
 Cloudy corneal
 Buphthalmos
 Optic nerve cupping
 Descemet,s membrane tear
 Increased axial length

blunt trauma .
hyphema
Rupture of globe
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Congenital
Glaucoma.
All infants with cloudy corneas must be
evaluated for Congenital Glaucoma .
General practitioners especially
obstetricians and paediatricians should
know importance of early referral and
intervention of congenital glaucoma.
Sporadic but mutation found in the
CYPIBI gene on chromosome 2 p 21.
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Systemic conditions with
Glaucoma
Aniridia
Retinopathy of prematurity
Neuro fibromatosis
Sturge weber syndrome
Congenital Rubella
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Congenital Rubella Syndrome
Invasion of lens by virus ( first trimister)
Dense bilateral nuclear Cataract
PDA,deafness & mental retardation
Immature & poorly dilated Iris ,Microcornea.
1/3 hazy cornea due to Keratitis & Glaucoma
Elevated infant IgM antibody against rubella.
Extreme inflammation post-op
Complete removal of lens material.
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Treatment
Poor if present at birth
Poor if corneal diameter is> 14 mm
50% becomes legally blind
favourable prognositic group
onset 3-12 months
Amblyopia is major problems
Treatment is not sought until considerable
damage has already occurred.
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How Is Glaucoma
Treated?
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Medications
– Prostaglandin analogs
– Beta blockers
– Alpha agonists
– Carbonic anhydrase inhibitors
– Cholinergic agents
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
Laser therapy
Surgery
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Causes of Visual Loss in Congenital Glaucoma
Optic never damage
Corneal opacities
Corneal astigmatism
Surface irregularitis
Amblyopia
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Anti Glaucoma Drops
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TRABECULOTOMY-GONIOTOMY
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Differential Diagnosis of
Congenital Glaucoma
Axial myopia
primary megalocornea
CORNEAL FINDINGS
slerocornea
congenital hereditary endothelial dystrophy
Keratitis
cystinosis
birth trauma
EPIPHORA
Nasolacrimal duct obstruction
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Clinical
presentation
Rapid onset of pain
Conjunctival injection (Redness)
Photophobia
Decreased vision
Discharge and lid edema
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Ocular
infections
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Corneal Dismeters and Axial Lengths for
Glaucoma
Corneal Diameters
Age
Normal
Possible Glaucoma
Axial Length (mm)
normal
Glaucoma
Newborns
9.5-10.5
11.5-12.5
16-17
>20
1year
10-11.5
12.0-12.5
20.1
>22.5
2year
11.5-12
12.5-13.0
21.3
>23
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THANKS FOR YOUR ATTENTION
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Complete Ocular Examination
Slit lamp Exam
Retinoscopy
Gonioscopy
Tonometry
Measurment of corneal diameter
Optic Never evaluation
Follow -up Evaluation (4-6 weeks)
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Aqueous Outflow Pathway
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