Glaucoma is caused by higher-than-normal pressure inside the eyeball, which damages the optic nerve and retina, resulting in gradual loss of vision. In infants and children, this can also cause eye enlargement, clouding of the front surface of the eye, and lazy vision (amblyopia). Pediatric glaucoma can be treated with a combination of eye medicines and eye surgery designed to lower the pressure by allowing more eye fluid to escape (“opening the drain”) or by allowing less eye fluid to be created (“closing the faucet”). Your child may need frequent visits to measure eye pressure or to treat lazy vision with eyeglasses and eye patching
Pediatric Glaucoma Eye Surgery
Your Pediatric ophthalmologist, Dr. Packwood, Norman, or Hunt, will carefully consider whether your child will benefit most from glaucoma surgery or further treatment with medications. Eyeglasses or eye patching may be used in cases accompanied by lazy vision.
Glaucoma surgery is usually performed as an outpatient procedure, and serious complications are unusual. These include severe bleeding or scarring inside the eye, infection, detachment of the retina and complete loss of vision, or severe anesthetic reaction. Glaucoma surgeries performed by an experienced pediatric eye surgeon are considered safe and effective.
Problems Related to Glaucoma
Pediatric glaucoma is more difficult to treat than glaucoma in adults. Re-operations on children with glaucoma are the rule rather than the exception. Some children require only one or two surgeries, but in severe cases, 10 or more operations may need to be performed, spaced months to years apart.
Lazy vision (amblyopia) occurs in up to 90% of infants and children with glaucoma, and will need to be treated with glasses (or contact lenses) and eye patching. Amblyopia is usually caused by clouding of the front of the eye or unequal focusing.
Eye crossing (strabismus) and eye wiggling (nystagmus) occur in up to 50% of children with glaucoma. These can often be corrected or significantly improved with eye muscle surgery.
Clouding of the eye lens (cataract) occurs in 20% of children with glaucoma. If the cataract becomes dense, cataract surgery will need to be performed and contact lenses or glasses worn. About 5% of children with glaucoma will also require a corneal transplant, due to clouding of the front clear covering of the eye.
What to Expect
On the night before surgery, don’t give your child food or milk after midnight. Medicines may be taken with sips of water. Only apple juice and water may be taken up to three hours before the admission time. See the Hospital Pre-Op page.
If your child is acutely ill (has a fever, deep cough or vomiting) in the days before surgery, please call us at (817) 529-9949.
The time of day you’ve been given for the operation is tentative and may need to be changed on the day of surgery. In general, patients are taken by age, with the youngest going first.
The anesthesia doctor may order a preoperative oral sedative. A young child will be put to sleep within seconds by breathing gas from a mask held near his or her face. An intravenous (IV) line and a breathing tube (endotracheal tube) are placed only after the child is asleep, and the breathing tube is removed before he or she is fully awake. Children age 13 or older who are not unduly frightened may be given an IV line of sedatives beforehand. Depending on the special needs or medical condition of a patient, the anesthesiologist may slightly alter the routine.
After your child is fully asleep in the operating room, the pediatric eye surgeon will perform microsurgery using specialized instruments and high power microscopes. The surgery may take one of several forms:
- We may insert tubes to create new drainage channels at the far edges of the iris (colored part of the eye), allowing the escape of natural fluid created inside the front chamber of the eye.
- We may use lasers to turn off some of the cells that create the fluid.
- We may use an incision technique to open normal drainage channels.
At the end of surgery, the eye is bandaged shut for one night. The entire process usually takes about 60 minutes, although this may vary from 45 minutes to 2 hours depending on the complexity of the case. Dr. Packwood, Norman or Hunt will find you to discuss the operation immediately afterward.
There may be mild discomfort from the surgery, and mild nausea is common. The nurses will treat any discomfort with appropriate medication and possibly Tylenol. Before you leave, we’ll schedule a postoperative exam for the next day, and provide a patch and shield to protect your child’s eye until then. We discharge most patients within two to three hours after surgery.
The nurse may give you eye drops or ointment to help healing and prevent infection in the first 4-6 weeks after surgery. When giving the medicines, do not apply pressure on the eyeball itself.
Your child can resume limited activities the day after surgery. Younger children often play within hours after surgery, though some children may be tired, grouchy or nauseated for a day or two. We discourage rough play for the first week after surgery. Your child should avoid submerging his or her eyes in a bath or swimming pool for 7 to 10 days after surgery. Bathing, showering and washing of the hair with the eye gently closed (with care not to splash water directly in the eye) won’t interfere with healing. Redness of the eye usually disappears in a few weeks. Your child can return to day care or to school within days after surgery.
Eye shield and eyeglasses
In the first weeks after glaucoma surgery, your child’s eye will need protection from possible injury. An eye shield will provide this at night and naptime for about two weeks. Eyeglasses or a shield will protect the eye during waking hours.
On Follow-Up Exams
The Surgery Scheduler will set up a time for a short check-up the day after surgery. This information will be mailed out to you before the surgery, with any other important information. If you have questions regarding this, you may call the Surgery Scheduler at (817) 529-9949.
We may also need to arrange a brief examination under anesthesia in the weeks after glaucoma surgery. This allows us to make precise measurements and to ensure the healing process is continuing normally.