Symptoms of primary congenital glaucoma
Lachrymation, photophobia and blepharospasm form a classical triad. Usually, children with congenital glaucoma prefer a semi-darkness and avoid being in the bright light. Mark excessive lacrimation. In the case of a one-sided lesion, the mother may notice asymmetry in the eyes of the child, an increase (the affected side) or a decrease (the normal side) of the size of the eyes.
The normal horizontal diameter of the cornea in full-term newborns is 10-10.5 mm. It increases to an adult size (approximately 11.5-12 mm), to two years. The diameter of the cornea in the newborn more than 12 mm indicates a high probability of congenital glaucoma.
Corneal opacities, descemet membrane ruptures (Haab striae), deep anterior chamber, intraocular pressure above 21 mm Hg, hypoplasia of the iris stroma, isolated trabeculodysgenesis in gonioscopy, an increase in the excavation of the optic nerve disk can also be detected. The Haab strata can be single or multiple, they are usually oriented horizontally or concentrically to the limb.
Evaluation of the optic nerve disc is a key moment in the diagnosis of glaucoma. Glaucomatous disc changes occur in infants faster and against a background of lower intraocular pressure than in adolescents and adults. The ratio of excavation area to the area of the optic nerve disk is more than 0.3 in normal infants rarely, indicating a high probability of glaucoma development. The same is evidenced by the asymmetry of wheel excavations, especially the difference of more than 0.2 between two eyes. Glaucomatous excavation in form can be oval, but more often it is round, located in the center. After normalization of intraocular pressure, the recovery of the excavation to the initial state is observed.
To establish an accurate diagnosis and the appointment of an adequate treatment, it is necessary to assess the angle of the anterior chamber of the eye. Developmental anomalies can be present in two basic forms: a flat attachment of the iris, in which the iris is attached directly or anteriorly from the trabecular network, its processes can be thrown over the scleral spur, and the convex attachment of the iris, in which it is visible behind the trabecular network, but covered with a dense an abnormal tissue. For comparison, a photograph of the gonioscopic picture of the normal angle of the baby's anterior chamber is presented.
An increase in intraocular pressure leads to a strong increase in the eyeball with a progressive thickening of the cornea in children under 3 years of age. With the increase in the cornea, its stretching leads to rupture of the descemet membrane, edema of the epithelium and stroma, and also to the opacity of the cornea. The stretching of the iris leads to a thinning of the stroma. The scleral canal through which the optic nerve passes also increases with increasing intraocular pressure, which leads to a rapid increase in the excavation of the optic nerve disc, which quickly returns to its original state with the normalization of intraocular pressure. In adults, such rapid recovery of excavation size does not happen, probably because of the greater elasticity of the connective tissue of the nipple of the optic nerve in infants. If intraocular pressure can not be controlled, a bufalm can develop.