Glaucoma diagnosis,  Gonioscopy, retinal examination, visual activity

Glaucoma diagnosis, Glaucoma, Gonioscopy, retinal examination, visual activity

Glaucoma diagnosis, Gonioscopy, retinal examination, visual activity

The typical infant who has congenital glaucoma usually is initially referred to an ophthalmologist because of apparent corneal edema.

The commonly described triad of epiphora (excessive tearing), blepharospasm and photophobia may be missed until the corneal edema becomes apparent.[2]


The diagnosis is clinical. The intraocular pressure (IOP) can be measured in the office in a conscious swaddled infant using a Tonopen or hand-held Goldmann tonometer.

Usually, the IOP in normal infants is in the range of 11-14 mmHg.[2] Buphthalmos and Haab’s striaecan often be seen in case of congenital glaucoma.


Some pedigrees suggest inherited primary congenital is autosomal dominant but three major autosomal recessive loci have been identified:

  • GLC3A – on chromosome 2 (2p21)
  • GLC3B – on chromosome 1 (1p36)
  • GLC3C – on chromosome 14 (14q24.3)

Differential diagnosis[edit]

Corneal cloudiness may have a myriad of causes. Corneal opacity that results from hereditary dystrophies is usually symmetric.

Corneal enlargement may result from megalocornea, a condition in which the diameter of the cornea is larger than usual and the eye is otherwise normal.

Systemic associations[edit]

Two of the more commonly encountered disorders that may be associated with congenital glaucoma are Aniridia and Sturge-Weber syndrome.


The preferred treatment of congenital glaucoma is surgical not medical.

The initial procedures of choice are goniotomy or trabeculotomy if the cornea is clear, and trabeculectomy ab externo if the cornea is hazy.

The success rates are similar for both procedures in patients with clear corneas. Trabeculectomy and shunt procedures should be reserved for those cases in which goniotomy or trabeculotomy has failed.

Cyclophotocoagulation is necessary in some intractable cases but should be avoided whenever possible because of its potential adverse effects on the lens and the retina.[3]


In the United States, the incidence of primary congenital glaucoma is about one in 10,000 live births. Worldwide, the incidence ranges from a low of 1:22,000 in Northern Ireland to a high of 1:2,500 in Saudi Arabia and 1:1,250 among Gypsies in Romania.

In about two-thirds of cases, it is bilateral. The distribution between males and females varies with geography.

In North America and Europe it is more common in boys, whereas in Japan it is more common in girls.[4]

Congenital glaucoma
  • Incidence: one in every 10000-15000 live births.
  • Bilateral in up to 80% of cases.
  • Most cases are sporadic (90%). However, in the remaining 10% there appears to be a strong familial component.


Glaucoma is a difficult disease because there may not symptoms to warn you that you may have it. The most common type of glaucoma, Primary Open Angle Glaucoma, has virtually no symptoms and no pain. At times vision loss begins with your peripheral, or side vision, but you may compensate for this involuntarily by turning your head to the side and not notice anything until substantial vision is lost. Half the people who have glaucoma may not know they have it.glaucoma-example___Source

An eye exam may be used to diagnose glaucoma. The doctor will need to examine the inside of the eye by looking through the pupil, often while the pupil is dilated. The doctor will usually perform a complete eye exam.

Checking the intraocular pressure alone (tonometry) is not enough to diagnose glaucoma because eye pressure changes. Pressure in the eye is normal in about 25% of people with glaucoma. This is called normal-tension glaucoma. There are other problems that cause optic nerve damage.


  • Gonioscopy (use of a special lens to see the outflow channels of the angle)
  • Tonometry test to measure eye pressure
  • Optic nerve imaging (photographs of the inside of the eye)
  • Pupillary reflex response
  • Retinal examination
  • Slit lamp examination
  • Visual acuity
  • Visual field measurement

To schedule an eye exam click here or call 1-800 EYECARE. Early detection and treatment is crucial for protecting your vision.