Visão geral e aspectos clínicos do glaucoma em bebês e crianças

Abstract

Introduction: Glaucoma represents a heterogeneous group of ocular diseases with progressive optic neuropathy, manifested by excavation of the optic disc and generally associated with increased intraocular pressure (IOP). It can lead to damage to the optic nerve and consequent visual loss. Loss of peripheral vision occurs first, but if glaucoma is left untreated, it can lead to loss of central vision and complete blindness. In infants and young children, additional damage to the visual system may occur, including large and potentially asymmetrical refractive error, corneal edema or scarring, astigmatism, strabismus, and amblyopia. Early diagnosis and referral are crucial to ensure an ideal visual outcome. Objective: understand the overview of glaucoma in babies and children. Methodology: Literature review from Scielo, PubMed and VHL databases, from March to May 2024, with descriptors “glaucoma”, “management”, “babies”, and “children”, registered in DeCS/MeSH and operator “AND”. Articles from 2019-2024 (total 181) were included, excluding other criteria and choosing 5 full articles. Results and Discussion: Glaucoma can be classified according to the anterior chamber angle (open/closed) and primary/secondary. Open-angle is the most common in children and adults, with progressive loss of the peripheral visual field followed by loss of the central field in a typical pattern. When primary, there is isolated angular malformation (trabeculodysgenesis), which is rare in childhood and begins in the first years of life. The age at which symptoms first appear is likely related to the severity of angular dysgenesis. If juvenile, it appears after 4-5 years of age. They are usually asymptomatic and damage to the optic nerve is hidden. The diagnosis is made by damage to the optic nerve on fundus examination typically in the presence of elevated IOP and visual field deficit. In most cases, there is a positive family history. Surgical intervention is the therapeutic basis and medications are adjuvants. The frequency of follow-up depends on the severity. When secondary, it is acquired or related to the underlying ocular abnormality, at any age and may be present at birth (e.g. tumors, trauma, glucocorticoids, retinopathy of prematurity). The diagnosis is confirmed with fundus examination, tonometry and campimetry. Conclusion: Glaucoma is the second leading cause of blindness in the world. Optic neuropathy does not always present with increased intraocular pressure, which can delay diagnosis. Early recognition and diagnosis is important, as well as follow-up with an ophthalmologist in childhood.