1 MR SHOJA MD Shahid sadoughi Medical School

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MR SHOJA. MD Shahid sadoughi Medical School 2

INTERNATIONAL CENTRE FOR EYE HEALTH TEACHING SET NO. 4 PREVENTION OFCHILDHOOD BLINDNESS . Causes of Childhood Blindness 3

Cloudy Cornea in infancy Gonococcal keratitis. Congenital Corneal Diseases. Obstetrical Forceps Trauma. Congenital Gluacoma. 4

Birth Trauma : (Forceps injury ) 5

6 Horizontal Tear in Descemet M in Congenital Glaucoma

Sclero Corneal Dermoid Aniridia Congenital Rubella 7

MUCOPOLYSACCHARIDOSE 8

CYSTINOSIS KAYSER FLEISHER RING 9

Peter, s anomaly 10

Congenital Hereditary Endothelial Dystrophy (CHED) Endothelial dysfunction. Increased cornea thickness. Cornea is edematous & bluish. IOP is normal. Primary treatment is keratoplasty 11

Macro Cornea 13 mm horizontal diameter X-linked reccessive pattern 90% patients are male No Cornea clouding , photophobia Microcornea 12

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. 13

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 14

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 15

Cloboma of Iris Occur in inferonasal Iris. Microphthalmia is common. Cloboma of retina & choroid. VA ranges is low. 16

Stromal Dystrophies Granular Macular Lattice 17

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 18

INTERNATIONAL CENTRE FOR EYE HEALTH TEACHING SET NO. 4 PREVENTION OFCHILDHOOD BLINDNESS Congenital Glaucoma 19

Clinical Triad 1 - Epiphora 2 - Photophobia 3 – Blepharospasm 20

Signs : F C C C Elevated IOP Cloudy corneal Buphthalmos Optic nerve cupping Descemet, s membrane tear Increased axial length blunt trauma. hyphema Rupture of globe 21

Congenital Glaucoma. All infants with cloudy corneas must be evaluated for Congenital Glaucoma. ôGeneral practitioners especially obstetricians and paediatricians should know importance of early referral and intervention of congenital glaucoma. ôSporadic but mutation found in the CYPIBI gene on chromosome 2 p 21. 22

Systemic conditions with Glaucoma Aniridia Retinopathy of prematurity Neuro fibromatosis Sturge weber syndrome Congenital Rubella 23

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 Ig. M antibody against rubella. Extreme inflammation post-op Complete removal of lens material. 24

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. 25

How Is Glaucoma Treated? n Medications – Prostaglandin analogs – Beta blockers – Alpha agonists – Carbonic anhydrase inhibitors – Cholinergic agents Laser therapy n Surgery n 26

Causes of Visual Loss in Congenital Glaucoma Optic never damage Corneal opacities Corneal astigmatism Surface irregularitis Amblyopia 27

Anti Glaucoma Drops 28

TRABECULOTOMY-GONIOTOMY 29

Differential Diagnosis of Congenital Glaucoma Axial myopia primary megalocornea CORNEAL FINDINGS slerocornea congenital hereditary endothelial dystrophy Keratitis cystinosis birth trauma EPIPHORA Nasolacrimal duct obstruction 30

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Clinical presentation Rapid onset of painn Conjunctival injection (Redness)n Photophobian Decreased visionn Discharge and lid edeman 32

Ocular infections 33

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 1 year 10 -11. 5 12. 0 -12. 5 20. 1 >22. 5 2 year 11. 5 -12 12. 5 -13. 0 21. 3 >23 34

THANKS FOR YOUR ATTENTION 35

Complete Ocular Examination Slit lamp Exam Retinoscopy Gonioscopy Tonometry Measurment of corneal diameter Optic Never evaluation Follow -up Evaluation (4 -6 weeks) 36

Aqueous Outflow Pathway 37