[Secondary glaucoma in childhood uveitis]

Abstract

Ocular hypertension and secondary glaucoma are frequent and challenging complications in childhood uveitis. They are commonly found in patients with panuveitis or anterior uveitis and are often associated with juvenile idiopathic arthritis. Angle closure is rare, while secondary open angle glaucoma accounts for the majority of cases and often continues after the acute inflammation has healed. Monitoring should include tonometry, perimetry, and the objective assessment of the optic disc and nerve fibre layer. First-line therapy should consist of topical carbonic anhydrase inhibitors, followed by beta blockers, and then the alpha-2 agonists. Topical therapy must be monitored closely, as drug-related systemic side effects may preferentially occur in children. Because topical therapy in children is commonly ineffective, surgical interventions are often required. Reports on the use of trabeculectomy, goniosurgery, glaucoma drainage devices, and cyclodestructive procedures show higher failure rates than when used for primary open angle glaucoma in adults.