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Primary Congenital Glaucoma (cont.)

What Exams and Tests Do Health-Care Professionals Use to Diagnose Primary Congenital Glaucoma?

Depending on the child's age and level of cooperation, some of the examination can be performed in the office. In infants, the examination is often less challenging if performed when the infant is relaxed or drowsy, such as during feeding or shortly after.

In most cases, additional examination and testing will need to be performed under sedation or anesthesia, and arrangement can be made to treat at the time of diagnosis.

The ophthalmologist begins by asking the caregivers about duration of the child's symptoms and any known family history of glaucoma or other eye disorders. The following tests are performed in the office and/or in the operating room:

  • Vision is checked. In an infant, this may be limited to checking if he/she can fixate on an object and follow a moving object with the eyes.
  • Refraction is measured. This is a measurement of nearsightedness, farsightedness, or astigmatism. In PCG, the high eye pressure can produce nearsightedness (myopia) resulting from an increase in the eye's length and astigmatism resulting from scarring or swelling of the cornea.
  • Tonometry to measure the eye pressure: This measurement of the eye's size determines if it is enlarged (buphthalmos). The diameter of the cornea is measured using calipers, and the length of the eye is measured using A-scan ultrasound. Examination of the cornea checks for cloudiness and small breaks on the back layer (called Haab's striae) that are sometimes present when the cornea is stretched under high eye pressure. A measure of the cornea's thickness (pachymetry) might also be done.
  • Direct visualization of the trabecular meshwork: This is called gonioscopy and is performed with special contact lenses and mirrors. This test is important to determine if the angles (the area where the trabecular meshwork is located) are open, narrowed, or closed, and if other conditions such as scar tissue in the angle are present.
  • The optic nerves are carefully examined (using ophthalmoscopy) to look for signs of glaucomatous optic nerve damage. This may require dilation of the pupils to ensure an adequate view.
    • Fundus photographs, which are pictures of the optic nerve, may be taken for future reference and comparison.
Medically Reviewed by a Doctor on 7/8/2016
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Read What Your Physician is Reading on Medscape

Glaucoma, Primary Congenital »

By definition, primary congenital glaucoma is present at birth; however, its manifestations may not be recognized until infancy or early childhood.

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