Congenital / Developmental Glaucoma



  • Due to failure or abnormal developmental of the trabecular meshwork.
  • The iris may not be completely spared from cornea so that the angle remains closed by persistent embryonic tissue.
  • If glaucoma is present at birth or within 3-4 years after birth it is called congenital or infantile glaucoma
  • When it is present b/w 3-10 years it is c/d Juvenile glaucoma.
  • Congenital glaucoma may or may not be associated with other syndrome.
  • Accordingly congenital glaucoma is classified as following:

1. Primary congenital/ Developmental glaucoma:

  • Except for glaucoma there is no other ocular or systemic anomaly.
  1. Congenital: Disease manifests at birth or within one month.
  2. Infantile: Presents b/w one month to 3-4 years of age.
  3. Developmental or Late congenital or Juvenile: Presents b/w 4-10 years of age.

2. Secondary congenital Glaucoma: 

  • Glaucoma associated with ocular anomalies & systemic syndrome.
  • Aniridia
  • iridocorneal dysgenesis
  • Struge-weber syndrome
  • Von-Recklinghausen’s neurofibromatosis
  • Lowe’s syndrome
  • congenital microcornea 
  • Rubella syndrome


  • Disease is bilateral
  • Boys affected more than girls.

Common symptopms are:

  1. photophobia, blepharospasm
  2. lacrimation & eye rubbing

On examination following findings are there:

  1. First sign is corneal edema with watering of eye with marked photophobia
  2. Haab striae (Discrete corneal opacities appear as lines with double contour due to rupture in Descemet’s membrane)
  3. Cornea is hazy with frosted glass appearance.
  4. Corneal enlargement
  5. Thin & blue sclera
  6. Deep anterior chamber
  7. Lens is antero-posterior flat & may be subluxated backward.
  8. Iridodonesis (tremulous iris) & atrophic patch on iris.
  9. Large eye (Buphthalmos or hydrophthalmos)
  10. Variable cupping & atrophy of disc
  11. Raised IOP (niether acute nor marked)
  12. Axial myopia due to increased axial length which may give rise to anisometropic amblyopia.


  • Initial treatment is often surgical.
  • A drainage angle surgery is often recommended for congenital glaucoma.

Surgical procedures used are:

  1. Goniotomy
  2. Trabeculotomy→ can be performed with corneal clouding
  3. Trabeculectomy
  4. Combined trabeculotomy & trabeculectomy
  • Medications are not very effective.
  • IOP is lowered by use of hyperosmotic agents
  • Acetazolamide & beta blockers till surgery is taken up.

Exam Important

  • Congenital glaucoma presents as Photophobia.
  • Incidence of congenital glaucoma is 1 in 10,000 births.
  • In buphthalmos, lens is Anteroposterior flat.
  • Habbs striae are seen in Buphthalmos.
  • Photophobia in an infant could be due to Buphthalmos.
  • Most common symptom in buphthalmos is Lacrimation.
  • Initial treatment of buphthalmos is Goniotomy.
  • The treatment of congenital glaucoma is Trabeculotomy with trabeculectomy.
Don’t Forget to Solve all the previous Year Question asked on CONGENITAL / DEVELOPMENTAL GLAUCOMA

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