Juvenile Glaucoma 

  • Author: David Sellers Walton, MD; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Nov 17, 2011
 

Background

Juvenile glaucoma is a rare juvenile-onset open-angle glaucoma (JOAG) often found associated with myopia that shows autosomal dominant transmission. This entity does not include other childhood glaucomas outlined below in the listing of other primary developmental and secondary childhood glaucomas.

Primary developmental glaucomas

Primary congenital glaucoma

  • Newborn primary congenital glaucoma
  • Infantile primary congenital glaucoma
  • Late-recognized primary congenital glaucoma

Autosomal dominant juvenile open-angle glaucoma

Primary angle-closure glaucoma

Primary glaucoma associated with systemic abnormalities

  • Sturge-Weber syndrome
  • Neurofibromatosis (NF-1)
  • Stickler syndrome
  • Oculocerebrorenal (Lowe) syndrome
  • Rieger syndrome
  • SHORT syndrome
  • Hepatocerebrorenal (Zellweger) syndrome
  • Marfan syndrome
  • Rubinstein-Taybi syndrome
  • Infantile glaucoma associated with retardation and paralysis
  • Oculodentodigital dysplasia
  • Open-angle glaucoma associated with microcornea and absent sinuses
  • Mucopolysaccharidosis
  • Trisomy 13
  • Duplication 3q syndrome
  • Trisomy 21 (Down syndrome)
  • Cutis marmorata telangiectatica congenita
  • Warburg syndrome
  • Kniest syndrome (skeletal dysplasia)
  • Michel syndrome
  • Nonprogressive hemiatrophy
  • PHACE syndrome
  • Sotos syndrome
  • Linear scleroderma
  • GAPO syndrome
  • Roberts pseudothalidomide syndrome
  • Wolf-Hirschhorn (4p-) syndrome
  • Robinow syndrome
  • Nail-patella syndrome
  • Cranio-cerebello-cardiac syndrome (3C syndrome)
  • Brachmann-de Lange syndrome
  • Rothmund-Thomson syndrome
  • 9p deletion syndrome
  • Phakomatosis pigmentovascularis (PPV)

Primary glaucoma associated with ocular abnormalities

  • Congenital pupillary-iris-lens membrane syndrome
  • Aniridia (congenital and acquired glaucoma)
  • Congenital ocular melanosis
  • Sclerocornea
  • Iridotrabecular dysgenesis
  • Peters syndrome
  • Congenital iris ectropion syndrome
  • Posterior polymorphous dystrophy
  • Idiopathic or familial elevated episcleral venous pressure
  • Anterior corneal staphyloma
  • Congenital microcoria with myopia
  • Congenital hereditary endothelial dystrophy
  • Congenital hereditary iris stromal hypoplasia
  • Axenfeld-Rieger anomaly

Secondary acquired glaucomas

Traumatic glaucoma

  • Acute glaucoma (angle concussion, hyphema, ghost cell glaucoma)
  • Late-onset glaucoma with angle recession
  • Arteriovenous fistula

Secondary to intraocular neoplasm

  • Retinoblastoma
  • Juvenile xanthogranuloma
  • Leukemia
  • Melanoma of ciliary body
  • Melanocytoma
  • Iris rhabdomyosarcoma
  • Aggressive nevi of the iris
  • Medulloepithelioma
  • Mucogenic glaucoma with iris stromal cyst

Secondary to chronic uveitis

  • Open-angle glaucoma
  • Angle-blockage glaucoma (synechial angle closure, iris bombé with pupillary block, trabecular endothelialization)

Lens-related glaucoma

  • Subluxation-dislocation and pupillary block (Marfan syndrome, homocystinuria, Weill-Marchesani syndrome, axial subluxation with progressive high myopia)
  • Spherophakia and pupillary block
  • Phacolytic glaucoma

Following lensectomy for congenital cataracts

  • Pupillary block
  • Chronic open-angle glaucoma following infantile lensectomy

Steroid-induced glaucoma

Secondary to rubeosis

  • Retinoblastoma
  • Coats disease
  • Medulloepithelioma
  • Familial exudative vitreoretinopathy
  • Chronic retinal detachment

Secondary angle-closure glaucoma

  • Cicatricial retinopathy of prematurity (ROP)
  • Microphthalmos
  • Nanophthalmos
  • Retinoblastoma
  • Persistent hyperplastic primary vitreous
  • Congenital pupillary-iris-lens membrane
  • Topiramate therapy
  • Ciliary body cysts
  • Following laser therapy for ROP

Malignant glaucoma

Glaucoma associated with increased venous pressure

  • Cavernous or dural A-V shunt
  • Orbital disease

Secondary to intraocular infection

  • Acute recurrent toxoplasmosis
  • Acute herpetic iritis
  • Endogenous endophthalmitis
  • Maternal rubella infection

Glaucoma secondary to undetermined etiology

  • Iridocorneal endothelial syndrome (ICE)
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Pathophysiology

Increased intraocular pressure (IOP) is caused by impaired outflow of aqueous humor through the trabecular meshwork into the Schlemm canal. On clinical examination, the filtration tissues appear normal in persons with juvenile glaucoma. Pathologic examination has found thickened tissue and abnormal deposit of extracellular tissue between the anterior chamber and the Schlemm canal.

Following recognition of linkage of the gene for juvenile glaucoma on chromosome 1 (band 1q21-q31), the gene itself was identified and related to mutations found in the trabecular meshwork inducible glucocorticoid response (TIGR) gene in patients with juvenile glaucoma. This gene, now called myocilin, codes for the glycoprotein myocilin that is found in the trabecular meshwork and other ocular tissues. The normal function of myocilin and its role in causing glaucoma is undetermined. In studies of consanguineous populations, Khan et al concluded that mutation in CYP1B1 rather than mutation in MYOC can sometimes underlie familial primary glaucoma.[1, 2]

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Epidemiology

Frequency

United States

Juvenile glaucoma is rare, with an estimated occurrence of 1 per 50,000 persons, when compared in frequency to other types of childhood glaucoma.

Mortality/Morbidity

No risk of mortality exists with juvenile glaucoma. Loss of vision is possible without early diagnosis and treatment.

Race

Juvenile glaucoma has been observed in Japanese, French, French Canadian, American, Panamanian, German, English, Irish, Danish, Italian, and Spanish families.

Sex

Juvenile glaucoma probably occurs with equal frequency and severity in males and females; however, a greater frequency in males has been observed.

Age

Patients with juvenile glaucoma show no evidence of congenital or infantile glaucoma. When candidate children are monitored carefully in families with a history of glaucoma, the onset of abnormal eye pressures occurs in children aged 5-10 years. Recognition of this glaucoma has occurred more often in adolescence or during the early adult years in sporadic patients.

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Contributor Information and Disclosures
Author

David Sellers Walton, MD  Clinical Professor of Ophthalmology, Harvard Medical School; Surgeon in Ophthalmology, Massachusetts Eye and Ear Infirmary; Assistant Pediatrician, Massachusetts General Hospital

David Sellers Walton, MD is a member of the following medical societies: American Academy of Ophthalmology, American Academy of Pediatrics, American Association for Pediatric Ophthalmology and Strabismus, and American Ophthalmological Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Gerhard W Cibis, MD  Clinical Professor, Director of Pediatric Ophthalmology Service, Department of Ophthalmology, University of Kansas School of Medicine

Gerhard W Cibis, MD is a member of the following medical societies: American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, and American Ophthalmological Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Martin B Wax, MD  Clinical Professor, Department of Ophthalmology, University of Texas Southwestern Medical School; Vice President, Ophthalmology Research and Development, Head, Ophthalmology Discovery Research, Alcon Labs, Inc

Martin B Wax, MD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Society for Neuroscience

Disclosure: Nothing to disclose.

Lance L Brown, OD, MD  Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

References
  1. Khan AO. Genetics of primary glaucoma. Curr Opin Ophthalmol. Sep 2011;22(5):347-55. [Medline].

  2. Khan AO, Al-Abdi L, Mohamed JY, Aldahmesh MA, Alkuraya FS. Familial juvenile glaucoma with underlying homozygous p.G61E CYP1B1 mutations. J AAPOS. Apr 2011;15(2):198-9. [Medline].

  3. Tawara A, Inomata H. Developmental immaturity of the trabecular meshwork in juvenile glaucoma. Am J Ophthalmol. Jul 15 1984;98(1):82-97. [Medline].

  4. Aponte EP, Diehl N, Mohney BG. Medical and surgical outcomes in childhood glaucoma: a population-based study. J AAPOS. Jun 2011;15(3):263-7. [Medline]. [Full Text].

  5. de Silva DJ, Khaw PT, Brookes JL. Long-term outcome of primary congenital glaucoma. J AAPOS. Apr 2011;15(2):148-52. [Medline].

  6. Alward WL, Fingert JH, Coote MA, Johnson AT, Lerner SF, Junqua D, et al. Clinical features associated with mutations in the chromosome 1 open-angle glaucoma gene (GLC1A). N Engl J Med. Apr 9 1998;338(15):1022-7. [Medline].

  7. Bruttini M, Longo I, Frezzotti P, Ciappetta R, Randazzo A, Orzalesi N, et al. Mutations in the myocilin gene in families with primary open-angle glaucoma and juvenile open-angle glaucoma. Arch Ophthalmol. Jul 2003;121(7):1034-8. [Medline].

  8. Gupta V, Dutta P, Ov M, Kapoor KS, Sihota R, Kumar G. Effect of glaucoma on the quality of life of young patients. Invest Ophthalmol Vis Sci. Oct 2011;52(11):8433-7. [Medline].

  9. Melamed S, Ashkenazi I. Juvenile-onset open angle glaucoma. In: Albert D, Jakobiec F, ed. Principles and Practice of Ophthalmology. Philadelphia: WB Saunders Co; 1994:1345-9.

  10. Puska P, Lemmela S, Kristo P, Sankila EM, Jarvela I. Penetrance and phenotype of the Thr377Met Myocilin mutation in a large Finnish family with juvenile- and adult-onset primary open-angle glaucoma. Ophthalmic Genet. Mar 2005;26(1):17-23. [Medline].

  11. Stone EM, Fingert JH, Alward WL, Nguyen TD, Polansky JR, Sunden SL, et al. Identification of a gene that causes primary open angle glaucoma. Science. Jan 31 1997;275(5300):668-70. [Medline].

  12. Tamm ER, Russell P. The role of myocilin/TIGR in glaucoma: results of the Glaucoma Research Foundation catalyst meeting in Berkeley, California, March 2000. J Glaucoma. Aug 2001;10(4):329-39. [Medline].

  13. Tsai JC, Chang HW, Kao CN, Lai IC, Teng MC. Trabeculectomy with mitomycin C versus trabeculectomy alone for juvenile primary open-angle glaucoma. Ophthalmologica. Jan-Feb 2003;217(1):24-30. [Medline].

  14. Wiggs JL, Del Bono EA, Schuman JS, Hutchinson BT, Walton DS. Clinical features of five pedigrees genetically linked to the juvenile glaucoma locus on chromosome 1q21-q31. Ophthalmology. Dec 1995;102(12):1782-9. [Medline].

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