eMedicine Specialties > Ophthalmology > Intraocular Pressure

Glaucoma, Juvenile: Treatment & Medication

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
Contributor Information and Disclosures

Updated: Feb 22, 2008

Treatment

Medical Care

Glaucoma medications may temporally control IOP. Often, a rising eye pressure over 1-3 years may become resistant to all medications and dictate a need for eye surgery.

Surgical Care

Operations found useful for adult-onset open-angle glaucoma are useful in juvenile glaucoma. In addition, goniotomy is an effective procedure for this disease in both children and adults.

Consultations

Consultation with an ophthalmologist familiar with this unusual glaucoma and rare condition may be helpful.

Activity

No limitations on activity are necessary. When vision remains only in one eye, protection of the remaining seeing eye is mandatory.

Medication

The goals of pharmacotherapy are to reduce morbidity and to prevent complications.

Beta-blockers

The exact mechanism of ocular antihypertensive action is not established, but it appears to be a reduction of inflow or aqueous humor production.


Timolol (Timoptic, Timoptic XE, Blocadren)

May reduce elevated and normal IOP, with or without glaucoma by inhibiting inflow. Used as 0.25% or 0.5% solution and applied topically to the eye 1-2 times per day.

Adult

1 gtt OU bid

Pediatric

1 gtt OU in morning

Adverse reaction may be intensified by simultaneous systemic administration of beta-blocker (eg, Inderal)

Documented hypersensitivity; bronchial asthma or reactive airway disease

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

May cause bradycardia, apnea, confusion, and asthma

Prostaglandin agonists

For reduction of IOP in patients intolerant to other IOP-lowering medications or who have failed to respond optimally to other IOP-lowering medications.


Latanoprost (Xalatan)

May decrease IOP by increasing outflow of aqueous humor.

Adult

1 gtt (1.5 mcg) in affected eye qd in evening; higher frequency administrations may decrease effectiveness

Pediatric

Not established

Coadministration with eye drops containing the preservative thimerosal may reduce effects (administer at intervals of 5 min between applications)

Documented hypersensitivity; signs of inflammation

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Do not administer while wearing contact lenses; may increase brown pigment in iris and gradually change eye color (unknown effect)

More on Glaucoma, Juvenile

Overview: Glaucoma, Juvenile
Differential Diagnoses & Workup: Glaucoma, Juvenile
Treatment & Medication: Glaucoma, Juvenile
Follow-up: Glaucoma, Juvenile
References
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References

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

  2. 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].

  3. 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].

  4. 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.

  5. 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].

  6. 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].

  7. 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].

  8. 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].

  9. 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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Further Reading

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Keywords

juvenile glaucoma, vision loss, visual deficit, juvenile-onset open-angle glaucoma, JOAG, childhood glaucoma, myopia, goniotomy, myocilin gene, MYOC gene

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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.

Medical Editor

Gerhard W Cibis, MD, Clinical Professor, Director of Pediatric Ophthalmology Service, Department of Ophthalmology, University of Kansas, Kansas City
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.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

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: Alcon Labs Salary Employment

CME Editor

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.

 
 
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