What are the first line treatments for secondary congenital glaucoma?

Updated: Jul 27, 2020
  • Author: Inci Irak Dersu, MD, MPH; Chief Editor: Hampton Roy, Sr, MD  more...
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In managing secondary congenital glaucoma, medical therapy is the first-line treatment.

Topical beta-blockers, carbonic anhydrase inhibitors (CAI), and prostaglandin analogs can be used. Alpha-2-adrenergic agonists should be avoided in children younger than 3 years due to possible apnea and other central nervous system adverse effects. Topical beta-blockers should be used very carefully in neonates and should be avoided in premature babies. Timolol should be started low dose as 0.25% initially. Bradycardia and bronchospasm can be a problem in some children.

When beta-blockers are contraindicated, topical CAIs (dorzolamide or brinzolamide bid or tid) can be used. They can still be helpful to add even if the child is taking oral CAIs (oral acetazolamide or methazolamide). Acetazolamide is used with food in divided doses at the dose of 10-20 mg/kg/d. Adverse effects of topical CAIs on graft survival have been questioned.

Miotics are not used as often as they used to be. Pilocarpine is only used before and after goniotomy or trabeculectomy. Echothiophate iodide can still be used successfully in aphakic glaucoma in some cases.

Prostaglandin analogs have not been extensively studied in children. However, they appear to be safe. Lengthening of eyelashes with drops is more excessive in children.

Depending on whether the glaucoma is early or late onset or depending on its severity, patients may respond to treatment, but surgery is necessary in most cases.

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