|Year : 1959 | Volume
| Issue : 3 | Page : 79-81
Juvenile glaucoma simulating progressive myopia
|Date of Web Publication||8-May-2008|
E J Somerset
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Somerset E J. Juvenile glaucoma simulating progressive myopia. Indian J Ophthalmol 1959;7:79-81
This case is recorded as it shows several interesting features, notably the very early age of onset and the importance of careful routine examination of the fundus oculi in all cases however trivial.
| Case Report|| |
G. S., a 15 year old school boy, was first seen on 13-4-56 complaining that the power of his spectacles was constantly increasing and asking if something could be clone to stop this.
On going to school at the age of 6 years he had great difficulty in seeing the blackboard. Glasses were eventually prescribed some 5 years later, when he was ii years old, and their power has been increasing ever since; they have had to be changed several times during the last 5 years but no explanation for the remarkable loss of vision in the right eye had been given.
Past History. There is no history of past illness of any consequence. He sometimes uses mustard oil for cooking but has never had "beri beri" or swelling of the legs with gastro-intestinal disturbances.
Family History. His father has an elevated blood pressure and has had a stroke but has had no trouble with his eyes. His mother, 1 sister and 6 brothers are all well and are said to have no eye trouble.
Right vision with - 12 D sph. - 2.o D cyl. axic 90° =Counts fingers at I ft.
Left vision with - 12 D sph. -2.o D cyl. axis 90° =6/9 partly.
Both pupils reacted to light but very sluggishly. Corneas were normal in size and shape. The anterior chambers were very shallow. Tension felt raised and was measured and found to be: right eye 32 mm. and left eye 30 mm. (Schiotz). Fields showed only fixation in the right eye and extensive peripheral loss in the left, particularly on the nasal side [Figure - 1]. Fundi showed cupping of both discs but no myopic degeneration. Gonioscopy revealed narrow but open angles. General examination revealed no abnormality and blood Wassermann and Kahn tests were both negative.
| Treatment and Follow Up|| |
Right iridencleisis (one pillar) was performed on 22-5-56 and Left iridencleisis on 29-5-56. Convalesence was uneventful and both eyes obtained filtering blebs.
Right vision improved from counting fingers at 1 foot to 2/6o and left vision with glasses has remained at 619 (partly).
Fields improved considerably. The left field [Figure - 1] improved to that shown in [Figure - 2]. The right field which before operation appeared to be only fixation improved to that shown in [Figure - 3] three months after operation. Further improvement was seen in the field of this eye [Figure - 4]. The boy has since passed his matriculation.
| Discussion|| |
The very young age of the patient is remarkable. There seems to be no evidence of buphthalmos or epidemic dropsy glaucoma. Sugar (1951) states that from 0.5 to 2% of cases of primiary glaucoma occur before the age of 20 years but gives no details of the youngest age recorded. Weinstein(1953) in probably the most extensive review of the literature of glaucoma notes that in those cases with a hereditary background the phenomenon of anticipation is frequently seen and quotes three members of a third generation with glaucoma between the ages of 20-25 years. However, Duke-Elder notes that the term juvenile glaucoma is used for the disease in young people, the upper age limit varying from 20 to 40 years with different authorities. He notes that Graefe (1862) observed it in a girl of 1o years and that in a series of 1032 cases Haag (1915) found four occurring in the first decade and 16 in the second.
It is impossible to state when the glaucomatous process started in this case but from the extensive destruction of vision in the right eye one would guess a duration of several years in that eve. Probably the elasticity and plasticity of the tissues in young people allows the eye to stretch and yield before the raised pressure, so that a longer time will be required for a given amount of damage than in older people with more resistant and unyielding tissues. The case demonstrates the importance of keeping in mind the occurrance of juvenile glaucoma and the importance of routine examination of the fundus oculi in all cases.
| Summary|| |
1. A case of juvenile glaucoma aged 15 years is described.
2. The importance of routine fundus examination in all cases for refraction is stressed.
| References|| |
Duke-Elder (Info) Text book of Ophthalmology Vol. 3. P. 3330. Kimpton, London.
V. Graefe (1862) A.f.O., 8, 242.
Haag (1915) K. Al. Aug., 54, 133. Cited b y
Sugar H. S. (1951) The Glaucomas, p 126. C. V. Mosby, St. Louis.
Weinstein (1953) Glaucoma Pathology C Therapy Translated by .
1. Folde. p. 61. C. V. Mosby, St. Louis.
[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4]