The management of glaucoma in reproductive-age women includes consideration of a second patient that does not need the medication (fetus). Proper treatment of the mother includes the consideration that therapy should not harm the unborn or breast-feeding child.
The management of pediatric glaucoma is different from that of adult glaucoma in several aspects. Pediatric glaucoma is mostly managed surgically, with medical therapy serving mostly to control the IOP during surgical planning. In addition, medical therapy can temporarily decrease the IOP to facilitate surgery by clearing the cornea, permitting certain operations. If long-term therapy is required, it is often the more severe disease that cannot be adequately managed surgically. In this situation, medication can be a useful adjunct to surgery.
The medications used in glaucoma for the most part were developed and tested primarily in adults. Future studies of the effects of glaucoma medications in pediatric patients will improve our knowledge of dosing, effectiveness, and side effect profile. As noted above, the side effects can be very different for small children, although they tend to approximate the adult level as the child grows in size and metabolic maturity. The management of pediatric glaucoma is a long-term effort, and any potential for vision loss needs to be treated aggressively, including the use of medical therapy when needed.
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