According to abbreviationfinder, Hydrophthalmos is the enlargement of one or both eyes, which is due to a disturbed outflow of aqueous humor . Hydrophthalmos is associated with the congenital form of glaucoma. The treatment is surgical.
What is hydrophthalmos?
The eye is part of the central nervous system and enables visual impressions through receptors and their connection to the brain. Glaucoma is also known as glaucoma. It is an eye disease that results in nerve fiber loss. Where the optic nerve exits, the optic nerve head progressively hollows out or atrophies as the disease progresses.
Visual field defects occur, which can increase to blindness of the eye. Glaucoma can be acquired or congenital. The congenital form is often associated with hydrophthalmos. This is a pathologically enlarged eyeball that is associated with high intraocular pressure.
Also known as buphthalmos or oxeye, the appearance can be present in one or both eyes. Oftentimes, infants with hydrophthalmos are easily shy in addition to the eyeball enlargement. Hydrophthalmos literally means “water eye” and never occurs in isolation. The phenomenon is almost always accompanied by the congenital form of the glaucoma, which in this case is necessarily triggered by the increased intraocular pressure.
Causes
Congenital glaucoma is caused by congenital elevation of intraocular pressure. Those affected suffer from an aqueous humor outflow disorder due to embryonic developmental disorders of the chamber angle. In many cases, the embryonic developmental disorder also manifests itself in other parts of the body.
The primary cause of the developmental disorder is infection with rubella during early pregnancy. The increased intraocular pressure causes the eyeball to enlarge on one or both sides. As soon as hydrophthalmos is accompanied by clouding of the cornea or photophobia, the diagnosis of congenital glaucoma applies to a larger extent. An infection with rubella does not always have to be responsible for the developmental disorder in the embryonic period.
In some cases, hydrophthalmos and glaucoma are also hereditary. Due to the developmental disorder of the chamber angles, the efferent pathways of the eye close in hydrophthalmos, so that an excessive amount of aqueous humor accumulates. The designation of the eyeball enlargement as water eye is due to this connection.
Symptoms, Ailments & Signs
Patients with hydrophthalmos suffer from “big eyes” with photophobia and tearing. In addition, blepharospasm may occur. Short-sightedness is also often present. Corneal opacity or descement tears are also characteristic. The same applies to deep anterior chambers and narrowing of the chamber angle.
In addition to an atrophy of the iris, the affected eye may have a de-rounded pupil that reacts pathologically. The uvea of the eye often shines through with a bluish tint. In most cases, the intraocular pressure values are elevated. Up to 60 mmHg can be measured. The front section stretches and the increase in pressure usually increases up to the first year of life.
The sclera and cornea lose their elasticity after the first year of development. For this reason, hydrophthalmos usually only affects the optic nerve. Due to the changes occurring in the optic nerve head, an optic nerve atrophy usually occurs. With this atrophy, the optic nerve degrades bit by bit. Complete destruction of the optic nerve leads to blindness. The appearance is either on both sides or only in one eye.
Diagnosis & disease progression
Hydrophthalmos is usually diagnosed immediately after birth. Above all, the one-sided form can already be guessed at purely by visual diagnostics. The bilateral form is sometimes not recognized immediately after birth. In addition to a careful anamnesis, the diagnosis includes an intraocular pressure measurement.
As part of the diagnosis, the ophthalmological examination often corresponds to a microscopy of the anterior and middle section of the eye in combination with a gonioscopy, an examination of the fundus or a skiascopy. Due to the young age of the patients, the procedures are usually performed under anesthesia.
In the differential diagnosis, space-occupying processes and inflammation must be ruled out. Hydrophthalmos is prognostically rather unfavorable. Blindness is likely in the affected eye.
Complications
Hydrophthalmos usually requires surgical treatment to relieve the symptoms. In most cases, the disease causes myopia in the patient. The cornea is also clouded and the chamber angle is narrowed.
As a result, the patient’s vision is severely restricted, so that the quality of life is also severely restricted by hydrophthalmos. As a rule, eyesight deteriorates and decreases with age. The patient’s optic nerve also recedes, so that in the worst case the patient can become completely blind.
Hydrophthalmos does not necessarily have to occur in both eyes. In most cases, the disease is diagnosed relatively early and without complications, so that early treatment can also take place. There are no particular complications with this either, and the symptoms disappear after the procedure.
In most cases, the surgery can also restore vision so that the person concerned no longer suffers from any symptoms. Life expectancy is not reduced by the disease. However, if treatment is delayed, permanent blindness can result.
When should you go to the doctor?
Hydrophthalmos is usually diagnosed immediately after birth. Whether medical treatment is required depends, among other things, on whether the child has any symptoms. In any case, pain or visual disturbances require medical clarification. Externally visible changes in the eyes should also be examined to ensure that there are no vascular injuries. Drug treatment is usually sufficient to reverse the enlargement of one or both eyes.
However, since small children are sometimes sensitive to medicines, parents should pay close attention to any side effects and interactions. If problems arise, the child must be taken to the pediatrician immediately. Chronic conditions often require therapeutic treatment. In the long term, hydrophthalmos not only leads to blindness in the affected eye, but also causes mental problems. In order to avoid serious complaints such as depression or inferiority complex, the child should speak to a psychologist. Visiting a self-help group can also be useful.
Treatment & Therapy
Some conservative drug treatments that are applied locally are available for therapy for patients with hydrophthalmos. However, such therapies often remain ineffective and are inferior to surgical interventions. Invasive treatment methods such as trabeculotomy or goniotomy are the most successful in hydrophthalmos.
Surgical therapy is indicated when the intraocular pressure is above 19 mmHg. In addition, intervention is recommended for corneal diameters of more than twelve millimeters within the first year of life. There is also an indication for an operation with increasing pupillary cupping, an increasing corneal diameter or an increase in axial length of the globe. The time of the diagnosis and the regularity of the check-up are crucial for the success of the therapy.
Pure drug therapies are sometimes suggested, but result in blindness in the affected eye more often than surgical procedures. The procedure requires hospitalization of the patient. If both eyes are affected, the operation is often performed on one eye at first and then has to be repeated on the other eye after a certain amount of time.
Outlook & Forecast
Without medical care and surgery, the prognosis of hydrophthalmos is unfavorable. An improvement in the symptoms is not to be expected in these cases. As the disease progresses, most patients complain of a gradual increase in the existing symptoms or the occurrence of further sequelae. In severe cases, the patient gradually becomes blind. This condition is experienced as very stressful and can trigger psychological complications in particular.
If a treatment plan is created and implemented, there is a better prognosis. The prospect of alleviating the symptoms depends on when therapy begins. The sooner surgery or drug treatment can begin, the better the prognosis. If no complications occur, early treatment can almost completely regenerate the affected person’s vision. In these cases, the patient is discharged from treatment as recovered.
Despite the favorable prospect of being free of symptoms, regular check-ups with a doctor are necessary afterwards. The internal pressure of the eye as well as general vision must be checked and monitored over the long term. The probability of a recurrence and thus a new development of the underlying disease is possible at any time, even if the patient is symptom-free and must therefore be continuously monitored.
Prevention
Hydrophthalmos can be prevented to a certain extent by vaccination against rubella. With the rubella vaccination, pregnant women are safe from the disease, so that rubella-induced malformations of their fetus do not occur. However, since hydrophthalmos can also be due to genetic factors, the child’s illness cannot be completely ruled out.
Aftercare
In the case of hydrophthalmos, those affected are primarily dependent on a quick diagnosis and subsequent treatment so that there are no further complications and symptoms. This is the only way to prevent the symptoms from getting worse. Self-healing cannot occur with this disease, so that those affected are always dependent on treatment.
The follow-up measures are very limited, so that early detection and diagnosis of hydrophthalmos is the priority for this disease. In most cases, hydrophthalmos is treated by surgery. This usually leads to success and runs without complications.
Those affected should take it easy after this procedure and rest their bodies. In any case, exertion or stressful physical activities should be avoided in order not to unnecessarily burden the body. In most cases, further examinations of the eyes are necessary even after a successful procedure.
The procedure must then also be carried out on the second eye. As a rule, this disease does not reduce the life expectancy of the affected person. Since hydrophthalmos can also lead to depression or psychological upsets, psychological treatment should also be carried out in this case.
You can do that yourself
Hydrophthalmos must always be treated by a doctor. For this reason, there are no opportunities for self-help for those affected. However, the symptoms can usually be relieved by surgery.
The disease can possibly be prevented by a rubella vaccination, although the effect of this vaccination on the disease has not yet been fully researched. If the disease occurs due to genetic conditions, it cannot be prevented. The rubella vaccination should be carried out directly during pregnancy. In this way, infection of the unborn child can be avoided.
Those affected must take care of their bodies after the surgical procedure. A high level of hygiene must also be ensured in order to avoid further inflammation or infections. If the hydrophthalmos also affects the second eye, the procedure usually has to be repeated on the other eye as well. Regular check-ups by a doctor are also necessary after treatment to prevent complications. Especially with children, the controls should be observed. If the patients suffer from visual problems, these are compensated for with the help of visual aids. The visual aids should always be worn, as the eyesight can be reduced even further.
