# Childhood Uveitic Glaucoma: Complex Management in a Fragile Population
## 1 Introduction  
Childhood glaucoma is a heterogeneous group of disorders often associated with severe visual loss affecting individuals under the age of 16 years old (UK, Europe, UNICEF) or under 18 years old (USA). It affects more than 300,000 children worldwide and accounts for 5% of the causes of blindness in the pediatric population [1, 2].  
The Childhood Glaucoma Research Network (CGRN) proposed a novel classification system to unify nomenclature in childhood glaucoma [3]. According to this classification, the diagnosis of childhood glaucoma requires the presence of two or more of the following criteria:  
* Intraocular pressure (IOP): >21 mmHg;
* Visual field defects consistent with glaucomatous optic neuropathy;
* Progressive myopia or myopic shift with increased axial length (AL);
* Presence of Haab striae or increased corneal diameter;
* Progressive increase in cup-disc ratio (C/D), cup-disc asymmetry of 0.2 or more between both eyes and/or focal rim thinning.  
The CGRN classification system identifies primary or secondary forms of childhood glaucoma. Primary glaucoma can be further subdivided into Primary Congenital Glaucoma (PCG) and Juvenile Open-Angle Glaucoma (JOAG).  
Secondary glaucoma includes four categories: glaucoma following cataract surgery, glaucoma associated with non-acquired systemic disease or syndrome, glaucoma associated with non-acquired ocular anomalies and glaucoma related to acquired conditions such as ocular trauma or uveitis.  
Glaucoma secondary to uveitis (UG) is one of the most common causes of secondary glaucoma in the pediatric population. Despite this, few recent papers have dealt with this topic.  
In childhood, anterior uveitis is the prevalent cause of secondary glaucoma [4,5]. Moreover, children with uveitis have a higher risk of developing complications, including glaucoma, compared to adults with uveitis [6].  
Whilst pediatric uveitis represents 5-10% of all uveitis cases, visual loss is more prevalent and severe, resulting in no light perception in one-third of patients, according to [PERSON] et al. [7]. Visual outcomes depend on the anatomical location and duration of the uveitis, age of presentation, management of intraocular inflammation and the prescribed corticosteroid therapy [8].  
The British Infantile and Childhood Glaucoma (BIG) eye study shows that 5.3-19% of all childhood glaucoma cases in the United Kingdom are caused by uveitis [9].  
[PERSON] et al., reported in a previous work a 25% prevalence of uveitis glaucoma in children affected by uveitis [10]. In a retrospective analysis of 182 pediatric uveitis patients, secondary glaucoma was reported in 48 patients (26.23%) with female predominance (F:M, 29:19) [4].  
Complications involving the eye structures in children uveitis differ from the ones in adult patients uveitis in terms of etiology, prognosis and prevalence [6]. Ocular complications occur in around 76% of children with uveitis. Pediatric uveitis is often misdiagnosed, and this increases the onset of well-known complications, such as cataracts, band ker-atopathy, glaucoma, and cystoid macular edema but also of specific complications for the pediatric population, such as amblyopia [8]. [PERSON] et al., reported glaucoma as the second most common complication (19%) after cataracts and one of the most common causes of severe visual impairment in children with uveitis [11]. The therapeutic approach of UG is still challenging due to poor randomized controlled trials (RCTs) in this pediatric population and the lack of universally agreed guidelines.  
The aim of this paper is to describe the clinical features of uveitis glaucoma in a fragile population, such as pediatric patients, and to provide an update on eigot Pathogenesis and the current therapeutic approach.