Journal of Paediatric Medicine & Surgery
Open Access

Pediatric ophthalmology anaesthesia covers a wide range of patients and procedures. Patients range from premature babies with all the comorbidities that come with them, to infants with congenital disorders, to healthy kids and teenagers. For a paediatric patient, many ocular operations that are performed in adults under MAC require general anaesthetic.

Because measuring IOP and doing a complete visual examination in an awake child is challenging due to lack of cooperation, general anaesthesia is usually used. IOP is affected by anaesthetic medicines and treatments such as laryngoscopy. While accurate IOP measurement is critical for diagnosing and treating juvenile glaucoma, it is only one of many diagnostic criteria. The examination includes an examination of the optic nerve, pachymetry to determine corneal thickness, and gonioscopy of the iridocorneal angle. In management, trends in IOP measurement in the same patient over time and under the same conditions are also important.

A sevoflurane inhalation induction is routinely used in paediatric patients and is associated with a reduction in IOP within minutes. Because agitation and weeping falsely raise IOP, premedication with oral midazolam enables a smooth induction. Oral midazolam does not appear to have any effect on IOP. The Oberacher and colleagues are investigated the effects of oral midazolam in a group of young children and discovered no significant differences in IOPs measured while awake and when sedated. Ketamine, which has a low influence on IOP, has been used in children for sedation and IOP measurement. However, during recovery, anxiety and hallucinations have limited its utility.

Before a profound level of anaesthesia is reached, the ophthalmologist can assess the IOP in collaboration with the anesthesiologist. Prior to induction, the ophthalmologist should be present with all necessary instruments. The inhalational mask is placed such that the ophthalmologist can see the eye without being hindered. The mask can be removed briefly for IOP measurement and then restored as necessary. Pediatric glaucoma is treated predominantly with surgical techniques such as goniotomy, trabeculectomy, and pressure reduction devices, as opposed to adult glaucoma, which is usually controlled medically.

Primary congenital glaucoma is inherited in about 10% of cases. A systemic illness like as neurofibromatosis, rubella, or Sturge-Weber syndrome can cause secondary glaucoma (congenital capillary hemangiomatosis). The majority of instances of paediatric glaucoma, on the other hand, have no known cause. The treatment of these youngsters necessitates frequent anaesthetic exams. In order to promote a seamless induction of anaesthesia, it is critical to build a solid rapport with the patient and family and to consider the use of premedication with midazolam and/or parental presence. Except for the very young infant, who requires endotracheal intubation, an LMA is adequate for anaesthetic investigations. If surgery is required, the LMA may be replaced with an endotracheal tube at the anaesthesia provider's discretion.

The subject of ocular genetics is rapidly evolving. Genetic tests that improve diagnostic precision are now available, and they should be explored frequently as part of the clinical evaluation of children with inherited eye illness. Importantly, recent advances in genome editing, gene transfer and stem cell biology have made slowing disease progression in presently incurable inherited eye illnesses a feasible possibility.