Glaucoma is a serious blinding eye disease that requires early detection and treatment. Glaucoma in children is unique in that signs suggestive of glaucoma are often seen, but despite the many medical treatments available, the physiological peculiarities of children require a very different examination and treatment plan than adults. Glaucoma in children is divided into primary infantile glaucoma, primary juvenile glaucoma, glaucoma with other developmental abnormalities, and secondary glaucoma. The first three types of glaucoma are known as developmental glaucoma, which has a clear family history of about 10%, and is now considered to be polygenic, and is a type of glaucoma caused by abnormal development of the atrial horn of the eye during embryonic and developmental periods, resulting in impaired drainage of atrial fluid. Secondary glaucoma can be caused by other eye or systemic diseases, trauma, surgery, or even medications. So how do you find out if your child has glaucoma? Let’s start with primary infantile glaucoma, the most common type of developmental glaucoma, which refers to developmental glaucoma before the age of 3. Because the eye and body are still actively developing during infancy, it has unique signs and symptoms unlike glaucoma patients of other ages. Because of the enlarged size of the diseased eye, infantile glaucoma was once called “bull’s-eye” or “watery eye” due to corneal edema. The first symptoms are photophobia, lacrimation, and blepharospasm, with early photophobia in bright light and later lacrimation and blepharospasm as the disease progresses. Since infants do not complain, they often show behaviors such as rubbing their eyes with their hands, being irritable, and preferring to bury their heads. When the disease worsens, photophobia and tearing may suddenly increase, and the child may become irritable and cry, unwilling to open his eyes and bury his head. In addition, the cornea may become white or gray with white lines of clouding. Some parents may notice enlargement of the eyeball and corneal enlargement, especially in children with monocular disease. The lateral diameter of the cornea in a normal newborn is 10-10.5mm, increasing by 0.5-1.0mm in the first year of life, i.e. to 10.5-11.5mm. If it exceeds 12mm, infantile glaucoma should be highly suspected. At the same time, the sclera will be dilated and a “blue sclera” will appear, which is often referred to as a blue white eye. In addition, children with refractive errors, especially myopic refractive errors, should be aware of glaucoma. Primary juvenile glaucoma usually refers to developmental glaucoma that develops in adolescents after the age of 3 years and before maturity. This type of glaucoma is similar to primary open-angle glaucoma in that it has an insidious onset and is not easily detected because there are no early symptoms. It is only when it has progressed to a certain level that it develops iridescence (rainbow-like sensation when looking at lights), eye swelling, headache and even nausea and vomiting that it is seen. Most patients have significant visual field defects that are only detected when they become night blind. A significant number also present with myopia. Since the wall of the eye is less elastic after the age of 3 years than in infants, the eye and cornea remain normal in appearance after an increase in intraocular pressure, but some cases may show an increase in myopia due to continued scleral stretching, so much so that some cases have been thought to be myopia deepening and keep changing glasses, only to be seen when the vision cannot be corrected, and the central visual field is already compromised. This type of glaucoma can promote the occurrence and development of myopia, while myopia is susceptible to glaucoma damage, and the two affect each other. Therefore, adolescents with rapid myopia progression (more than 1.0D per year) or who are prone to eyestrain should undergo systematic eye examinations to rule out glaucoma, with regular checkups if necessary. The symptoms of glaucoma with other developmental abnormalities are similar to those of infantile glaucoma and developmental glaucoma, but are often more complex and diverse due to the presence of other ocular or systemic abnormalities. Secondary glaucoma is acquired due to other eye or systemic diseases, trauma, surgery, and even medications, so the child is born with a normal eye and develops it only after encountering the above-mentioned external factors, and the symptoms are often similar to those of adult glaucoma: eye distention, headache, blurred vision, visual field loss, and even nausea and vomiting. Parents who notice these symptoms after the above mentioned eye disease should seek medical attention. When a child is suspected of having glaucoma, a number of tests will be done to confirm the diagnosis. These include corneal diameter, corneal edema and cloudiness, posterior corneal elastic layer rupture, corneal thickness, corneal topography, IOP measurement, anterior chamber and anterior chamber angle examination, fundus examination, visual field, refraction, optic nerve fiber layer thickness analysis of the optic disc, and for infants and children who cannot cooperate, general anesthesia and special examination instruments are required. After a clear diagnosis comes treatment. In principle, primary infantile glaucoma should be operated as soon as it is diagnosed. The safety of anti-glaucoma drugs in children is difficult to evaluate, and children do not complain of any adverse effects, so they are only used for short-term overtreatment or for children who cannot be operated on. In terms of surgical outcomes, the success rate of the first surgery is high, especially at 1 to 24 months of age, and the surgery can be performed multiple times. Primary juvenile glaucoma is treated with medication in the early stages and surgery in the middle and late stages, all with a poor prognosis. Glaucoma with other developmental abnormalities requires a combination of problems associated with the other abnormalities to determine treatment options. Secondary glaucoma is first treated for the primary disease, and when drug therapy is unsatisfactory, surgery is promptly performed.