Observations based on 28 trabeculotomy ab externo operations in 18 children with glaucoma are presented. Controlled intraocular pressure (IOP) and stable or improved optic disc status was achieved in 80% of 22 eyes followed for one year or longer. Factors associated with a poorer result were glaucoma associated with ocular syndromes, older age at the time of surgery, and corneal diameter greater than 14 mm at diagnosis. In patients with successful IOP lowering, 40% had a documented improvement in the appearance of the optic disc cup, representing an important criterion for surgical success. Reversal of cup size enlargement was observed exclusively in the first year of life in this series. In the evaluation and follow-up of children with glaucoma, it has been found useful to utilize ketamine sedation, hand-held applanation tonometry, and dilated, stereoscopic disc examination and photography.