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Glaucoma

Medically reviewed by Drugs.com. Last updated on Sep 30, 2022.

Overview

Glaucoma is a group of eye conditions that damage the optic nerve. The optic nerve sends visual information from your eye to your brain and is vital for good vision. Damage to the optic nerve is often related to high pressure in your eye. But glaucoma can happen even with normal eye pressure.

Glaucoma can occur at any age but is more common in older adults. It is one of the leading causes of blindness for people over the age of 60.

Many forms of glaucoma have no warning signs. The effect is so gradual that you may not notice a change in vision until the condition is in its later stages.

It's important to have regular eye exams that include measurements of your eye pressure. If glaucoma is recognized early, vision loss can be slowed or prevented. If you have glaucoma, you'll need treatment or monitoring for the rest of your life.

Open-angle glaucoma

Usually, fluid (aqueous humor) in the eye flows freely through the anterior chamber and exits through the drainage system (trabecular meshwork). If that system is blocked or isn't functioning well, the pressure inside the eye (intraocular pressure) builds, which in turn damages the optic nerve. With the most common type of glaucoma, this results in gradual vision loss.

Symptoms

The symptoms of glaucoma depend on the type and stage of your condition.

Open-angle glaucoma

Acute angle-closure glaucoma

Normal-tension glaucoma

Glaucoma in children

Pigmentary glaucoma

When to see a doctor

If you experience symptoms that come on suddenly, you may have acute angle-closure glaucoma. Symptoms include severe headache and severe eye pain. You need treatment as soon as possible. Go to an emergency room or call an eye doctor's (ophthalmologist's) office immediately.

Causes

Glaucoma develops when the optic nerve becomes damaged. As this nerve gradually deteriorates, blind spots develop in your vision. For reasons that doctors don't fully understand, this nerve damage is usually related to increased pressure in the eye.

Elevated eye pressure happens as the result of a buildup of fluid that flows throughout the inside of the eye. This fluid also is known as the aqueous humor. It usually drains through a tissue located at the angle where the iris and cornea meet. This tissue also is called the trabecular meshwork. The cornea is important to vision because it lets light into the eye. When the eye makes too much fluid or the drainage system doesn't work properly, eye pressure may increase.

Open-angle glaucoma

This is the most common form of glaucoma. The drainage angle formed by the iris and cornea remains open. But other parts of the drainage system don't drain properly. This may lead to a slow, gradual increase in eye pressure.

Angle-closure glaucoma

This form of glaucoma occurs when the iris bulges. The bulging iris partially or completely blocks the drainage angle. As a result, fluid can't circulate through the eye and pressure increases. Angle-closure glaucoma may occur suddenly or gradually.

Normal-tension glaucoma

No one knows the exact reason why the optic nerve becomes damaged when eye pressure is normal. The optic nerve may be sensitive or experience less blood flow. This limited blood flow may be caused by the buildup of fatty deposits in the arteries or other conditions that damage circulation. The buildup of fatty deposits in the arteries also is known as atherosclerosis.

Glaucoma in children

A child may be born with glaucoma or develop it in the first few years of life. Blocked drainage, injury or an underlying medical condition may cause optic nerve damage.

Pigmentary glaucoma

In pigmentary glaucoma, small pigment granules flake off from the iris and block or slow fluid drainage from the eye. Activities such as jogging sometimes stir up the pigment granules. That leads to a deposit of pigment granules on tissue located at the angle where the iris and cornea meet. The granule deposits cause an increase in pressure.

Glaucoma tends to run in families. In some people, scientists have identified genes related to high eye pressure and optic nerve damage.

Risk factors

Glaucoma can damage vision before you notice any symptoms. So be aware of these risk factors:

Some people have narrow drainage angles, putting them at increased risk of angle-closure glaucoma.

Prevention

These steps may help detect and manage glaucoma in its early stages. That may help to prevent vision loss or slow its progress.

Diagnosis

Your health care provider will review your medical history and conduct a comprehensive eye examination. Your provider may perform several tests, including:

Treatment

The damage caused by glaucoma can't be reversed. But treatment and regular checkups can help slow or prevent vision loss, especially if you catch the disease in its early stages.

Glaucoma is treated by lowering intraocular pressure. Treatment options include prescription eye drops, oral medicines, laser treatment, surgery or a combination of approaches.

Eyedrops

Glaucoma treatment often starts with prescription eye drops. Some may decrease eye pressure by improving how fluid drains from your eye. Others decrease the amount of fluid your eye makes. Depending on how low your eye pressure needs to be, you may be prescribed more than one eye drop.

Prescription eye drop medicines include:

Because some of the eye drop medicine is absorbed into your bloodstream, you may experience some side effects unrelated to your eyes. To minimize this absorption, close your eyes for 1 to 2 minutes after putting the drops in. You also may press lightly at the corner of your eyes near your nose to close the tear duct for 1 or 2 minutes. Wipe off any unused drops from your eyelid.

You may have been prescribed multiple eye drops or need to use artificial tears. Make sure you wait at least five minutes in between using different drops.

Oral medications

Eye drops alone may not bring your eye pressure down to the desired level. So your eye doctor may also prescribe oral medicine. This medicine is usually a carbonic anhydrase inhibitor. Possible side effects include frequent urination, tingling in the fingers and toes, depression, stomach upset, and kidney stones.

Surgery and other therapies

Other treatment options include laser therapy and surgery. The following techniques may help to drain fluid within the eye and lower eye pressure:

After your procedure, you'll need to see your eye doctor for follow-up exams. And you may eventually need to undergo additional procedures if your eye pressure begins to rise or other changes occur in your eye.

Treating acute angle-closure glaucoma

Acute angle-closure glaucoma is a medical emergency. If you're diagnosed with this condition, you'll need urgent treatment to reduce the pressure in your eye. This generally will require treatment with medicine and laser or surgical procedures.

You may have a procedure called a laser peripheral iridotomy. The doctor creates a small hole in your iris using a laser. This allows fluid to flow through the iris. This helps to open the drainage angle of the eye and relieves eye pressure.

Lifestyle and home remedies

These tips may help you control high eye pressure or promote eye health.

Alternative medicine

Some alternative medicine approaches may help your overall health, but none is an effective glaucoma remedy. Talk with your doctor about their possible benefits and risks.

Coping and support

When you receive a diagnosis of glaucoma, you're potentially facing lifelong treatment, regular checkups and the possibility of progressive vision loss.

Meeting and talking with other people with glaucoma can be very helpful, and many support groups exist. Check with hospitals and eye care centers in your area to find local groups and meeting times. Look for online resources, including support groups.

Preparing for an appointment

You may start by seeing your primary health care provider. Or you may be referred immediately to an eye specialist (ophthalmologist).

Here's some information to help you get ready for your appointment.

What you can do

When you make the appointment, ask if there's anything you need to do in advance, such as fasting before having a specific test. Make a list of:

Take a family or friend along, if possible, to help you remember the information you're given.

For glaucoma, some basic questions to ask include:

Don't hesitate to ask other questions.

What to expect from your doctor

Your doctor is likely to ask you several questions, such as:

What you can do in the meantime

Avoid doing anything that seems to worsen your symptoms.

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