Glaucoma: symptoms, treatment and glaucoma surgery

Glaucoma symptoms are painless and initially often do not cause any complaints of vision loss. Glaucoma is a chronic eye condition in which there is increased pressure in one or both eyes, often caused by obstruction of fluid flow from the eye. Initially, a person with glaucoma will not notice anything, but if it continues for too long, glaucoma can permanently damage their vision. As the disease process progresses, the symptoms of glaucoma increase. Untreated glaucoma can eventually lead to blindness. With proper treatment, visual field loss can be stopped or slowed down. Two forms of glaucoma are distinguished: chronic glaucoma or open angle glaucoma and acute glaucoma or closed angle glaucoma.

  • What is glaucoma?
  • Cause of glaucoma
  • Risk factors for glaucoma
  • Medications that can trigger acute glaucoma
  • Glaucoma symptoms and types
  • Acute glaucoma symptoms
  • Chronic glaucoma symptoms
  • Other shapes
  • Examination and diagnosis
  • Glaucoma treatment
  • Prevention
  • Regular eye check
  • Prognosis
  • Complications

 

Glaucoma / Source: Jonathan Trobe, MD, Wikimedia Commons (CC BY-3.0)

What is glaucoma?

Glaucoma is a chronic eye condition in which the fibers of the optic nerve at the back of the eye are usually damaged as a result of increased intraocular pressure. With persistently elevated intraocular pressure, the optic nerve fibers gradually die. At a certain point, the damaged nerves no longer transmit signals from certain parts of the retina, causing parts of the peripheral visual field to disappear. Gaps then appear in the field of vision, without the person in question realizing this. These holes grow larger and merge over time until only a narrow field of view remains. Ultimately, untreated glaucoma can lead to blindness. Therefore, early detection of glaucoma is important. Treating glaucoma at an early stage can limit damage to the visual field or significantly slow its progression.

Cause of glaucoma

It is not yet known exactly how glaucoma develops. Glaucoma is usually the result of excessive intraocular pressure due to a disruption of the balance between production and drainage of ocular fluid. In the majority of cases it is not clear what causes the increase in intraocular pressure. However, glaucoma can also develop with normal eye pressure. This form of glaucoma is thought to be caused by inadequate irrigation of the surrounding blood vessels of the optic nerve.

Risk factors for glaucoma

In principle, anyone can get glaucoma. There are a number of risk factors that increase the risk of glaucoma. The most important risk factors are:

  • having increased eye pressure;
  • if there is a family history of glaucoma;
  • age (glaucoma is rare under 40 years of age and most common over 60 years of age);
  • being highly farsighted or nearsighted;
  • be of African or Asian descent;
  • suffer from cardiovascular disorders (i.e. disorders affecting the heart and blood vessels);
  • the use of corticosteroids (in certain medicines or eye drops).

 

Medications that can trigger acute glaucoma

Acute glaucoma can be triggered by different types of medication if you are sensitive to them. The most important are:

  • Eye drops to enlarge the pupil, which are used, for example, during an eye check.
  • Tricyclic antidepressants (TCAs) or ‘SSRI-type’ antidepressants.
  • Some medications belong to the group of phenothiazines, a group of medications with a central action against nausea and vomiting. But they can also be used to treat schizophrenia.
  • Salbutamol (ipratropium), a bronchodilator for asthma.
  • Topamax (topiramate), an antiepileptic drug.
  • Some medications used to treat allergies, such as chlorpheniramine.
  • Some medications used to treat stomach ulcers, such as cimetidine (Tagamet) and Ranitidine (these drugs inhibit the production of stomach acid).
  • Medicines used during general anesthesia.

 

Glaucoma symptoms and types

Different types of glaucoma are distinguished. The two main types are:

  • chronic or open angle glaucoma; and
  • acute or closed angle glaucoma.

 

Blurred vision due to acute glaucoma / Source: Gene Hunt, Flickr (CC BY-2.0)

Acute glaucoma symptoms

Acute glaucoma develops suddenly and is characterized by a sudden, sharp increase in eye pressure because the drainage system of the eye becomes blocked. With this form, the eye becomes red and painful. This pain can be very severe. Other symptoms include headaches, nausea, seeing halos around light sources at night and very blurred vision .

Chronic glaucoma symptoms

Chronic glaucoma, on the other hand, develops slowly, often over many years, and is painless. There are often no noticeable symptoms. If chronic glaucoma is not diagnosed and treated in time, this condition will gradually lead to a loss of the visual field. But it can take years before demonstrable visual field loss is identified.

Other shapes

Both forms can be familial. Other forms are glaucoma with normal eye pressure (see above), and a number of secondary forms of glaucoma that arise from an underlying disorder, from medications (for example eye drops with corticosteroids), or eye trauma.

Examination and diagnosis

The diagnosis can only be established after a complete ophthalmological examination, which includes eye pressure measurement and visual field examination. A visual field examination examines which parts of the visual field are affected. Once a diagnosis of glaucoma has been made, there are a number of treatments available.

Glaucoma treatment

With untreated glaucoma there is a risk of progression (deterioration). Treatment is aimed at preventing progression of the visual field. The pressure in the eye can be lowered with eye drops. There are products that reduce moisture production and there are products that improve its drainage. Combination agents are also available. It is important that the patient is compliant with treatment and is dripping properly. If eye drops do not provide sufficient relief, laser treatment or microsurgery may provide a solution. Adequate treatment usually prevents further vision loss.

Prevention

There is no way to prevent glaucoma. However, you can adequately combat the condition and prevent complications through early diagnosis and treatment.

Regular eye check

Someone who belongs to a risk group would be wise to have their eyes checked periodically from the age of forty.

Prognosis

Damage to the eye caused by glaucoma cannot be repaired. Vision cannot be restored. However, lowering eye pressure can help maintain your current vision. Most people with glaucoma who are treated and have regular eye exams do not go blind.

Complications

Left untreated, glaucoma can lead to visual impairment or even blindness. Early detection is therefore very important, as timely treatment at an early stage can limit the damage or slow its progression.

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