Glaucoma

Glaucoma is a group of eye diseases that damage the optic nerve, often related to elevated pressure inside the eye (intraocular pressure). The most common form, primary open-angle glaucoma, develops slowly and painlessly; peripheral vision is lost first, so people may not notice until significant damage has occurred.

Acute angle-closure glaucoma is less common and causes sudden painful vision loss — a medical emergency. Glaucoma is a leading cause of irreversible blindness worldwide. Early detection through regular eye exams and pressure-lowering treatment can preserve vision in most people.

Open-angle glaucoma

• Often no early symptoms
• Gradual loss of peripheral vision
• In advanced stages, tunnel vision

Acute angle-closure glaucoma

• Severe eye pain and headache
• Blurred vision
• Halos around lights
• Redness of the eye
• Nausea and vomiting
• Sudden visual disturbance

Normal-tension glaucoma can cause optic-nerve damage despite pressure in the statistical normal range. Congenital and secondary glaucomas have additional features depending on cause.

In open-angle glaucoma, drainage through the trabecular meshwork becomes less efficient, pressure rises, and the optic nerve is damaged. In angle-closure, the iris blocks the drainage angle. Other forms result from eye injury, inflammation, steroids, advanced cataract, or developmental anomalies.

Optic-nerve vulnerability varies among individuals; some develop damage at relatively normal pressures, while others tolerate higher pressures without damage.

Risk factors include:

• Elevated intraocular pressure
• Age over 60 (earlier for some populations)
• Family history of glaucoma
• African, Hispanic, or Asian ancestry (different forms more common in different groups)
• Thin central corneas
• High myopia or hyperopia
• Diabetes, hypertension, migraine, or sleep apnea (associations)
• Long-term corticosteroid use
• Prior eye injury or surgery

Untreated glaucoma leads to progressive, irreversible vision loss and can result in blindness. Even with treatment, some people continue to lose vision and need closer monitoring or more aggressive therapy. Acute angle-closure can cause rapid permanent damage if not relieved quickly.

Glaucoma cannot always be prevented, but vision loss can often be prevented by:

• Regular eye examinations that include optic-nerve assessment and pressure measurement
• Following prescribed treatment and follow-up schedules if glaucoma or high-risk ocular hypertension is diagnosed
• Protecting eyes from injury
• Using corticosteroid eye drops only under supervision

A comprehensive glaucoma evaluation may include:

• Tonometry (eye-pressure measurement)
• Gonioscopy (inspection of the drainage angle)
• Optic-nerve examination (slit lamp with lenses, photography, OCT imaging of the nerve fiber layer)
• Visual field testing (perimetry) to detect functional loss
• Pachymetry (corneal thickness)
• Additional imaging as needed

Diagnosis considers the whole clinical picture, not pressure alone.

Have regular comprehensive eye exams as recommended for your age and risk factors. Seek emergency care for sudden severe eye pain, headache, blurred vision, halos, and nausea — possible acute angle-closure glaucoma.

The goal is to lower intraocular pressure enough to prevent further optic-nerve damage:

• Medicated eye drops — prostaglandin analogues, beta-blockers, alpha agonists, carbonic anhydrase inhibitors, rho-kinase inhibitors; often used in combination
• Laser therapy — selective laser trabeculoplasty for open-angle disease; laser iridotomy for angle-closure or narrow angles
• Surgery — minimally invasive glaucoma surgery (MIGS), trabeculectomy, tube shunts for more advanced or refractory disease
• Acute angle-closure — emergency pressure-lowering medicines and laser (or surgical) iridotomy

Treatment is lifelong for most people. Adherence to drops and regular monitoring are critical.

If you have glaucoma:

• Use eye drops exactly as prescribed; ask for techniques to reduce systemic absorption if needed
• Keep all follow-up appointments and visual field tests
• Bring drop bottles to visits so adherence and technique can be reviewed
• Inform every clinician of your glaucoma diagnosis before any steroid prescription
• Protect your eyes during sports and work
• Report new vision changes promptly

Bring:

• Personal and family history of glaucoma or blindness
• List of all medicines and eye drops
• Previous eye-exam records if available
• Questions about target pressure, drop options, laser vs surgery, and how often you need monitoring