Doctor's Notes on Glaucoma
Glaucoma is a type of eye disease that affects the optic nerve and causes vision loss. Most types of glaucoma are due to elevated pressure inside the eye, called intraocular pressure (IOP). There are two main types of glaucoma: angle-closure glaucoma, in which the normal drainage canals within the eye are physically blocked and open-angle glaucoma, in which the drainage system remains open. Both types of glaucoma may cause vision damage without symptoms.
Most of the time, glaucoma does not result in noticeable symptoms until significant vision loss has occurred. As optic nerve fibers are damaged by glaucoma, small blind spots may begin to develop, usually in the peripheral or side vision. If there are sudden increases in intraocular pressure (IOP), symptoms of glaucoma may include
- blurred vision,
- halos around lights,
- severe eye pain,
- abdominal pain,
- nausea, and
What is the Treatment for Glaucoma?
Treatment of glaucoma is key to prevent further damage to the eye and loss of vision. Common treatments for glaucoma include medicines (usually eye drops), laser treatment, and surgery.
Prescription eye drops are the most common treatment. The eye drops work by lowering the pressure in the eye by helping the fluid drain from the eye, and by lowering the amount of fluid the eye produces, which helps prevent damage to the optic nerve. Eye drops used to treat glaucoma include:
- Rho kinase inhibitor
- Netarsudil (Rhopressa)
- Nitric oxides
- Latanoprostene bunod (Vyzulta)
- Miotic or cholinergic agents
- Pilocarpine (Isopto Carpine)
- Alpha-adrenergic agonists
- Alphagan P
- Carbonic anhydrase inhibitors
A laser treatment called trabeculoplasty is used to treat open-angle glaucoma. It is performed in a doctor’s office and it helps drain fluid from the eye to decrease the pressure.
Different types of surgery for glaucoma that can help lower the pressure in the eye include:
- Glaucoma implant surgery
- Minimally invasive glaucoma surgery (MIGS)
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Acute Angle-Closure GlaucomaAcute angle-closure glaucoma is caused by a rapid or sudden increase in pressure inside the eye, called intraocular pressure (IOP). Symptoms of acute angle-closure glaucoma severe eye pain, nausea and vomiting, headache, blurred vision and/or seeing haloes around lights, profuse tearing. The condition requires treatment by an ophthalmologist which may include medication, surgery, or a combination approach.
Adult Glaucoma SuspectGlaucoma is usually high pressure inside the eye that damages the optic nerve and can result in permanent vision loss. Various exams and tests are used to diagnose the disease.
Angle Recession GlaucomaAngle recession glaucoma refers to a group of ocular disorders that occur after the eye undergoes trauma. Following this trauma, different mechanisms can cause an abnormal elevation of pressure inside the eye. An ophthalmologist diagnoses angle recession glaucoma using special instruments. Treatment may include eye drops, medication, laser surgery, or conventional incisional surgery. Taking steps to prevent traumatic eye injury is the best way to prevent angle recession glaucoma.
Glaucoma FAQsGlaucoma is usually high pressure inside the eye that damages the optic nerve and can result in permanent vision loss. While high pressure inside the eye, damage to the optic nerve and vision loss are common criteria for diagnosing glaucoma, glaucoma can be present without all three of these criteria. The two main types of glaucoma are open-angle and angle-closure glaucoma. Glaucoma may be symptomless until significant permanent vision damage has occured, but may show symptoms as well, including pain, redness, haloes, and blurred vision.
Glaucoma MedicationsGlaucoma is a disease characterized by increased intraocular pressure (IOP). (Intraocular means within the eye.) Increased intraocular pressure results from either increased production or decreased drainage of aqueous humor. Treatment for glaucoma can include medication and/or surgery to lower the intraocular pressure.
Lens-Particle GlaucomaLens-particle glaucoma is a form of glaucoma that occurs due to leakage of material from the inside of the lens of the eye. It may be caused be trauma, surgery, or inflammation. Signs and symptoms of lens-particle glaucoma may include blurred vision, sensitivity to light, eye pain, headache, redness, and tearing. The condition is diagnosed by ophthalmologic evaluation. Treatment may include eyedrops to control eye pressure and inflammation.
Normal-Tension GlaucomaNormal-tension glaucoma or low-tension glaucoma is a condition in which the optic nerve is damaged despite normal fluid pressure inside the eye (other types of glaucoma result vision loss because of abnormally high pressure inside the eye. Normal-tension glaucoma typically occurs in older adults and can be caused by congenital nerve defects and irregularities in blood flow to the eye. Eyedrops and surgery are treatments for this disorder.
Primary Congenital GlaucomaPrimary congenital glaucoma is present at birth and may be inherited. Blepharospasm, photophobia, and epiphora are symptoms. A cloudy whitish-gray cornea is a common sign. Treatment of primary congenital glaucoma typically involves surgery.
Primary Open-Angle GlaucomaGlaucoma describes chronic high pressure within the eyeball. The pressure eventually causes nerve damage, though glaucoma can still occur without elevated pressure. Primary open-angle glaucoma is a subtype of the disease characterized by atrophy of the optic disc in the back oif the eye and other problems.
What Is Usually the First Sign of Glaucoma?Early glaucoma usually has few symptoms, but the buildup of pressure in the eye over time leads to slow vision loss starting with peripheral vision.
Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.