Glaucoma Symptoms and Treatment Options
This article provides a detailed overview of glaucoma, including the types and causes. It also describes symptoms and explores risk factors and treatment options.
Glaucoma is a medical condition that affects the eyes and results in damage to the optic nerve. Usually, the damage is due to increased intraocular eye pressure (IOP).
Fluid inside the eye, called aqueous humor, normally fills the front compartment of the eye and exerts a certain amount of pressure to inflate the eye. The fluid constantly drains and replenishes to nourish the eye. When the fluid does not drain properly, IOP increases and can damage the optic nerve.
Optic nerve damage from glaucoma usually affects your peripheral vision first, leading to tunnel vision. It moves progressively to involve your central vision. In most cases, vision loss occurs slowly over many years. However, angle-closure glaucoma can come on suddenly and, without immediate treatment, can cause permanent eye damage or vision loss.
Contact your ophthalmologist or go to your nearest emergency room for the following symptoms:
According to the NEI, there are two broad categories of glaucoma: primary and secondary. Researchers continue to study the cause of primary glaucoma. Secondary glaucoma can result from another medical condition, use of a medication, or a form of surgery.
Primary glaucoma includes the following types:
- Open-angle glaucoma: This is the most common type, accounting for about 90% of glaucoma cases. It is the result of a gradual buildup of fluid and pressure in the eye. The canals that carry fluid away from the eyes do not drain properly. Deposits form as well, further hindering drainage.
- Normal-tension glaucoma: This is a less common form of open-angle glaucoma. Although the pressure is considered normal for the general population, it is too high for that particular eye and causes optic nerve damage. Other names for it include normal-pressure and low-tension glaucoma.
- Closed-angle glaucoma: This is a less common form of glaucoma. It is the result of the iris narrowing or blocking the drainage angle. This happens very quickly and abruptly increases IOP, causing sudden symptoms. This type of glaucoma is a medical emergency because it can cause vision loss within a day. Other names for it include angle-closure glaucoma, narrow-angle glaucoma, and acute glaucoma.
- Congenital glaucoma: This type of glaucoma is present at birth. It occurs when the eye’s drainage system does not develop properly during fetal development.
Often, glaucoma causes no symptoms until damage has already occurred. When glaucoma symptoms occur, they vary depending on the specific type of glaucoma a person has.
Common symptoms of open-angle glaucoma
There are no early warning signs of open-angle glaucoma. Loss of vision proceeds slowly and typically starts at the sides of your visual field, causing tunnel vision. It progresses toward the center of your vision.
Common symptoms of angle-closure glaucoma
Angle-closure glaucoma typically causes a sudden onset of symptoms, sometimes being severe. This form of glaucoma is a serious condition that needs immediate medical care. Contact an ophthalmologist or go to your nearest emergency department for any of these symptoms:
- eye pain
- headache with eye symptoms
- a loss of vision or changes in vision
- nausea with or without vomiting
- red, sore, or bloodshot eyes
- seeing halos around lights
Common symptoms of congenital glaucoma
Congenital glaucoma is present at birth. Signs and symptoms can be present at birth, but they may not be apparent until several months of age. Symptoms include:
- excessive tearing
- cloudiness in the normally clear cornea
- increased sensitivity to light
- enlargement of one or both eyes
Common symptoms of secondary glaucoma
The symptoms of secondary glaucoma can be the same as either open-angle or angle-closure glaucoma, depending on the specific cause.
Seek prompt eye care as soon as you notice any symptoms of glaucoma.
The increase in pressure with glaucoma is generally due to an excess of aqueous humor in the eye. This occurs when the drainage mechanism cannot keep up with the rate of fluid production. The cornea and iris create the drainage angle.
In primary open-angle glaucoma, the drainage system itself may change with age. However, the exact cause of open-angle glaucoma is not known.
People who develop angle-closure glaucoma tend to have a narrow drainage angle. As people age, the lens of the eye enlarges. This, in turn, narrows the space between the iris and cornea.
The process may occur slowly or abruptly. Angle-closure glaucoma usually affects one eye at a time. Certain medications can increase the risk of developing angle-closure glaucoma.
The optic nerve damage typical of glaucoma can also occur with normal eye pressure. Some people may have a higher likelihood of developing glaucoma because the optic nerve is more sensitive to pressure, according to the NEI.
Secondary glaucoma has many possible causes. These include:
- advanced cataracts
- the use of certain medications, such as steroids
- eye surgery
- diabetic eye disease
- eye trauma
Although glaucoma can affect anyone, it generally affects people over the age of 60 years. The risk of glaucoma is also higher in people with a family history of it.
African American people are six to eight times more likely to develop glaucoma than white individuals. Glaucoma is also more common in Hispanic people older than 60 years of age compared with white people in a similar age group. People of Asian descent may have a greater risk of developing angle-closure glaucoma.
Other risk factors for glaucoma include:
- high blood pressure
- farsightedness or nearsightedness
- eye trauma
- corneas that are thin in the center
- thinning of the optic nerve
- long-term steroid use
Reducing your risk of glaucoma
Many of these risk factors involve situations that you cannot control, such as thinning of the optic nerve. However, you may be able to reduce your risk of vision impairment or loss from glaucoma by having regular eye exams.
A comprehensive eye exam includes screening tests for glaucoma, starting at the age of 40 years. Exams may also include optic nerve imaging and checking the visual field. Screening may occur earlier than 40 years of age in people with a family history of glaucoma.
To diagnose glaucoma, your doctor will take a medical history and perform an eye exam and other tests.
Questions that your doctor may ask include:
- Are you currently experiencing any eye symptoms or changes in vision?
- When was your last eye exam?
- Do you have a family history of glaucoma or another eye condition?
- What other medical conditions do you have?
- What medications do you take?
Your eye exam may include the following painless tests to check for glaucoma:
- a dilated eye exam, which allows your doctor to view the optic nerve at the back of the eye
- gonioscopy, which examines the drainage angle where the iris and cornea meet
- pachymetry, which measures the thickness of the cornea
- optical coherence tomography of the retina and optic nerve head
- retinal imaging, which takes a digital picture of your retina and optic nerve
- a slit lamp exam, which magnifies the eye for examination
- a visual acuity test, which uses eye charts to check your vision
- visual field testing, which measures the total area you can see, including your peripheral vision
The goal of treatment is to prevent further damage and vision loss. Doctors accomplish this by lowering the IOP.
Several treatment options are available, but none can reverse optic nerve damage that is already present. Treatment options include medicated eye drops and surgery.
Medications for glaucoma
Treatment typically involves the use of certain eye drops, including:
- Alpha-adrenergic agonists: These decrease fluid production and increase outflow. Examples include apraclonidine (Iopidine) and brimonidine (Alphagan-P).
- Beta-blockers: These reduce fluid production in the eye. Examples include betaxolol (Betoptic) and timolol (Timoptic, Betimol). There are also combination products, such as timolol and brimonidine (Combigan) and timolol and dorzolamide (Cosopt).
- Carbonic anhydrase inhibitors: These reduce fluid production. Examples include brinzolamide (Azopt) and dorzolamide (Trusopt).
- Cholinergic drugs: These increase fluid outflow. Examples include pilocarpine (Isopto Carpine, Pilopine HS Gel) and carbachol (Isopto Carbachol).
- Prostaglandins: These increase fluid outflow. Examples include bimatoprost (Lumigan), latanoprost (Xalatan, Xelpros), tafluprost (Zioptan), and travoprost (Travatan Z). Bimatoprost also comes as an implant by the name of Durysta.
- Rho kinase inhibitors: These block an enzyme to reduce fluid production. One exmple is netarsudil (Rhopressa).
If eye drops alone do not control IOP, doctors may prescribe oral medication.
Additional treatment methods include laser surgery to make the fluids drain more easily through existing drainage channels or to create new fluid outflow channels. Laser surgery may also be a primary treatment. If successful, it can delay the need for eye drops.
Angle-closure glaucoma treatment
For angle-closure glaucoma, an emergency medical professional may administer IV acetazolamide (Diamox) through a vein as well as medicated eye drops to reduce fluid production and decrease IOP. A doctor can prescribe medication to relieve pain, nausea, and vomiting. Glaucoma surgery or laser treatment may also be necessary.
Potential complications of glaucoma are not life threatening. However, without treatment, glaucoma can lead to vision impairment and blindness, which can reduce quality of life.
You can help minimize your risk of serious complications by following your treatment plan.
Complications of glaucoma include:
- a loss of central or peripheral vision
- blindness or changes in vision
- chronic eye pain
Glaucoma is an eye condition wherein increased pressure inside the eye damages the optic nerve. Glaucoma is a leading cause of blindness, according to the Centers for Disease Control and Prevention (CDC).
If you experience a loss of vision or changes in your vision, it is important to seek the help of an eye doctor right away. Early diagnosis and treatment can prevent further damage.
Be sure to get annual eye exams. If you have risk factors or a family history of glaucoma, ask your eye doctor if you should have more frequent eye exams.
Glaucoma treatment can include eye drops and eye surgery to reduce and maintain IOP.