Glaucoma

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Glaucoma is a group of eye conditions that damage the optic nerve, which is vital to good vision. This damage is often caused by an abnormally high pressure in your eye.

The most common form of glaucoma has no warning signs. The effect is so gradual that you may not notice a change in vision until the condition is at an advanced stage.

Vision loss due to glaucoma can’t be recovered. So 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.

Symptoms

signs and symptoms of glaucoma vary depending on the type and stage of your condition. For example:

Open-angle glaucoma

  • Patchy blind spots in your side (peripheral) or central vision, frequently in both eyes
  • Tunnel vision in the advanced stages

Acute angle-closure glaucoma

  • Severe headache
  • Eye pain
  • Nausea and vomiting
  • Blurred vision
  • Halos around lights
  • Eye redness

If left untreated, glaucoma will eventually cause blindness. Even with treatment, about 15 percent of people with glaucoma become blind in at least one eye within 20 years.

When to see a doctor

Seek immediate medical care

Promptly go to an emergency room or an eye doctor’s (ophthalmologist’s) office if you experience some of the symptoms of acute angle-closure glaucoma, such as severe headache, eye pain and blurred vision.

Schedule eye exams

Open-angle glaucoma gives few warning signs until permanent damage has already occurred. Regular eye exams are the key to detecting glaucoma early enough to successfully slow or prevent vision loss.

The American Academy of Ophthalmology recommends glaucoma screening:

  • Every four years beginning at age 40 if you don’t have any glaucoma risk factors
  • Every two years if you’re at high risk or over 65

Causes

Glaucoma is the result of damage to the optic nerve. As this nerve gradually deteriorates, blind spots develop in your visual field. For reasons that doctors don’t fully understand, this nerve damage is usually related to increased pressure in the eye.

Elevated eye pressure is due to a buildup of a fluid (aqueous humor) that flows throughout your eye. This fluid normally drains into the front of the eye (anterior chamber) through tissue (trabecular meshwork) at the angle where the iris and cornea meet. When fluid is overproduced or the drainage system doesn’t work properly, the fluid can’t flow out at its normal rate and pressure builds up.

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

Types of glaucoma

The types of glaucoma include the following:

  • Open-angle glaucoma
  • Angle-closure glaucoma
  • Normal-tension glaucoma
  • Glaucoma in children
  • Pigmentary glaucoma

Risk factors

Chronic forms of glaucoma can destroy vision before any signs or symptoms are apparent, be aware of these risk factors:

  • Having high internal eye pressure (intraocular pressure)
  • Being over age 60
  • Being black or Hispanic
  • Having a family history of the condition
  • Having certain medical conditions, such as diabetes, heart disease, high blood pressure and sickle cell anemia
  • Having certain eye conditions, such as nearsightedness
  • Having had an eye injury or certain types of eye surgery
  • Early estrogen deficiency, such as can occur after removal of both ovaries (bilateral oophorectomy) before age 43
  • Taking corticosteroid medications, especially eyedrops, for a long time

Tests and diagnosis

Your doctor will review your medical history and conduct a comprehensive eye examination. He or she may perform several tests, including:

  • Measuring intraocular pressure (tonometry)
  • Testing for optic nerve damage
  • Checking for areas of vision loss (visual field test)
  • Measuring corneal thickness (pachymetry)
  • Inspecting the drainage angle (gonioscopy)

Treatments and drugs

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

The goal of glaucoma treatment is to lower pressure in your eye (intraocular pressure). Depending on your situation, your options may include eyedrops, laser treatment or surgery.

Eyedrops

Glaucoma treatment often starts with prescription eyedrops. These can help decrease eye pressure by improving how fluid drains from your eye or by decreasing the amount of fluid your eye makes.

Prescription eyedrop medications include:

  • Prostaglandins
  • Beta blockers
  • Alpha-adrenergic agonists
  • Carbonic anhydrase inhibitors
  • Miotic or cholinergic agents

Oral medications

If eyedrops alone don’t bring your eye pressure down to the desired level, your doctor may also prescribe an oral medication, usually a carbonic anhydrase inhibitor.

Surgery and other therapies

Other treatment options include laser therapy and various surgical procedures.

The following techniques are intended to improve the drainage of fluid within the eye, lowering pressure:

  • Laser therapy
  • Filtering surgery
  • Drainage tubes
  • Electrocautery

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 both medication and laser or other surgical procedures.

You may have a procedure called a laser peripheral iridotomy in which the doctor creates a small hole in your iris using a laser. This allows fluid (aqueous humor) to flow through it, relieving eye pressure.

Lifestyle and home remedies

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

  • Eat a healthy diet
  • Exercise safely
  • Limit your caffeine.
  • Sip fluids frequently
  • Sleep with your head elevated
  • Take prescribed medicine

Prevention

You may not be able to prevent glaucoma. But these self-care steps can help you detect it early, limit vision loss or slow its progress.

  • Get regular eye care
  • Know your family’s eye health history
  • Exercise safely
  • Take prescribed eyedrops regularly
  • Wear eye protection

 

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