The symptoms and treatment of Glaucoma

Description

Glaucoma is an eye disease that damages the optic nerve. This damage can lead to vision loss or blindness. The optic nerve sends visual information from the eye to the brain and is vital for good vision. The damage to the optic nerve is often related to the high pressure in the eye. But glaucoma can occur even with the typical pressure in the eye.

Glaucoma can occur at any age but is more common in older adults. It is one of the leading causes of blindness for people over 60 years of age.

Many forms of glaucoma have no warning signs. The effect is so gradual that you may not notice a change in vision until the disease is in its later stages.

It is important to have regular eye exams that include measurements of your eye pressure. If glaucoma is detected early, vision loss can be reduced or avoided. If you have glaucoma, you will need treatment or monitoring for the rest of your life.

Symptoms

The symptoms of glaucoma depends on the type and stage of the disease.

Open-angle glaucoma

There are No symptoms in the early stages.
Little by little, patches of blind spots in the side vision. Side view is also called peripheral vision.
In later stages, the difficulty to see things in their central vision.

Acute angle-closure glaucoma

Strong headache.
Intense pain in the eye.
Nausea or vomiting.
Blurred vision.
Halos or colored rings around lights.
Redness of the eyes.

Normal-tension Glaucoma

There are No symptoms in the early stages.
Little by little, the blurred vision.
In later stages, loss of side vision.

Glaucoma in children

An opaque or cloudy eyes (babies).
The increase of blinking (babies).
Tears without crying (infants).
Blurred vision.
Myopia worsens.
The pain of a headache.

Pigmentary glaucoma

Halos around lights.
Blurred vision with exercise.
Gradual loss of side vision.

When to see a doctor

If you have symptoms that appear suddenly, you may have acute closed angle glaucoma. The symptoms include headache and severe pain in the eye. You need treatment as soon as possible. Go to an emergency room or call an eye doctor called an ophthalmologist immediately.

Causes

Glaucoma occurs when the optic nerve is damaged. As this nerve gradually gets worse, blind spots develop in your vision. For reasons that the eyes of the doctors do not fully understand, this nerve damage is usually related to increased pressure in the eye.

Raised eye pressure that occurs as the result of an accumulation of fluid that flows along the inner part of the eye. This fluid, called the aqueous humor normally drains through a tissue that is located in the angle where the iris and cornea meet. This tissue is called the trabecular meshwork. The cornea is important for vision, as it lets the light into the eye. When the eye becomes too much liquid or the drainage system does not work properly, the pressure in the eye may increase.

Open-angle glaucoma

This is the most common form of glaucoma. The drainage angle formed by the iris and cornea remains open. But other parts of the drainage system does not drain properly. This can lead to a slow, gradual increase in eye pressure.

Acute angle-closure glaucoma

This form of glaucoma occurs when the iris bulges. The protrusion of the iris, partially or totally blocking the drainage angle. As a result, fluid can't circulate through the eye and pressure increases. Closed-angle glaucoma can occur suddenly or gradually.

Normal-tension Glaucoma

No one knows the exact reason for the optic nerve is damaged when the pressure of the eye is healthy. The optic nerve may be sensitive or experience less blood flow. This limits the flow of blood can be caused by the accumulation of fatty deposits in the arteries, or other conditions that damage the movement. The accumulation of fatty deposits in the arteries also known as atherosclerosis.

Glaucoma in children

A child can be born with glaucoma or develop in the first years of life. Blocked drainage, injury, or an underlying medical condition can cause damage to the optic nerve.

Pigmentary glaucoma

In pigmentary glaucoma, small pigment granules rid of iris and block or slow drainage of fluid from the eye. Activities such as jogging, sometimes, stir until the granules of pigment. That leads to a deposit of the pigment granules in the tissue that is located in the angle where the iris and cornea meet. The granule deposits cause an increase in pressure.

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

Risk factors

Glaucoma can damage your vision before symptoms appear. So be aware of these risk factors:

The high internal pressure in the eye, also known as intraocular pressure.
The age of more than 55 years.
Black, Asian or Hispanic heritage.
Family history of glaucoma.
Certain medical conditions, such as diabetes, migraines, high blood pressure and sickle cell anemia.
Thin corneas in the center.
Extreme nearsightedness or farsightedness.
Injury to the eyes or certain types of eye surgery.
Take corticosteroid medicines, particularly eye drops, for a long time.

Some people have narrow drainage angles, putting them at increased risk of angle-closure glaucoma.

Prevention

These steps can help you to find and manage glaucoma in its early stages. That can help prevent vision loss or slow its progress.

Get regular eye exams.Regular eye exams can help find the glaucoma in its early stages, before a large amount of damage occurs. As a general rule, the American Academy of Ophthalmology recommends a comprehensive eye exam every 5 to 10 years, if you're under 40 years of age; every 2 to 4 years if you are 40 to 54 years of age; every 1 to 3 years if you are aged 55 to 64 years of age; and every 1 to 2 years if you have more than 65 years. If you are at risk for glaucoma, you need to have a check in more often. Ask a health care professional to recommend the right screening program for you.
Know your family's eye health history. Glaucoma tends to run in families. If you are at a higher risk, you may need tests more often.
Wear eye protection. Serious eye injury can lead to glaucoma. Wear eye protection when using power tools or sports.
Take prescribed eye drops regularly. The Glaucoma drops can significantly reduce the risk of high eye pressure progress of glaucoma. The use of eye drops as prescribed by a health care professional, even if you have no symptoms.

Get regular eye exams. Regular eye exams can help find the glaucoma in its early stages, before a large amount of damage occurs. As a general rule, the American Academy of Ophthalmology recommends a comprehensive eye exam every 5 to 10 years, if you're under 40 years of age; every 2 to 4 years if you are 40 to 54 years of age; every 1 to 3 years if you are aged 55 to 64 years of age; and every 1 to 2 years if you have more than 65 years.

If you are at risk for glaucoma, you need to have a check in more often. Ask a health care professional to recommend the right screening program for you.

Diagnosis

An eye care professional will review your medical history and perform a complete examination of the eye. Several tests can be performed, including:

Measurement of intraocular pressure, also called tonometry.
The test of optic nerve damage with a dilated eye exam and imaging tests.
The checking of the areas of vision loss, also known as an examination of the visual field.
The measurement of the thickness of the cornea with a test called pachymetry.
Inspect the drainage angle, also known as gonioscopy.

Treatment

The damage caused by glaucoma cannot be reversed. But treatment and regular checkups can help slow or prevent vision loss, especially if the disease is in its early stages.

Treatment of glaucoma aims to lower intraocular pressure. Treatment options include eye drops, oral medications, laser treatment, surgery or a combination of approaches.

Eye drops

Glaucoma treatment often starts with prescription eye drops. Some may decrease the eye pressure by improving the functioning of fluid that drains from the eye. Others decrease the amount of fluid the eye. Depending on how low the pressure of the eye should be, more than one eye drop may be prescribed.

Prescription eye drops drugs include:

Prostaglandins.These increase the outflow of fluid in the eye, helping to reduce pressure in the eye. Medicines in this category include latanoprost (Xalatan), travoprost (Travatan Z), tafluprost (Zioptan), bimatoprost (Lumigan) and latanoprostene bunod (Vyzulta). Possible side effects include mild redness and itching of the eyes, darkening of the iris, the darkening of the pigment of the lashes of the eyes or of the skin of the eyelids, and blurred vision. This class of medicine that is prescribed by a once-a-day.
Beta-blockers.These reduce the production of fluid in the eye, which helps to reduce the eye pressure. Examples include timolol (Betimol, Istalol, Timoptic) and betaxolol (Betoptic S). Possible side effects include difficulty breathing, a slow heart rate, low blood pressure, impotence, and fatigue. This class of medication may be prescribed to once or twice a day, use, depending on your condition.
Alpha-adrenergic receptors.These reduce the production of fluid that flows along the inner part of the eye. It also increases the secretion of fluid in the eye. Examples include the apraclonidine (Iopidine) and brimonidine (Alphagan P, Qoliana). Possible side effects include irregular heart rate, high blood pressure, fatigue, redness, itching or swelling of the eyes and dryness of mouth. This class of medications are prescribed for twice-daily use, but can sometimes be prescribed for use three times a day.
Carbonic anhydrase inhibitors. These drugs reduce the production of fluid in the eye. Examples include the dorzolamide and brinzolamide (Azopt). Possible side effects include a metallic taste in the mouth, frequent urination, and tingling sensation in the fingers of the hands and feet. This class of medications are prescribed for twice-daily use, but can sometimes be prescribed for use three times a day.
Rho kinase inhibitor. This medicine reduces the eye pressure for the suppression of the rho-kinase enzymes responsible of liquid on the rise. It is available as netarsudil (Rhopressa) and is prescribed for a once-a-day. Possible side effects include eye redness and discomfort in the eyes.
Miotic agents or cholinergic. These increase the outflow of fluid from the eye. An example is the pilocarpine (Isopto Carpine). The side effects include headache, pain of the eyes, the younger pupils, it is possible to blurred or dim vision, and myopia. This class of medication is generally prescribed to be used up to four times a day. Due to the possible side effects and the need for frequent daily use, these medications are not prescribed very often.

Prostaglandins. These increase the outflow of fluid in the eye, helping to reduce pressure in the eye. Medicines in this category include latanoprost (Xalatan), travoprost (Travatan Z), tafluprost (Zioptan), bimatoprost (Lumigan) and latanoprostene bunod (Vyzulta).

Possible side effects include mild redness and itching of the eyes, darkening of the iris, the darkening of the pigment of the lashes of the eyes or of the skin of the eyelids, and blurred vision. This class of medicine that is prescribed by a once-a-day.

Beta-blockers. These reduce the production of fluid in the eye, which helps to reduce the eye pressure. Examples include timolol (Betimol, Istalol, Timoptic) and betaxolol (Betoptic S).

Possible side effects include difficulty breathing, a slow heart rate, low blood pressure, impotence, and fatigue. This class of medication may be prescribed to once or twice a day, use, depending on your condition.

Alpha-adrenergic receptors. These reduce the production of fluid that flows along the inner part of the eye. It also increases the secretion of fluid in the eye. Examples include the apraclonidine (Iopidine) and brimonidine (Alphagan P, Qoliana).

Possible side effects include irregular heart rate, high blood pressure, fatigue, redness, itching or swelling of the eyes and dryness of mouth. This class of medications are prescribed for twice-daily use, but can sometimes be prescribed for use three times a day.

Due to that some of the drop to the eyes of the medicine is absorbed into your bloodstream, you may experience some side effects not related to their eyes. To minimize this absorption, close your eyes for 1 to 2 minutes after putting the drops in. You can also lightly press on the corner of your eye near the nose to close the lacrimal duct for 1 to 2 minutes. Wipe away any excess drops of your eyelid.

Can be prescribed in several drops for the eyes, or the need to use artificial tears. Be sure to wait at least five minutes between the use of different drops.

Oral medications

Eye drops alone can't carry the eye pressure down to the desired level. So, an eye doctor may also prescribe an oral medication. This medication usually is a carbonic anhydrase inhibitor. Possible side effects include frequent urination, tingling sensation in the fingers of the hands and feet, depression, disorder, stomach, and kidney stones.

Surgery and other treatments

Other treatment options include laser therapy and surgery. The following techniques can help to drain the fluid inside the eye and the eye pressure:

The laser therapy. Laser trabeculoplasty (truth-BEK-u-low-plas-tee) is an option if the drops can not be tolerated. It can also be used if the medicine has not stopped the progression of the disease. An eye doctor may also recommend laser surgery before using eye drops. Is done in the office. An eye doctor uses a small laser to improve the drainage of the tissue located in the angle where the iris and cornea meet. It may take a couple of weeks before the full effect of this procedure is evident.
Filtering surgery. This is a surgical procedure called trabeculectomy (truth-bek-u-LEK-tuh-me). The eye doctor creates an opening in the white part of the eye, which is also known as the sclera. The surgery creates another space for the fluid to exit the eye.
Drainage tubes. In this procedure, the surgeon inserts a small tube inside the eye to drain the excess fluid to reduce pressure in the eye.
Minimally invasive surgery, glaucoma surgery (MIGS). An eye doctor may suggest a MIGS procedure to lower the eye pressure. This procedure generally require less immediate postoperative care, and has less risk than the trabeculectomy or the use of a drainage device. A MIGS procedure is often combined with cataract surgery. There are a number of MIGS techniques available.

After your procedure, you will need to see your eye doctor for follow-up examinations. And you may need to undergo additional procedures if the pressure of the eye starts to rise or to other changes happen in your eye.

The treatment of acute angle-closure glaucoma

Acute angle-closure glaucoma is a medical emergency. If you are diagnosed with this condition, you will need urgent treatment to reduce the pressure in the eye. This usually requires treatment with medications and laser or surgical procedures.

You can have a procedure called laser iridotomy peripheral. The doctor creates a small hole in the iris through a laser. The hole allows the liquid to flow through the iris. This helps to open the drainage angle of the eye and relieves the pressure of the eye.

Lifestyle and home remedies

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

Eat a healthy diet. Eating a healthy diet can help you maintain your health, but do not prevent glaucoma from worsening. Several vitamins and nutrients that are important for eye health, including zinc, copper, selenium, and antioxidant vitamins C, E and A.
Exercise safely. Regular exercise can reduce the pressure of the eye. Talk with your healthcare provider about an appropriate exercise program.
Limit your consumption of caffeine. Drink large amounts of caffeine can increase the pressure in the eye.
Drink liquids with care. Drinking moderate amounts of fluids. Drink a litre or more of any liquid within a short period of time may temporarily increase the pressure of the eye.
The taking of prescription drugs. The use of eye drops or other medications as prescribed can help you obtain the best possible result in your treatment. Be sure to use the eye drops exactly as prescribed. Otherwise, damage to the optic nerve could get worse.

Alternative medicine

Some alternative medicine approaches can help the health in general, but none is effective in glaucoma remedy. Talk to an eye doctor about the potential benefits and risks.

Herbal remedies. Some herbal supplements, such as bilberry extract, has been announced as the glaucoma remedies. But more studies are needed to demonstrate its efficacy. Do not use herbal supplements in place of proven therapies.
Relaxation techniques. Stress can trigger an attack of acute angle-closure glaucoma. Try to find healthy ways to cope with stress. Meditation and other techniques can help.
Marijuana. The research shows that marijuana reduces eye pressure in people with glaucoma, but only for 3 to 4 hours. Other, standard treatments are more effective. The American Academy of Ophthalmology does not recommend marijuana for the treatment of glaucoma.

Coping and support

When you receive a diagnosis of glaucoma, you are potentially facing the life-long treatment, regular check-ups and the possibility of progressive vision loss.

Meet and talk to other people with glaucoma, it can be very useful, and many support groups that exist. Check with the hospitals and eye care centers in your area to find local groups and meeting times. Search for online resources, including support groups.

Preparing for your appointment

You can start by seeing your primary healthcare professional. Or you may be referred immediately to an eye specialist, also called an ophthalmologist.

Here's some information to help you prepare for your appointment.

What you can do

When you make the appointment, ask if there is something that you need to do in advance, such as fasting before a specific test. Make a list of:

Your symptoms, including any that seem unrelated to the reason for your appointment.
Key personal information, including major stresses, recent life changes and family medical history.
All medications, vitamins or supplements that you are taking, including the dosage.
Questions to ask your eye doctor.

Take a family member or friend along, if possible, to help you remember the information they give you.

For glaucoma, some basic questions to ask include:

What is likely causing my symptoms?
Other that the most likely cause, what are other possible causes of the symptoms?
What tests do I need?
Is my condition likely to be short-term or for life?
What is the best course of action?
What are the alternatives to the primary approach you're suggesting?
I have these other health conditions. How can I best manage them together?
There are No limits should I follow?
What other self-care measures might help me?
What is the long-term outcome in my case?
You should see a specialist?
Are there brochures or other printed material I can have? What sites do you recommend?

Do not hesitate to ask other questions.

What to expect from your doctor

Your doctor may ask you several questions, such as:

When did your symptoms begin?
The symptoms been continuous or occasional?
How severe are the symptoms?
What, if anything, seems to improve your symptoms?
What, if anything, appears to worsen your symptoms?

What you can do in the meantime

Avoid doing anything that seems to make your symptoms worse.