They called glaucoma the silent stealer of eye sight.
Indeed many cases of glaucoma do not present any symptoms until the glaucoma is well established and has caused large area of loss of peripheral (side) vision.
Glaucoma( A Simple Guide to Glaucoma) is a condition in which there is an increase in the pressure in the eye.
Because of the increase of this intraocular pressure (IOP), the nerve that connects the eye to the brain(the optic nerve) may be damaged.
This can result in decreased peripheral vision and, eventually, blindness.
The following are at risk from Glaucoma:
1. age above 65 yrs
2. family history of glaucoma
3.history of serious eye injury or eye surgery
4.very short sighted
5. long term usage of steroid-containing eye drops
6. Diabetes (A Simple Guide to Diabetes)
The pressure in the eye (Intraocular pressure) is increased when there is poor drainage of the fluid that flows in and out of the anterior chamber of the eye.
The higher pressure can then cause damage to the nerve.
There are two major types of glaucoma:
1.Chronic Glaucoma( or Primary open angle Glaucoma )is sometimes referred to as a "silent thief of eyesight". This is because it progress slowly and does not produce any symptom until it is very advanced. By that time irreversible damage of the optic nerve may have occurred causing blurring of vision.
2.A less common form of Glaucoma known as acute closed angled Glaucoma causes sudden symptoms of intense eye pain, headaches, halos around lights, dilated pupils, vision loss, red eyes, nausea and vomiting. These signs may last for a few hours, then return again for another round. Each attack takes with it part of your field of vision. This requires emergency treatment.
I had a patient who exhibit very early symptoms of intense eye pain, headaches, halos around lights, dilated pupils, vision loss, red eyes ( very classic). I put him on spironactone tablets and immediately sent him to the eye center for treatment. An emergency operation was done. To this day he was eternally grateful to me for saving his eyesight. According to the eye surgeon a hour delay and he would lose his vision.
Glaucoma is diagnosed using specialized instruments.
Your eye pressure (intraocular pressure) will be measured with a tonometer. Some tonometers blow a puff of air onto your eye's surface.
An increased IOP reading indicates a problem with the amount of aqueous humor (fluid) in the eye:
1.either the eye is producing too much, or
2. it's not draining properly.
The drainage area is the angle formed between the cornea and the iris, which is why you see the word "angle" in the different glaucoma names.
Narrow-angle glaucoma occurs in less than 10% of glaucoma patients. In this form of the disease, aqueous humor cannot drain out of the eye due to very narrow drainage angles that are usually blocked by the iris. This condition can occur slowly and progressively, or very quickly.
Rapid closing of the angles, or acute angle-closure glaucoma, is a medical emergency. Optic nerve damage and vision loss will occur within hours if the angles are not opened to drain fluid and lower IOP.
Congenital glaucoma is a rare form of the disease affecting babies.
These children are born with narrow angles or some other defect in the drainage system of the eye.
Pigmentary glaucoma is caused by pigment from the iris clogging the draining angles, preventing aqueous humor from leaving the eye.
Secondary glaucoma develops after trauma to the eye that affects the drainage system. Injury, infection, inflammation, tumor or an enlarged cataract can precipitate secondary glaucoma.
Glaucoma is a lifelong disease.
Any damage to the optic nerve that is discovered at diagnosis is irreversible.
The aim of treatment is thus to prevent further damage and vision loss.
This is done by lowering the intraocular pressure to a safe level.
1. pressure lowering eye drops.You may be prescribed eye drops to lower the intraocular pressure.
Examples are prostaglandin eye drops(eg. Xalatan eye drop), which will allow better flow of fluid within the eye or beta blocker eye drops( Timolol, Alphagan) which reduces the pressure in the eye.
These has to be applied diligently in order to work well. The majority of glaucoma patients can be well controlled with one or more of these eye drops
2. Laser treatment
You may need laser treatment to help lower the pressure or to manage acute angle closure Glaucoma.
3. Surgery is used only:
1.when eye drops and/or laser treatment fails
2.if you develop side effects with the eye drops
3.if you need other eye surgery (eg cataract)
You should go for regular follow up with your doctor.
He will check whether treatment is effective by:
1. measuring your intraocular pressure
2. examining the optic nerve for further damage
3. analyzing your visual fields.
With proper monitoring and treatment most patients will be less likely to lose their vision.
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