Glaucoma (Increased Intraocular Pressure): Symptoms, Causes, Diagnosis & Treatment

Glaucoma is a type of eye disorders that cause damage to the optic nerve that carries information from the eye to the brain. In its early stages, glaucoma usually has no symptoms, which is what makes it so dangerous — by the time you notice problems with your sight, the disease has progressed to the point that irreversible vision loss has already occurred and additional loss may be difficult to stop.

The two major categories of glaucoma are open-angle glaucoma (OAG) and narrow-angle glaucoma. The “angle” in both cases refers to the drainage angle inside the eye that controls the outflow of the watery fluid (aqueous) that is continually being produced inside the eye. If the aqueous can access the drainage angle, the glaucoma is known as open-angle glaucoma. If the drainage angle is blocked and the aqueous cannot reach it, the glaucoma is known as narrow-angle glaucoma.

In most cases, glaucoma is associated with higher-than-normal pressure inside the eye — a condition called ocular hypertension. But it also can occur when intraocular pressure (IOP) is normal. If untreated or uncontrolled, glaucoma first causes peripheral vision loss and eventually can lead to blindness.

According to the American Academy of Ophthalmology, the most common type of glaucoma — called primary open-angle glaucoma — affects an estimated 2.2 million people in the United States, and that number is expected to increase to 3.3 million by 2020 as the U.S. population ages.

Most cases of glaucoma have few or no early symptoms thus, about half of Americans with glaucoma don’t know they have it.

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How Does Glaucoma Affect Your Body?

Glaucoma occurs due to raised intraocular pressure. It is this raised pressure that compresses and damages the optic nerve. Once the optic nerve is damaged, it fails to carry visual information to the brain and this results in loss of vision.

What Are The Causes of Glaucoma?

The main cause of the glaucoma is a pressure that is created in the eye which damages the optic nerve. The optic nerve is the sensitive part of the eye to high pressures because the nerves easily get damaged by direct pressure or decreased blood flow to the nerve.

Some gene related to high pressure and optic nerve damage can cause glaucoma. Some condition that causes glaucoma, such as inflammation of nerves, tumor, diabetes and an advanced cataract

What Are The Risk Factors of Glaucoma?

Common risk factors of glaucoma are:

  • People above the age of 45
  • Family hereditary of glaucoma
  • People who with intraocular pressure (IOP)
  • Medical conditions such as myopia, diabetes, hyperopia, previous eye injury and long-term use of the corticosteroids
  • People of African- American descent have high chances of developing glaucoma than other people
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What Are The Symptoms of Glaucoma?

Glaucoma doesn’t have symptoms at the initial stage. Symptoms are manifested after the disease has been reached to chronic form. The following symptoms may appear:

  • Severe eye pain is the first sign of Glaucoma
  • Redness in the eye.
  • Blurred or cloudy eye, particularly in infants.
  • Tunnel vision.
  • Headache
  • Sick stomach (nausea).
  • Rainbow colored halos around any light. The blind spot first develops in the side vision (peripheral vision) and outer side of the field of vision. In later stages, central vision is affected while seeing is fully lost
  • Eye inflammation and infection.
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How is Glaucoma Diagnosed?

Diagnostic methods used for detecting glaucoma are:

  • Intraocular pressure (IOP) – IOP is measured using tonometry. During this examination, your eye is numbed using eye drops to rest a lightweight probe gently on the surface of the eyeball. It touches the eyeball and measures the pressure. Sometimes a blast of air is applied to the eye’s surface. The normal IOP should be below 21 mmHg. If your IOP is greater than the 30 mmHg then you are at peak risk of losing vision.
  • Assessment of the optic nerve – An optometrist will use eye drops to dilate the pupils and through a slit lamp to assess the condition of the optic nerve. A bright light is passed into the eye to visualize the damage in the optic nerve. Eye drops that used to make pupil enlargement may develop difficult to drive and read from a long distance. It is important to have one of your family members along with you to get into the home.
  • Visual field test or perimetry – Visual field test finds the missing part of the vision loss. A series of light spots are displayed and asked to look at the spots and will determine the field of vision you have. In which some dots may appear on the sides of eyeballs call peripheral vision.
  • Corneal pachymetry – The high corneal thickness may interrupt the values of intraocular pressure and so it is measured using an instrument called pachymetry. It is a device having a pressure sensor probe at its tip is placed on the surface of the eye (Cornea). This procedure takes about 1 to 2 minutes.
  • Gonioscopy – The angle where the cornea and iris meets are measured. During the examination, a hand-held contact lens is placed gently on the eye. This lens has a mirror which will show the angle between the iris and cornea is open or closed.
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How to Prevent & Control Glaucoma?

Following are the methods to prevent glaucoma:

  • Regular eye exams should be done
  • Daily exercise such as walking, jogging, and running have chances to maintain the normal IOP.
  • During yoga practice, you should avoid inverted positions like headstands and shoulder stands.
  • Wear protective eyeglasses during your sports activities and home improvement projects.
  • If you find any blurred vision immediately go for an eye check-up.
  • Avoid high amount of salts in your diet if affected with hypersensitive glaucoma.
  • If you already have glaucoma, try to avoid coffee and caffeinated beverages to reduce high BP.
  • Avoid drinking water at a single sip. It is advised to drink a small amount of water during the course of a day.
  • Consume very less red wine, green tea, and black chocolate.
  • Have foods that are rich in omega 3-fatty acids.

Treatment of Glaucoma

Generally, glaucoma is an irreversible eye disorder. Treatment and medication may help to reduce and slows down the vision loss in the early stages. Common treatment options include:

  • Eye drops – These are prescribed to reduce the IOP in such a way to drain the extra fluid from the eye and regulates the fluid volumes through low secretion of fluids. Some of the eye drop medications are:
  • Beta-blockers – It reduces the secretion of fluids in the eye, thereby reducing the pressure in the intraocular region. Examples: timolol and betaxolol. Unlikely some side effects are low BP, slow heart rate, difficult breath, impotence, and fatigue.
  • Miotic or cholinergic agents – It increases the outflow of fluids from the eye. Ex: Pilocarpine. It may impose few side effects such as blurred vision, nearsightedness, and smaller pupils.
  • Alpha-adrenergic agonist – It lowers the production of aqueous humor and increases the outflow of fluid. Ex. Apraclonidine and brimonidine which includes some side effects such as irregular heartbeat, redness or swollen eye, low BP, fatigue, and dry mouth.
  • Carbonic anhydrase inhibitors – It also reduces the fluid buildup in the eye. Dorzolamide (Trusopt) and brinzolamide (Azopt) are some carbonic anhydrases which are having a metallic taste, frequent urination, and tingling in their side effects.
  • Prostaglandin – It increases the fluid outflow from the aqueous humor and tends to reduce the pressure. Possible side effects may be redness and stinging of an eye, color change in pigments of the lashes and blurred vision. Ex. Latanoprost and bimatoprost. FDA approved prostaglandins are Xalatan, Lumigan, Travatan Z, and Rescula.
  • Hyperosmotic agents – Usually these drugs are prescribed for people with severe high IOP and should be reduced before glaucoma become irreversible and permanent. It is usually given in emergency cases only. Hyperosmotic agents are oral glycerin and isosorbide orally, and mannitol and urea intravenously.
  • Surgery – When medicines are not able to cure glaucoma or show severe side effects, surgery is necessary to save the vision. There are different surgical techniques employed for glaucoma, like :
  • Laser surgery – It is the most popular and easy way of glaucoma surgery. Laser surgery is an intermediate procedure between traditional drugs and present drugs. During this surgery, the patient’s eye is numbed using eye drops, and your doctor places a special lens to the eyes. Then a high beam of the laser is applied to the eye. There are different types of laser surgeries used according to the form of glaucoma.
  • Argon Laser Trabeculoplasty (ALT) – ALT is mostly used for the primary open-angle glaucoma (POAG). In this, a type of laser beam is used to open the eye’s drainage channels while helping to drain the fluids properly. Sometimes medications are still needed along with this treatment.
  • Selective Laser Trabeculoplasty (SLT) – Very low-level lasers are used to treat specific cells, leaving the untreated portions of the intact trabecular meshwork. It is mostly used for the treatment of primary open-angle glaucoma (POAG). It is preferred as an alternative method of the unsuccessful eye drops and ALT treatment.
  • Laser Peripheral Iridotomy (LPI) – LPI is mostly employed for narrow-angle glaucoma. In this case, the angle between the cornea and the iris is too small and so it causes blockage in the fluid channel. LPI makes a small hole in the iris and makes it fall back from the draining channel to help fluid outlet.
  • Cycloablation – In this procedure, a part of the ciliary body is destructed to reduce the production of aqueous humor and hence the IOP is reduced.
  • Trabeculectomy – In this method, a passage is created on the sclera to drain the excess fluid. A flap is created on the sclera to drain out the fluids. This procedure doesn’t inflate the eyeball. A small bubble is formed which indicates the drainage of fluid from the eye.
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Glaucoma – Lifestyle Tips

Common lifestyle tips include:

  • Regular physical exercise daily.
  • Marijuana – Smoking marijuana can lower eye pressure. However, due to its short duration of action (3-4 hours), side effects, and lack of evidence that it alters the course of glaucoma, it is not recommended for glaucoma treatment.
  • Alcohol – Lowers eye pressure for a short duration but some studies suggest that daily alcohol consumption is associated with higher eye pressure. Alcohol use does not appear to alter the risk of developing glaucoma.
  • Cigarettes – Studies indicate that smoking cigarettes increases the risk of glaucoma, and has an overall negative impact on eye health.
  • Caffeine – Drinking coffee increases eye pressure for a short duration. A little coffee is fine, but excessive caffeine intake is not ideal. One study found that drinking 5 or more cups of caffeinated coffee increased the risk of developing glaucoma

What Are The Recommended Exercises For a Person With Glaucoma?

  • Exercise – Aerobic exercise helps lower eye pressure, but the studies were not conducted in glaucoma patients and you must have approval from your primary physician first. Weightlifting can raise eye pressure, especially if the breath is held; but it is also a form of exercise and the effects of exercise are generally positive.
  • Yoga – Head-down positions can increase eye pressure and are not recommended for glaucoma patients.
  • High-resistance wind instruments – includes trumpet and oboe; eye pressure increases while playing these.

Glaucoma & Pregnancy – Things to Know

The management of glaucoma during pregnancy and lactation presents unique challenges. Several glaucoma medications have potential adverse effects in the fetus or breastfeeding infant. These medications should be considered only after carefully balancing the potential dangers to the fetus or infant with the risk of worsening glaucoma in the mother. When medical treatment is employed, systemic absorption should be minimized through nasolacrimal duct occlusion or punctual plugging. Alternatives to medical treatment should be considered, including laser trabeculoplasty or observation of medical treatment.

Glaucoma surgery during pregnancy should be avoided, particularly in the first trimester when the risk of abortion and teratogenicity with anesthetics, sedative agents, and antimetabolites is highest. If glaucoma surgery is considered during pregnancy, special considerations should be taken regarding the use of antimetabolites, patient positioning, and the type of anesthesia administered.

Common Complications Related to Glaucoma

Glaucoma can cause poor vision and eventually lead to blindness if left untreated. Notable complications of glaucoma include sensitivity of the eye towards light and pain within the eye.

Other FAQs About Glaucoma

Q. What is the first sign of glaucoma?

A. Detecting glaucoma early is one reason you should have a complete exam with an eye specialist every 1 to 2 years. Occasionally, a pressure inside the eye can rise to severe levels. In these cases, you may have sudden eye pain, headache, blurred vision, or the appearance of halos around lights

Q. Can you stop the progression of glaucoma?

A. While there are no known ways of preventing glaucoma, blindness or significant vision loss from glaucoma can be prevented if the disease is recognized in the early stages. In its most prevalent form—primary open-angle glaucoma—vision loss is silent, slow, and progressive.

Q. What is the best vitamin to take for glaucoma?

A. Any specific nutritional deficiencies in your diet can be addressed with supplements that include Vitamins A, B-complex, C, and E as well as the minerals Magnesium, Calcium and Zinc. However, there is no convincing data that vitamin supplements help to prevent glaucoma.


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