Chakrabarti Eye Care Centre

Glaucoma

Glaucoma is an eye disease that collectively describes different eye conditions which affect the optic nerve and is often caused by internal eye pressure. This pressure buildup, known as intraocular pressure (IOP), damages the delicate fibers of the optic nerve over time. As the pressure continues to rise, it disrupts the normal flow of fluid within the eye, leading to gradual destruction of nerve tissue. The damage often begins in peripheral (side) vision and progresses inward, making it difficult for individuals to notice until significant loss has occurred. If left untreated, this can result in anywhere from mild vision impairment to severe and often irreversible blindness. Since glaucoma usually advances without warning signs, especially in the early stages, routine eye checkups are essential for early detection, monitoring, and treatment.

Types of Glaucoma

Glaucoma types vary depending on the integrity of outflow channels and in how they impact eye pressure and optic nerve health. Some forms, like open-angle glaucoma, progress slowly and silently over time, while others, such as angle-closure glaucoma, can cause sudden, painful vision loss. Each type requires a tailored approach to diagnosis, monitoring, and treatment to prevent irreversible damage. Understanding these differences is essential, as early-stage glaucoma often goes unnoticed until significant damage has occurred. Regular comprehensive eye exams play a crucial role in detecting the specific type of glaucoma early, enabling timely intervention to protect vision.

Primary Open-Angle Glaucoma

Primary open-angle glaucoma is the most common type of glaucoma and typically develops slowly over time. It occurs when the eye’s drainage canals become less efficient due to sclerosis of drainage system, leading to a gradual buildup of intraocular pressure. This pressure damages the optic nerve without causing noticeable symptoms in the early stages. Because of its silent progression, vision loss often goes undetected until it becomes more advanced. Regular eye examinations are essential to identify and manage this condition early.

Angle-Closure Glaucoma

Angle-closure glaucoma is a less common but more acute form of the disease. It occurs when the drainage angle of the eye becomes suddenly and completely blocked, causing a rapid rise in intraocular pressure. This can lead to severe eye pain, headache, nausea, and sudden vision loss. Because it progresses quickly, it is considered a medical emergency and requires immediate treatment. Prompt diagnosis is crucial to prevent permanent vision damage.

Normal-Tension Glaucoma

Normal-tension glaucoma is a type of glaucoma where optic nerve damage occurs even though the eye pressure stays within the normal range. It can be difficult to detect early, as symptoms are often absent until noticeable vision loss appears. This makes it particularly dangerous if left unchecked. A strong family history increases the likelihood of developing this condition. Timely diagnosis through regular eye check-ups is crucial to prevent further damage.

Secondary Glaucoma

Secondary glaucoma develops as a result of another underlying condition that affects the eye. It may be triggered by eye injuries, inflammation, diabetes, certain medications like steroids, or previous eye surgeries. This type of glaucoma can appear in either open-angle or angle-closure forms. Since it’s linked to other health issues, managing the primary cause is essential to control the pressure. Prompt treatment helps prevent further optic nerve damage and vision loss.

Congenital Glaucoma

Congenital glaucoma is a rare form that appears at birth or in early childhood due to abnormal development of the eye’s drainage system. This improper development leads to increased intraocular pressure, which can damage the optic nerve early in life. Symptoms may include enlarged eyes, excessive tearing, and light sensitivity. Early diagnosis and prompt surgical intervention are crucial to preserve vision. Regular follow-ups help monitor and manage the condition effectively.

Glaucoma Symptoms

Patchy blind spots in side vision

You may start noticing blurry or missing areas in your peripheral (side) vision, which can slowly worsen over time.

Eye redness

The white part of your eye may appear bloodshot or inflamed, often due to increased intraocular pressure.

Eye pain

A dull ache or sharp pain in or around the eyes, sometimes accompanied by headache or nausea, especially during pressure spikes.

Halos around lights

Bright lights may appear with rainbow-colored rings or glow, particularly noticeable at night or in dim lighting.

Sudden vision loss (in extreme cases)

In rare cases, untreated glaucoma may lead to an abrupt and severe loss of vision, requiring urgent care.

Headache

Persistent or sudden headaches, particularly around the eyes or forehead, can be an early warning sign of rising eye pressure.

Blurred vision

Vision may become foggy or unclear, especially during acute pressure episodes.

Nausea and vomiting

A sudden spike in eye pressure can trigger these symptoms, often accompanying intense eye pain or headache.

Narrowed vision

Often described as “tunnel vision,” this is a sign of progressive optic nerve damage from chronic glaucoma.

In its early stages, there are not always visible symptoms or indications that someone may be developing the disease, emphasiing the need for regular eye examinations.

Causes of Glaucoma

Glaucoma occurs more often in older adults but can also be caused or influenced by

Family history of glaucoma

If close family members like parents or siblings have glaucoma, your risk increases significantly due to inherited genetic factors that affect optic nerve health.

Diabetic conditions

Diabetes can lead to changes in blood vessels and fluid balance in the eye, increasing the risk of developing certain types of glaucoma, especially neovascular glaucoma.

High blood pressure

Elevated blood pressure may contribute to increased eye pressure or poor blood flow to the optic nerve, potentially worsening nerve damage over time.

Prescribed steroid medications

Long-term use of steroid eye drops, pills, or even inhalers can increase intraocular pressure, making glaucoma more likely to develop.

Prior Eye Trauma

Any injury to the eye, even if minor, can disrupt the drainage system or damage internal eye structures, setting the stage for secondary glaucoma later on.

Important risk factors of Glaucoma

Advancing age

The risk of developing glaucoma increases as you grow older, especially after the age of 40, due to natural wear and changes in the eye’s drainage system.

Family history

Having a close relative with glaucoma significantly raises your chances of developing the disease, highlighting the role of hereditary influence.

INTRA-OCULAR PRESSURE (IOP)

Elevated intraocular pressure (IOP) is one of the leading causes of optic nerve damage and is a key factor in most forms of glaucoma.

Glaucoma Treatment Options

Modern glaucoma treatment focuses on lowering intraocular pressure to prevent further optic nerve damage. The choice of treatment depends on the type and severity of glaucoma, and may involve medications, laser procedures, or surgery to effectively control eye pressure and preserve vision.

Types of Glaucoma Treatments

1

Medications

Medicated Eye Drops

These are usually the first line of treatment and work by either reducing the production of fluid in the eye or improving its outflow, effectively lowering intraocular pressure.

Oral Medications

Prescribed when eye drops alone are not sufficient, these pills help further reduce pressure by decreasing fluid production or enhancing drainage pathways.

2

Laser Treatments

Laser Trabeculoplasty (SLT)

A safe, outpatient procedure that targets the eye’s drainage system to improve fluid outflow. Commonly used in open-angle glaucoma, it helps reduce eye pressure with minimal discomfort.

Other Laser Therapies

Includes procedures like laser iridotomy typically used for angle-closure glaucoma and cyclophotocoagulation for neovascular glaucoma.

3

Surgical Procedures

Minimally Invasive Glaucoma Surgeries (MIGS)

These are newer techniques designed for patients with mild to moderate glaucoma, offering quicker recovery times and fewer complications. They involve tiny implants or stents to aid fluid drainage.

Traditional Surgery

For advanced glaucoma or when other methods fail, traditional procedures like trabeculectomy performed to create new pathways for fluid to leave the eye and relieve pressure.
Glaucoma drainage devices for recalcitrant glaucoma especially neovascular glaucoma’s which are not amenable to medical therapy.
Glaucoma drainage devices for recalcitrant glaucoma especially neovascular glaucoma which are not amendable to medial therapy.

Early Detection of Glaucoma Matters

Treating glaucoma effectively begins with early identification, early detection, immediate treatment, and regular monitoring could preserve your eyesight. Once detected, initiating timely treatment whether through medications, laser procedures, or surgery can significantly reduce eye pressure and slow down optic nerve damage.Regular follow-ups, pressure checks, and visual field tests and optical coherence tomography to measure and document optic-disc and retinal nerve fibre layer are crucial to monitor disease progression. With consistent care and expert guidance, vision loss from glaucoma can often be minimized or even prevented.