Glaucoma

Overview

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Glaucoma is a group of eye diseases that damage the optic nerve, often due to high pressure inside the eye (intraocular pressure). This damage can lead to vision loss and, if untreated, blindness. It’s a leading cause of blindness worldwide, but early detection and treatment can help manage the condition.

There are different types of Glaucoma. Open-Angle Glaucoma: The most common type, often developing slowly with few symptoms until significant vision loss occurs. It is caused by gradual clogging of the eye's drainage channels, leading to increased eye pressure; Angle-Closure Glaucoma: This type occurs when the iris is too close to the drainage angle, which can block fluid drainage and cause a rapid increase in eye pressure, leading to severe pain and vision changes; Normal-Tension Glaucoma - In this form, optic nerve damage occurs despite normal eye pressure.

The exact cause is unknown, though it may be related to poor blood flow to the optic nerve and Secondary Glaucoma - This can result from other conditions or eye injuries that raise eye pressure, such as inflammation, cataracts, or diabetes.

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Symptoms

Primary Open-Angle Glaucoma:

  • Early Stages: Often asymptomatic with no noticeable symptoms.
  • Advanced Stages: Gradual loss of peripheral vision, which can lead to tunnel vision.

Angle-Closure Glaucoma:

  • Acute Attack: Sudden, severe eye pain, headache, nausea and vomiting, blurred vision, halos around lights, and a red eye. This is a medical emergency requiring immediate treatment.
Complications
  • Permanent Vision Loss: If not treated promptly, glaucoma can lead to irreversible damage to the optic nerve and loss of vision.
  • Blind Spots: Loss of peripheral vision can occur, leading to tunnel vision.
  • Increased Risk of Falls: Vision loss can affect balance and coordination, increasing the risk of falls and accidents.
  • Secondary Effects: Chronic pain and discomfort in the eye.
Causes
  • Increased Intraocular Pressure (IOP): The most common cause of glaucoma, resulting from an imbalance in the production and drainage of aqueous humor (the fluid inside the eye).
  • Optic Nerve Damage: High IOP can cause damage to the optic nerve fibers.
  • Genetic Factors: A family history of glaucoma can increase risk.
  • Other Conditions: Certain eye conditions, injuries, or surgeries can contribute to the development of glaucoma.
Prevention
  • Regular Eye Examinations: Routine eye exams can detect glaucoma early, especially for those at higher risk.
  • Monitoring IOP: Regular monitoring of intraocular pressure to identify and manage any increases.
  • Protecting the Eyes: Wearing protective eyewear to prevent eye injuries.
  • Healthy Lifestyle: Maintaining a healthy lifestyle with regular exercise and a balanced diet may support overall eye health.
Risk Factors
  • Age: Risk increases with age, especially after 40 years old.
  • Family History: A family history of glaucoma increases the risk.
  • Ethnicity: Higher prevalence in African Americans and Asians.
  • Eye Conditions: Conditions such as high myopia (nearsightedness) or a history of eye trauma.
  • Medical Conditions: Diabetes, hypertension, and certain cardiovascular conditions.
  • Use of Steroids: Long-term use of corticosteroids can increase the risk.
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How is it treated?

Medications:

  • Eye Drops: The primary treatment for lowering IOP, including prostaglandin analogs, beta-blockers, alpha agonists, and carbonic anhydrase inhibitors.
  • Oral Medications: Used in conjunction with eye drops if necessary.

Laser Therapy:

  • Laser Trabeculoplasty: For open-angle glaucoma to improve fluid drainage.
  • Laser Iridotomy or Iridoplasty: For angle-closure glaucoma to create a new drainage pathway.

Surgical Options:

  • Trabeculectomy: Creating a new drainage pathway for the aqueous humor to reduce IOP.
  • Tube Shunt Surgery: Implanting a tube to help drain fluid from the eye.
  • Lifestyle Adjustments: Regular follow-ups with an ophthalmologist to monitor IOP and adjust treatment as necessary.
  • Early detection and ongoing management are crucial for preventing vision loss from glaucoma. Regular eye exams and adherence to prescribed treatments are essential for controlling intraocular pressure and protecting vision.
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How is it Diagnosed?

Glaucoma is diagnosed through a comprehensive eye examination that evaluates the optic nerve and measures intraocular pressure (IOP). The process typically begins with tonometry, a test to measure IOP, as elevated pressure is a primary risk factor for glaucoma. Ophthalmoscopy or fundoscopy is performed to inspect the shape and color of the optic nerve for signs of damage. Perimetry, or visual field testing, assesses peripheral vision loss, which often occurs in glaucoma before central vision is affected.

Advanced imaging techniques like Optical Coherence Tomography (OCT) provide crosssectional images of the optic nerve and retinal nerve fiber layer to detect thinning indicative of glaucoma. Gonioscopy is used to examine the drainage angle of the eye to differentiate between open-angle and angle-closure glaucoma.

A diagnosis is usually made based on a combination of findings such as increased IOP, optic nerve damage, and visual field loss. Since symptoms may be absent in early stages, routine screening is crucial, especially for individuals over 40 or with a family history.

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