Glaucoma is a group of eye conditions that damage the optic nerve, the health of which is vital for good vision. This damage is often caused by an abnormally high pressure in your eye.
Glaucoma is one of the leading causes of blindness for people over the age of 60. It can occur at any age but is more common in older adults.
Many forms of glaucoma have no warning signs. The effect is so gradual that you may not notice a change in vision until the condition is at an advanced stage.
Because vision loss due to glaucoma can't be recovered, it's important to have regular eye exams that include measurements of your eye pressure so a diagnosis can be made in its early stages and treated appropriately. If glaucoma is recognized early, vision loss can be slowed or prevented. If you have the condition, you'll generally need treatment for the rest of your life.
The signs and symptoms of glaucoma vary depending on the type and stage of your condition. For example:
Acute angle-closure glaucoma
If left untreated, glaucoma will eventually cause blindness. Even with treatment, about 15 percent of people with glaucoma become blind in at least one eye within 20 years.
When to see a doctor
Promptly go to an emergency room or an eye doctor's (ophthalmologist's) office if you experience some of the symptoms of acute angle-closure glaucoma, such as severe headache, eye pain and blurred vision.
Glaucoma is the result of damage to the optic nerve. As this nerve gradually deteriorates, blind spots develop in your visual field. For reasons that doctors don't fully understand, this nerve damage is usually related to increased pressure in the eye.
Elevated eye pressure is due to a buildup of a fluid (aqueous humor) that flows throughout the inside of your eye. This internal fluid normally drains out through a tissue called the trabecular meshwork at the angle where the iris and cornea meet. When fluid is overproduced or the drainage system doesn't work properly, the fluid can't flow out at its normal rate and eye pressure increases.
Glaucoma tends to run in families. In some people, scientists have identified genes related to high eye pressure and optic nerve damage.
Types of glaucoma include:
Open-angle glaucoma is the most common form of the disease. The drainage angle formed by the cornea and iris remains open, but the trabecular meshwork is partially blocked. This causes pressure in the eye to gradually increase. This pressure damages the optic nerve. It happens so slowly that you may lose vision before you're even aware of a problem.
Angle-closure glaucoma, also called closed-angle glaucoma, occurs when the iris bulges forward to narrow or block the drainage angle formed by the cornea and iris. As a result, fluid can't circulate through the eye and pressure increases. Some people have narrow drainage angles, putting them at increased risk of angle-closure glaucoma.
Angle-closure glaucoma may occur suddenly (acute angle-closure glaucoma) or gradually (chronic angle-closure glaucoma). Acute angle-closure glaucoma is a medical emergency.
In normal-tension glaucoma, your optic nerve becomes damaged even though your eye pressure is within the normal range. No one knows the exact reason for this. You may have a sensitive optic nerve, or you may have less blood being supplied to your optic nerve. This limited blood flow could be caused by atherosclerosis — the buildup of fatty deposits (plaque) in the arteries — or other conditions that impair circulation.
Glaucoma in children
It's possible for infants and children to have glaucoma. It may be present from birth or develop in the first few years of life. The optic nerve damage may be caused by drainage blockages or an underlying medical condition.
In pigmentary glaucoma, pigment granules from your iris build up in the drainage channels, slowing or blocking fluid exiting your eye. Activities such as jogging sometimes stir up the pigment granules, depositing them on the trabecular meshwork and causing intermittent pressure elevations.
Because chronic forms of glaucoma can destroy vision before any signs or symptoms are apparent, be aware of these risk factors:
These self-care steps can help you detect glaucoma in its early stages, which is important in preventing vision loss or slowing its progress.
Your doctor will review your medical history and conduct a comprehensive eye examination. He or she may perform several tests, including:
The damage caused by glaucoma can't be reversed. But treatment and regular checkups can help slow or prevent vision loss, especially if you catch the disease in its early stages.
Glaucoma is treated by lowering your eye pressure (intraocular pressure). Depending on your situation, your options may include prescription eyedrops, oral medications, laser treatment, surgery or a combination of any of these.
Glaucoma treatment often starts with prescription eyedrops. These can help decrease eye pressure by improving how fluid drains from your eye or by decreasing the amount of fluid your eye makes. Depending on how low your eye pressure needs to be, more than one of the eyedrops below may need to be prescribed.
Prescription eyedrop medications include:
Prostaglandins. These increase the outflow of the fluid in your eye (aqueous humor), thereby reducing your eye pressure. Medicines in this category include latanoprost (Xalatan), travoprost (Travatan Z), tafluprost (Zioptan), bimatoprost (Lumigan) and latanoprostene bunod (Vyzulta).
Possible side effects include mild reddening and stinging of the eyes, darkening of the iris, darkening of the pigment of the eyelashes or eyelid skin, and blurred vision. This class of drug is prescribed for once-a-day use.
Beta blockers. These reduce the production of fluid in your eye, thereby lowering the pressure in your eye (intraocular pressure). Examples include timolol (Betimol, Istalol, Timoptic) and betaxolol (Betoptic).
Possible side effects include difficulty breathing, slowed heart rate, lower blood pressure, impotence and fatigue. This class of drug can be prescribed for once- or twice-daily use depending on your condition.
Alpha-adrenergic agonists. These reduce the production of aqueous humor and increase outflow of the fluid in your eye. Examples include apraclonidine (Iopidine) and brimonidine (Alphagan P, Qoliana).
Possible side effects include an irregular heart rate, high blood pressure, fatigue, red, itchy or swollen eyes, and dry mouth. This class of drug is usually prescribed for twice-daily use but sometimes can be prescribed for use three times a day.
Because some of the eyedrop medicine is absorbed into your bloodstream, you may experience some side effects unrelated to your eyes. To minimize this absorption, close your eyes for one to two minutes after putting the drops in. You may also press lightly at the corner of your eyes near your nose to close the tear duct for one or two minutes. Wipe off any unused drops from your eyelid.
If you have been prescribed multiple eyedrops or you need to use artificial tears, space them out so that you are waiting at least five minutes in between types of drops.
If eyedrops alone don't bring your eye pressure down to the desired level, your doctor may also prescribe an oral medication, usually a carbonic anhydrase inhibitor. Possible side effects include frequent urination, tingling in the fingers and toes, depression, stomach upset, and kidney stones.
Surgery and other therapies
Other treatment options include laser therapy and various surgical procedures. The following techniques are intended to improve the drainage of fluid within the eye, thereby lowering pressure:
After your procedure, you'll need to see your doctor for follow-up exams. And you may eventually need to undergo additional procedures if your eye pressure begins to rise or other changes occur in your eye.
Treating acute angle-closure glaucoma
Acute angle-closure glaucoma is a medical emergency. If you're diagnosed with this condition, you'll need urgent treatment to reduce the pressure in your eye. This generally will require both medication and laser or other surgical procedures.
You may have a procedure called a laser peripheral iridotomy in which the doctor creates a small opening in your iris using a laser. This allows fluid (aqueous humor) to flow through it, relieving eye pressure.
Lifestyle and home remedies
These tips may help you control high eye pressure or promote eye health.
Some alternative medicine approaches may help your overall health, but none is an effective glaucoma remedy. Talk with your doctor about their possible benefits and risks.
Coping and support
When you receive a diagnosis of glaucoma, you're potentially facing lifelong treatment, regular checkups and the possibility of progressive vision loss.
Meeting and talking with other people with glaucoma can be very helpful, and many support groups exist. Check with hospitals and eye care centers in your area to find local groups and meeting times. Several online resources, including support groups, also are available.
Preparing for your appointment
Here's some information to help you get ready for your appointment.
What you can do
Before your appointment make a list of:
Some basic questions to ask your doctor include:
What to expect from your doctor
A doctor who sees you for possible glaucoma is likely to ask you a number of questions, such as: