Glaucoma

1 What is Glaucoma?

Glaucoma is a group of eye infections which leads to the damage of the optic nerve which is the most vital nerve for good vision.

This is caused by abnormally high pressure in the eyes. Glaucoma is one of the leading causes of blindness’s in the US.

It is a common condition among older adults. The most common form of glaucoma has no warning signs.

This disease is very gradual and one may not realize that they are having problems with their vision until when the disease is at an advanced stage.

Unfortunately, loss of vision due to glaucoma cannot be recovered. Regular eye examination is important including the measuring of pressure.

If glaucoma is detected early, vision loss can be prevented and avoided completely.

When the condition is established, one will need treatment for the rest of his life. 

2 Symptoms

The signs and symptoms of glaucoma vary with respect to the type and stage of the condition.

Open angle glaucoma has a patchy blind spot at the periphery of the side of the side of your eye or the central vision.

They frequently occur in both tunnel vision at the advanced stages of acute angle closure glaucoma.

It is accompanied by

  • severe headache,
  • pain in the eyes,
  • nausea,
  • vomiting,
  • blurred vision,
  • halos around lights,
  • redness if left untreated.

Glaucoma can lead to blindness. Even after treatment, only 15% of the population with glaucoma become blind only one eye in 20 years.

If possible, see the doctor (ophthalmologist) immediately for medical attention if you experience symptoms of acute angle closure glaucoma.

This may include;

  • severe headache,
  • eye pain,
  • blurred vision.

Open angle glaucoma gives a few warning signs before the permanent damage can occur. Regular eye checkup will help prevent the condition and avoid eye loss.

Glaucoma screening after the age of 40 and every 2 years when at higher risk and above 45 years of age.

3 Causes

Glaucoma is basically caused by the damage of the optic nerve.

This is as a result of the damage created in the optic nerve. This leads to the deterioration of the eyes; a blind spot is then formed in the visual field.

The damage is associated with increased pressure in the eye. It is also as a result of the eye pressure developed by the buildup of a fluid (aqueous humor) that flows through his eyes.

This is the fluid that drains in the front of the eye (anterior chamber) through tissues (trabecular meshwork) at the point at which the iris meets the cornea.

When fluids are overproduced, the drainage system may not work as required. The fluid may not work at the normal rate and pressure builds up.

It is believed that glaucoma can also run in families, special genes have been identified related to high eye pressure and optic nerve damage.

There are several types of glaucoma:

Open angle glaucoma which is the most common form of the disease.

The drainage angle created by the cornea and iris remains open while the trabecular meshwork will always be partially blocked. This makes the pressure in the eyes to gradually increase.

This pressure causes the damage to the optic nerve. This occurs very slowly that one may not know when the damage occurs.

Angle closure glaucoma is also called closed angle glaucoma which occurs when the iris bulges forward to narrow or block the drainage angle formed by the cornea and iris. As a result, fluid may not circulate in the eyes and pressure increases.

Some people may have narrow drainage angles placing them at risk of angle closure glaucoma. Angle glaucoma may also occur suddenly (acute angle closure glaucoma) or gradually (chronic angle closure glaucoma).

Acute angle glaucoma is a medical emergency. It is triggered by sudden dilation of your pupils.

Normal tension glaucoma is a normal tension glaucoma in which the optic nerve becomes damaged even though your eyes pressure is within the normal range.

It is believed to be as a result of the sensitivity of the optic nerve or as a result of less blood supply to the optic nerve. This limited blood flow could be as a result of the atherosclerosis or deposition of the fatty acids (plaques) in the arteries or other conditions which may impair blood circulation.

Glaucoma can also occur in children and infants. It may arise from birth. This is caused by drainage blockage or other medical conditions. Pigmentary glaucoma develops as a result of pigment granules building up in the iris at the drainage channels, eventually slowing or blocking the exiting eyes. It is believed that jogging may stir up pigments granules. 

4 Making a Diagnosis

The doctor will review the medical history and perform a comprehensive eye examination in order to make a diagnosis of glaucoma.

There are no noticeable symptoms for Glaucoma until when it I has caused permanent damage. It is recommended that one needs to regularly visit an eye specialist regularly for an eye exam.

When you have eye symptoms or vision problems, make an appointment with the ophthalmologist or ask for a referral. Before the appointment, make a list of the possible questions one can ask about your condition.

  • The symptoms you have been feeling.
  • Medications you have used previously or currently: supplements or vitamins, and the dosages.
  • Have you had any problems in the past such as vision, or eye discomfort?

Some possible questions would be:

  • do I have signs of glaucoma?
  • What tests are required?
  • What tests do I need to confirm a diagnosis?
  • What is the best treatment approach that can be recommended?
  • Are there alternatives to the primary glaucoma treatment approach?
  • Are there any follow up restrictions?
  • What self-care measures do I need to know?
  • How often do I need to make follow ups?
  • Does my condition require a specialist?
  • Do I have other health conditions?

Possibly, the doctor will also have questions for you. They may include;

  • have you had any eye problem in the recent past?
  • Are there any eye symptoms or signs that need to be addressed?
  • Is there any family history of glaucoma?
  • Have you attended any eye screening tests before?
  • Have you been diagnosed with any other medical condition?
  • Have you used any prescribed eye drops, vitamins, or supplements?

Intraocular pressure(tomometry) may also be done to make a diagnosis. Testing for optic nerve damage, checking for areas of vision loss (visual field tests) and measuring of the corneal thickness (pachymetry) by inspecting the drainage angle (gonioscopy). 

5 Treatment

Several treatment methods exist for glaucoma.

Damage caused by glaucoma is irreversible. However, proper treatment and frequent checkups can help reduce and slow down loss of vision more especially when the disease is in its early stages.

Glaucome treatment targets lowering of the eye pressure (intraocular pressure). This varies depending with the situation.

Available treatment includes use of eyedrops.

They help decrease eye pressure by reducing the eyes pressure by improving how the fluid drains from your eye or by decreasing the amount of fluid your eye can synthesize.

Eyes drops may include prostaglandins which increase the outflow of fluids in the eyes (aqueous humor) and hence lowering the eye pressure.

These drugs may include:

  • latanoprost (Xalatan)
  • bimatoprost (Lumigan).

However, the possible side effect from using these drugs include:

  • mild eye reddening and stinging,
  • darkening of the iris,
  • the pigment of the eyelashes change, or eyelid skin,
  • and blurred vision.

Also, the beta blockers have been used in management of glaucoma: they reduce the production of fluids in your eye, hence, reducing the intraocular pressure.

Beta blockers include: Timolol (Betimol, Timoptic) and betaxolol (Betoptic). Side effects associated with their use include:

  • Difficulty in breathing,
  • slowed heart rate,
  • lower blood pressure,
  • impotence and fatigue.

Moreover, alpha-adrenergic agonists can also be used to reduce the production of aqueous humor and increase outflow of the fluid in your eye.

Some examples are: apraclonidine (Iopidine) and brimonidine (Alphagan). Possible side effects after use include:

  • An irregular heart rate,
  • high blood pressure,
  • fatigue, red,
  • itchy or swollen eyes,
  • and dry mouth.

In addition, carbonic anhydrase inhibitors though rarely used for glaucoma, may be used to reduce the production of fluid in your eye.

Examples of carbonic anhydrases include; dorzolamide (Trusopt) and brinzolamide (Azopt). The potential side effects may be presented as:

  • metallic taste,
  • urinating frequently,
  • and a feeling of tingling in the fingers and toes.

It has also been managed by the use of miotic or cholinergic agents which increase the outflow of fluid from your eye. This drugs include; pilocarpine (Isopto Carpine). It however promotes the formation of smaller pupils, possible blurred or dim vision, and nearsightedness for all the users.

Oral medications may also be prescribed when eye drops when used alone do not give you the desired effect of reducing your eye pressure. The most common drugs prescribed are the carbonic anhydrase inhibitor. They are associated with a number of side effects such as

Other treatment options may include surgery and laser therapy.

Some of the possible complications that come with surgery or laser treatment includes:

  • pain,
  • redness,
  • infection,
  • inflammation,
  • bleeding,
  • abnormally high or low eye pressure,
  • and loss of vision.

However, eye surgery may sometimes increase the formation of cataracts. Besides checking your doctor, you may need additional procedures when your eye pressure begins to rise or other changes occur in your eye.

Laser therapy and specifically a procedure referred to as Laser trabeculoplasty is the best option for managing open-angle glaucoma. It's done in your doctor's office using a laser beam to open clogged channels in the trabecular meshwork.

After this process, it may take a week or two to experience the full effect of the procedure. Filtering surgery is also another form of procedure referred to as trabeculectomy, in which the surgeon may create an opening in the white of the eye (sclera) and extracts part of the trabecular meshwork.

Drainage tubes can also be used by inserting a small tube in the eye. Electrocautery is also an alternative procedure which is minimally invasive and is used for remove tissue from the trabecular meshwork using a small electrocautery device called a Trabecutome.

In treating of acute angle-closure glaucoma, it is supposed to be considered as medical emergency, urgent treatment is required to reduce the pressure in the eyes. It requires the use of both medications and laser or surgery.

Finally, a laser peripheral iridotomy may also be used to create a small hole in your iris using a laser. This allows the aqueous humor to flow through it, relieving eye pressure.

Currently, emerging therapies researchers are under evaluation for their effectiveness as potential new drugs, drug delivery methods, surgical procedures and devices.

6 Prevention

It may not be possible to prevent glaucoma. The use of the self-care step by step guideline provided by your doctor will be of great help in early detection, reduce the loss of vision, and slow down the progress.

Regular eye care and checkups are very important. Regular eye exams will help detect glaucoma early before the irreversible eye damage can occur.

It is recommended that you do an eye exam after every four years after the age of 40 and two years after the age of 65. Frequent screening may be required as recommended by your doctor.

Glaucoma also runs in families and one is exposed to even greater risks that may require frequent screening. Do safe exercises and in moderation to prevent glaucoma by reducing eye pressure.

Use only the prescribed eye drops as recommended. Use eye protection as advised by you doctor.

Moreover, serious eye injuries can also lead to glaucoma. In addition, use eye protection when using power tools or playing speed racket sports in enclosed courts. 

7 Alternative and Homeopathic Remedies

Alternative remedies for management of the overall health are present but some may not help in the management of glaucoma. Ask your doctor on the possible benefits and risks.

A few remedies have been evaluated and shown to be possible remedies in the management of glaucoma such as bilberry and gingko. However, more studies are required to test their effectiveness on glaucoma.

Only use proven therapies and never replace them with herbal remedies. Use appropriate relaxation techniques to manage stress in acute angle closure glaucoma.

Alternative ways of coping can also be explored. Use of marijuana has also been suggested to lower eye pressure in glaucoma but limited to durations of about 3-4 hours.

Uses of standard treatments are recommended and more effective. Use of marijuana for treatment of the glaucoma is not recommended.

8 Lifestyle and Coping

Lifestyle modifications are necessary in order to cope with glaucoma.

These are tips that only help you control eye pressure and improve your ability to see:

  • It is advised to eat healthy as a way of maintaining health and reduce the worsening of glaucoma.
  • It is known that several vitamins and nutrients are essential in eye health, especially those found in dark, leafy green vegetables and omega -3 – fatty acids in fish.
  • Use exercise to reduce eye pressure in open angle glaucoma. Limit the caffeine since it will increase the eye pressure. Use fluids frequently and moderately at any time in the course of the day.
  • Also, sleep with your head at an elevated position of about 20o(degrees); this reduces the intraocular eye pressure when sleeping.
  • Only use the prescribed medicine by your doctor so as to get the possible treatment for your condition. Use the drugs as prescribed since most of them come with some side effects and can be absorbed into your blood stream.
  • Minimize the rate of absorption by closing your eyes for one or two minutes after putting the eye drop. One may also press slightly at one of the corners of the eyes to the nose as a way of closing the tear duct for about one or two minutes. Remove any unused drops from your eyelid.
  • Understand that when diagnosed with glaucoma, you will be placed on a lifelong treatment, that will need regular checkups, and possibility of progressive vision loss. Seek for information from people with similar condition. Check with possible support groups. Check with hospitals and eye centers in your area for local groups and meetings. Seek to use online resources and support groups that exist online.

9 Risk and Complications

There are several risks associated with glaucoma.

It is known that chronic forms of glaucoma can permanently destroy your vision even before the signs and symptoms are apparent.

One needs to know the risk factors associated with this disease. It is associated with high internal eye pressure (intraocular pressure), it is prevalent among the black/Hispanics.

It is common also among families with history of glaucoma. It is associated with medical conditions associated with diabetes, heart diseases, high blood pressure, sickle cell anemia, eye conditions of near sightedness.

Eye injuries may also predispose one to glaucoma, eye surgery, estrogen deficiency as a result of removal of both ovaries (bilateral oophorectomy) before the age of 43 and use of corticosteroids drugs for long duration of time as eye drops. 

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