Glaucoma refers to a group of eye conditions that lead to damage to the optic nerve. This nerve carries visual information from the eye to the brain.
In most cases, damage to the optic nerve is due to increased pressure in the eye, also known as intraocular pressure (IOP).
Open-angle glaucoma; Chronic glaucoma; Chronic open-angle glaucoma; Primary open-angle glaucoma; Closed-angle glaucoma; Narrow-angle glaucoma; Angle-closure glaucoma; Acute glaucoma; Secondary glaucoma; Congenital glaucoma
Glaucoma is the second most common cause of blindness in the United States. There are four major types of glaucoma:
The front part of the eye is filled with a clear fluid called aqueous humor. This fluid is always being made behind the colored part of the eye (the iris). It leaves the eye through channels in the front of the eye in an area called the anterior chamber angle, or simply the angle.
Anything that slows or blocks the flow of this fluid out of the eye will cause pressure to build up in the eye. This pressure is called intraocular pressure (IOP). In most cases of glaucoma, this pressure is high and causes damage to the optic nerve.
Open-angle (chronic) glaucoma is the most common type of glaucoma.
Angle-closure (acute) glaucoma occurs when the exit of the aqueous humor fluid is suddenly blocked. This causes a quick, severe, and painful rise in the pressure in the eye.
Congenital glaucoma is seen in babies. It often runs in families (is inherited).
Secondary glaucoma is caused by:
A complete eye exam is needed to diagnose glaucoma. You may be given eye drop to widen (dilate) your pupil. The eye doctor can look at the inside of the eye when the pupil is dilated.
A test called (tonometry) is done to check eye pressure. However, eye pressure always changes. Eye pressure can be normal in some people with glaucoma. This is called normal-tension glaucoma. Your doctor will need to run other tests to confirm glaucoma.
Some of the tests your doctor may do can include:
The goal of treatment is to reduce eye pressure. Treatment depends on the type of glaucoma that you have.
If you have open-angle glaucoma, you will probably be given eye drops. You may need more than one type. Most people can be treated successfully with eye drops. Most of the eye drops used today have fewer side effects than those used in the past. You may also be given pills to lower pressure in the eye.
Other treatments may involve:
Acute angle-closure attack is a medical emergency. Blindness will occur in a few days if it is not treated. If you have angle-closure glaucoma, you will receive:
Some people also need an emergency operation, called an iridotomy. This procedure uses a laser to open a new pathway in the colored part of the eye. This relieves pressure and prevents another attack.
Congenital glaucoma is almost always treated with surgery. This is done using general anesthesia. This means the patient is asleep and feels no pain.
If you have secondary glaucoma, treatment of the underlying disease may help your symptoms go away. Other treatments may be needed.
Open-angle glaucoma cannot be cured. However, you can manage your symptoms by closely following your doctor's instructions. Regular check-ups are needed to prevent blindness.
Angle-closure glaucoma is a medical emergency. You need treatment right away to save your vision.
Babies with congenital glaucoma usually do well when surgery is done early.
How well a person with secondary glaucoma does depends on the disease causing the condition.
Call your health care provider if you have severe eye pain or a sudden loss of vision, especially loss of peripheral vision.
Call for an appointment with your health care provider if you have risk factors for glaucoma and have not been screened for the condition.
All adults should have a complete eye exam before age 40, or sooner if you have risk factors for glaucoma or other eye problems. You are more likely to get glaucoma if you are African American or have a family history of open-angle glaucoma.
If you are at high risk for acute glaucoma, talk to your doctor about having eye surgery to prevent an attack.
Anderson DR. The Optic Nerve in Glaucoma. In: Tasman W, Jaeger EA, eds. Duane’s Ophthalmology. 15th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2009:chap 48.
Kwon YK, Caprioli J. Primary Open-Angle Glaucoma. In: Tasman W, Jaeger EA, eds. Duane’s Ophthalmology. 15th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2009:chap 52.
Giaconi JA, Law SK, Caprioli J. Primary Angle-Closure Glaucoma. In: Tasman W, Jaeger EA, eds. Duane’s Ophthalmology. 15th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2009:chap 53.
Mandelcorn E, Gupta N. Lens-Related Glaucomas. In: Tasman W, Jaeger EA, eds. Duane’s Ophthalmology. 15th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2009:chap 54A.