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Glaucoma
Written by Dr Caroline MacEwen, consultant ophthalmologist
Acute angle closure glaucoma
This condition is usually diagnosed quite readily because of the pain, redness and reduced vision. The pupil of the eye is dilated and the pressure inside the eye is very high. The cornea (the clear window at the front of the eye) is usually swollen, causing the haloes round lights and blurring of vision.
Other types of glaucoma
A full examination of the eye will take place in anyone who has suspected glaucoma in order to ensure that there are no other eye diseases present.
How is primary open angle glaucoma treated?
There are a number of different types of eye drops which are available to treat primary open angle glaucoma:
Prostaglandin analogues
Adrenaline-type drops (sympathomimetics)
Carbonic anhydrase inhibitors
Miotics (parasympathomimetics)
They may give rise to headache. These drops were the original drops to be used for glaucoma but are now less commonly used because of the other newer drops as outlined above. Pilocarpine is an example of a miotic (parasympathomimetic).
Other treatments
Laser treatment
Surgical treatment
Complications of such surgery include transient reduction in vision after the operation, but this usually recovers. Long-term effects of infection must always be considered.
How is closed angle or acute angle closure glaucoma treated?
Laser treatment
Surgical treatment
How are other types of glaucoma treated?
Managing glaucoma
Activity
Possible deterioration
What can be done to avoid glaucoma?
Acute angle closure glaucoma
Other types of glaucoma
This drop is used once a day in the evening. It works by increasing the drainage of fluid out of the eye. The best recognised side effect of this drop is that it can change the colour of the eye. Latanoprost is an example of a prostaglandin analogue.
These are used twice a day and are generally well tolerated. They reduce the amount of fluid secreted into the eye. Patients with heart disease may be unsuitable for this treatment. Dipivefrine or Brimonidine are examples of adrenaline-type drops (sympathomimetics).
These drops are used twice a day if used with beta-blockers, or three times a day if used alone. They reduce the secretion of fluid into the eye. Dorzolamide is an example of a carbonic anhydrase inhibitor.
These drops are usually used four times a day. They increase the drainage of fluid out of the eye. These drops cause a small pupil which may mean that they cause a reduction in vision.
This treatment is used to increase the flow of fluid from the eye. The effect of this treatment may be temporary and therefore may not be suitable as a long-term solution.
Many patients have surgery to treat glaucoma. The operation used (trabeculectomy) allows drainage of fluid from inside the eye to the outside of the eye. This type of surgery usually results in a small 'blister' on the eye which is usually positioned under the upper eyelid. This type of surgery may include the use of anti-metabolite medicines in order to make the success of the operation higher, although this may increase the potential for complications.
Treatment in this condition needs to be rapid. It takes the form of drops, medicines given intravenously and orally, laser surgery and sometimes surgical treatment.
A hole in the coloured part of the iris is essential in order to prevent this condition happening again. This hole is usually made using a laser. Both eyes need to be treated, as although only one eye is usually affected, the other eye will go on to develop acute closed angle closure if left untreated.
Sometimes all the above treatments do not allow control of the pressure and therefore a trabeculectomy (as outlined above in primary open angle glaucoma) may be required.
A combination of drops, laser treatment and/or surgery may be required depending upon the type of glaucoma.
If picked up early enough, the vision should remain good and there should be no restrictions in activity. There are strict guidelines regarding visual standards for driving and people with glaucoma are advised to let the DVLA know about the diagnosis. They will require regular fields of vision testing to ensure that they remain fit to drive. After surgery there may be limitations on activities in the short term.
Glaucoma, if not treated appropriately or picked up early enough, may lead to blindness.
The acute attack with pain and reduction in vision may be preceded by similar less severe attacks in the past. There may be a history of haloes seen round lights, particularly in the evening, which tend to settle overnight when the affected person goes to sleep. People with such symptoms should seek medical advice.
Your eye specialist (ophthalmologist) may have given warning that you are more susceptible to glaucoma if you suffer from one of the conditions listed above.
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