What is glaucoma?

Glaucoma is a common disorder which causes damage to the optic nerve. Glaucoma has two forms: chronic glaucoma (open-angle) and acute glaucoma (closed-angle). Although glaucoma usually occurs in people older than 45 years, this eye disorder can appear at any age.

The eyeball is filled with fluid which itself is under a certain amount of pressure. This prevents the eye from losing its shape and keeps other elements in place. This fluid is constantly being drained and replenished; new fluid is secreted within the eye while old fluid flows into the bloodstream via inner channels. When this fluid is not allowed to drain at the correct rate, usually due to narrowed or clogged drainage channels, the pressure within the eye rises. This increase in pressure will subsequently affect the optic nerve.

Glaucoma: causes

Anyone can suffer from glaucoma. The following factors increase one’s risk of developing it:

  • Increased eye pressure
  • Heredity
  • Age: the older you get, the higher the risk
  • High degree myopia
  • Certain medication or eye drops
  • Optic nerve abnormalities, high blood pressure or trauma to the eye
  • People with African roots have a higher risk of developing glaucoma

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Chronic glaucoma (open-angle glaucoma)

What is open angle glaucoma?

The most common form, chronic glaucoma is characterized by high intraocular pressure, optic nerve abnormality and changes within the field of vision. This form can be treated well when at an early stage. The development of open-angle glaucoma usually points to partial blockage of the drainage system, leading to an increase in intraocular pressure (usually > 21 mmHg). If pressure within the eye remains high for any length of time, damage and the gradual death of optic nerve fibres will occur with loss of vision as a result.

Symptoms

In contrast to chronic glaucoma, the symptoms of this form are very quickly apparent: painful, red and cloudy eyes. The eyeball feels hard and is very sensitive. The sufferer will usually complain of blurred vision. More general symptoms are nausea, headache, vomiting and abdominal pain.
It is very important that one recognises this syndrome, as its treatment must be carried out as soon as possible. Acute glaucoma can cause permanent and irreparable vision loss within a few days.

Treatment

If chronic glaucoma has been diagnosed, the ophthalmologist will first attempt to reduce eye pressure with eye drops (collyrium).
If eye drops are no longer adequate, laser treatment can help. For chronic glaucoma the procedure is called laser trabeculoplasty, a technique in which laser energy is used to open the fluid drainage system within the eye and subsequently lower the eye pressure. If laser treatment is unsuccessful, surgery will be necessary. For chronic glaucoma, filtration surgery is carried out.

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Acute glaucoma (closed-angle glaucoma)

What is closed-angle glaucoma?

This acute form of glaucoma is much less common than chronic glaucoma, but is dangerous because it can cause serious vision impairment and even blindness in a short space of time. Closed-angle refers to a drainage system which has been completely shut off, with a rapid rise in eye pressure, often to > 50 mmHg, within just a few hours.

Symtoms

In contrast to chronic glaucoma, the symptoms of this form are very quickly apparent: painful, red and cloudy eyes. The eyeball feels hard and is very sensitive. The sufferer will usually complain of blurred vision. More general symptoms are nausea, headache, vomiting and abdominal pain.
It is very important that one recognises this syndrome, as its treatment must be carried out as soon as possible. Acute glaucoma can cause permanent and irreparable vision loss within a few days.

Treatment

If acute glaucoma has been diagnosed, the ophthalmologist will first attempt to reduce eye pressure with eye drops (collyrium).
If eye drops are no longer adequate, laser treatment can help. In acute glaucoma, a ‘Yag laser iridotomy’ is performed in which a tiny hole is made in the iris so that the drainage of ocular fluid is restored and the eye pressure can drop. If laser treatment is unsuccessful, surgery will be necessary. For acute glaucoma, a small hole is made in the upper part of the iris (iridectomy). It is also possible to remove the lens so that more space is created at the front of the eye (lens extraction).

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Glaucoma: diagnosis

Glaucoma is best detected before symptoms occur. Eye pressure measurement alone gives a false sense of security. Not everyone with increased eye pressure develops glaucoma, because the optic nerve cells of some people can endure higher levels of intraocular pressure. On the other hand, not everyone with normal eye pressure is safe, because some people have sensitive optic nerve cells that already begin to die off at a pressure of < 21 mmHg. This is often the case in eyes which suffer from poor circulation. A dilated fundus examination or fundoscopy (checking the inside of the eye to detect retinal abnormalities) is used to see the extent of possible optic nerve damage. This can also be determined from photographic material. Observation of increasing damage over consecutive visits is an indication of glaucoma. Other diagnostic methods:

  • Eye pressure measurements using the non-contact or contact method.
  • Visual field test or perimetry for the early detection of blind spots long before the person concerned notices any visual changes.
  • Gonioscopy (test to measure the angle of the anterior chamber) to see which form of glaucoma is present.
  • Pachymetry (corneal thickness measurement) serves to correct the measured eye pressure value.
  • “Scheimpflug” analysis (examination of the (angle of) the anterior chamber)

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