Glaucoma #101 – Causes, Symptoms, Types, & Treatment | MahaveerEyeHospital



Glaucoma is a chronic eye condition that causes a significant rise in the intraocular pressure (IOP) within the eye and damages the optic nerves, which leads to degradation of the eyesight.
Aqueous Humour is a fluid that is produced and drained out of the eye, maintaining a certain amount of pressure within the eye, known as the intraocular pressure (IOP). It nourishes the inner tissues and nerves of the eye by moving through a small space between the iris and the cornea’s innermost surface called the anterior chamber. If this fluid slows down within the chamber and starts accumulating, it also increases the IOP that the nerves and tissues in the eye experience. The rising pressure damages the optic nerves and hinders their light-detecting and signalling functionalities causing severe to complete loss of vision.
As the development of glaucoma in the eye is a painless and symptomless process, it is extremely difficult to detect its presence even when it grows severe. In fact, more than half of the patients who are detected with glaucomatous development suffer severe nerve and vision damage before detection. Hence, it is often phrased as ‘the sneak thief of sight’.
Causes of Glaucoma:
If the glaucoma is primary, it will severely affect the optic nerves, but no reliable causes are detected. However, secondary glaucoma is detectable with some causes and is more common in people who:
  • Are above the age of 50.
  • Are from a specific race from East Asia, African Americans, and those of Hispanic descent are at high risk of developing glaucoma.
  • Have been taking drugs like corticosteroids for a long time.
  • Have diseases such as diabetes or hypothyroidism that cause bodily changes.
  • Have suffered from traumatic injuries caused by accidents.
  • Have had eye surgery in the past.
  • Are nearsighted, i.e., suffering from myopia.

Symptoms Of Glaucoma:
Although glaucoma doesn’t develop any measurable or direct symptoms, both types of glaucoma might show the following signs:
Signs of primary open-angle Glaucoma:
  • Gradual dimming of the peripheral vision.
  • Tunnelled vision.

Signs of closed-angle Glaucoma:
  • Severe and persistent Eye pain.
  • Blurred vision.
  • Dilated pupils
  • Nausea and sometimes vomiting, along with eye pain.
  • Headaches on the same side as the affected eye
  • Halo glows around bright lights.
  • Redness in eyes
  • Poor vision in dimly lit areas.

Signs of Childhood Glaucoma:
  • Abnormally bulky eyes or a larger cornea
  • Excessive tearing 
  • Cloudiness in the corneal region
  • High sensitivity towards light
  • The baby continually rubs, squints or shuts his eyes for a long time

Types of Glaucoma:
Glaucoma develops in two distinct ways:
Acute angle-closure glaucoma (Closed-angle glaucoma):
This is a type of glaucoma attack that develops suddenly as the IOP rapidly rises. Sudden eye pain and a rapid loss in eyesight set in causing the patient to be hospitalized immediately.  
However, these symptoms also prove helpful in detecting the problem and prevent further permanent damage to the optic nerves. 
Chronic Glaucoma (Primary open-angle glaucoma):
When the condition of glaucoma gradually develops for several years without any signs or symptoms, the person suffering from it may not even notice the gradual degradation of his/her vision until it becomes obvious. It leads to a severe loss of vision in most cases.
Various factors can cause this type of glaucomatous growth. One such factor is the dispersion of the pigment cells from the iris into the cornea. As the pigment cells buildup in the cornea, they sometimes block the draining channels of the aqueous humour fluid and cause a gradual surge in the IOP. This condition is termed as Pigmentary glaucoma.
Congenital Glaucoma:
Often known as childhood glaucoma or infant glaucoma, develops in newborn babies and kids. 
It is most usually caused as a congenital disability or due to abnormal growth of the baby’s eye. Due to the defective growth, the IOP of the eye increases rapidly right after birth. 
It can be diagnosed within a year from birth as it causes excessive tearing or bulkiness of the eyes. Although lost vision cannot be restored, it is possible to optimize each child’s remaining vision. 

Treatments For Glaucoma:
Both medications and surgical procedures of glaucoma are aimed at reducing the IOP in the eye and improving the efficiency of draining the fluid content. 
Non-Surgical Treatments:
Eye drops are an initial step for treating glaucoma in initial stages after detection.
These drops mostly comprise of prostaglandin analogues, carbonic anhydrase inhibitors, cholinergic agents and beta-blockers which are prescribed to be used daily from time to time.
These drops can control the IOP either by halting the fluid formation process in the eye or by improving the drainage channels.
In some cases, certain tablets and capsules are also prescribed along with the eye drops when the IOP is too high to treat solely with the drops.
Surgical Treatments:
In severe cases where medications don’t help in reducing the symptoms, surgical options are a better fit. Invasive treatments for glaucoma aim at either manually draining out the fluids or improving the condition of drain channels.
Laser Trabeculoplasty:
A laser Trabeculoplasty uses a slit lamp equipped with an argon laser to burn tissues in specific spots of the eye and unclog the draining channels in the trabecular meshwork. It is a brief treatment which significantly improves the flow of liquids, thereby reducing the IOP.
Trabeculectomy:
This technique is used for creating a manual passage for the fluid to draining it out of the chamber.
First, a small hole is made into the eyewall (sclera).
Then, a surgical trap-door is sutured through the sclera such that the fluid moves out slowly at a constant rate.
This is done to make sure that the eye doesn’t experience any drastic pressure changes, which could cause more damage.
The fluid drains to a small reservoir or a bleb located underneath the conjunctiva of the eyelid, where it is absorbed. 
Viscocanalostomy:
Viscocanalostomy is an effective procedure in lowering intraocular pressure (IOP) in open-angle glaucomatous eyes.
It is a non-penetrating procedure which is performed by making changes in the morphology of the trabecular meshwork in the eye and opening up the drainage channels for the fluid.
Iridotomy:
Iridotomy is performed as a medical emergency for treating acute angle-closure glaucoma attacks.
First, some pressure-reducing medications are administered into the eye. 
Then, a laser procedure is performed to creates a tiny hole in the iris, and the fluid is allowed to pass into the trabecular meshwork of the eye (the drainage system of the eye).
Drainage implant (aqueous shunt implant):
in this procedure, a small silicone tube is inserted into the eye to access the fluid in the anterior chamber.
The fluid is carefully drained out of the eye through this tube to reduce the IOP. 
This surgery is performed for a patient with secondary glaucoma and sometimes for children too.  

Glaucoma treatment has dramatically advanced in India and is readily available at any ophthalmologist’s clinic. However, as glaucoma is a progressive disorder that escalates when the procedure fails, you must always look for an experienced ophthalmologist who is known to provide effective glaucoma treatment in Pune
And if you’re willing to have a glaucoma surgery in Pune, then Mahaveer Eye Hospital can help you have the most glaucoma treatment. Led by the most adept eye specialist in Pune, the team of doctors at Mahaveer Eye Hospital provide extensive treatment for all eye problems. You can visit their website to learn more about their treatment options and book an appointment with the most trusted eye specialists in Pune.

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