Glaucoma: Symptoms, Causes & Treatment by Dr. Suraj Munjal

What is Glaucoma?

Glaucoma refers to a set of conditions that harm the optic nerve, the vital communication pathway between the eye and the brain. It most commonly results from increased intraocular pressure (IOP) due to fluid build-up within the eye. Over time, this pressure damages the optic nerve fibers, leading to progressive and permanent vision loss.

There are several types of glaucoma, but the two main categories are:

• Primary Open-Angle Glaucoma (POAG): The most common form, where fluid drainage is blocked slowly, resulting in gradual pressure build-up.
• Angle-Closure Glaucoma (ACG): Less common but more acute and serious, it happens when the iris blocks the drainage angle, causing a sudden rise in eye pressure.

Early Symptoms of Glaucoma

In its early stages, glaucoma often has no noticeable symptoms. This is particularly true for POAG. Because of this silent progression, many people remain unaware they have glaucoma until they start to lose their peripheral vision.

Here are some general symptoms that might develop as the disease progresses:

1. Loss of Peripheral Vision

One of the earliest signs of glaucoma is the loss of side (peripheral) vision. Initially, it might go unnoticed, as central vision remains unaffected.

2. Eye Pain

In cases like angle-closure glaucoma, the individual might experience severe eye pain, often accompanied by nausea or vomiting.

3. Halos Around Lights

Seeing rainbow-colored rings around lights, especially in low-light environments, can be a warning sign.

4. Blurred Vision

This is a more advanced symptom and often signifies significant optic nerve damage.

5. Redness in the Eye

Sudden redness, along with eye pain and visual disturbances, could indicate acute angle-closure glaucoma and requires emergency treatment.

Common Causes of Glaucoma

Several factors contribute to the development of glaucoma, and while elevated intraocular pressure is the most common, it’s not the only cause. Some individuals may develop glaucoma with normal IOP levels, known as normal-tension glaucoma.

1. Increased Intraocular Pressure

The eye continuously produces aqueous humor (fluid) that drains through a mesh-like channel. When this drainage system malfunctions, fluid builds up, increasing eye pressure.

2. Genetics

Family history plays a significant role. If a close relative has glaucoma, your risk increases significantly.

3. Age

People over the age of 60 are at higher risk, and the risk continues to increase with age.

4. Ethnicity

African Americans, Asians, and Hispanics are more likely to develop glaucoma, and often at younger ages.

5. Eye Injuries

Physical trauma to the eye can lead to secondary glaucoma. This might occur immediately after an injury or years later.

6. Other Health Conditions

Certain conditions like diabetes, high blood pressure, and heart disease can increase the risk of developing glaucoma.

Different Types of Glaucoma

Understanding the different types of glaucoma helps in identifying the most suitable treatment approach.

1. Primary Open-Angle Glaucoma

This develops slowly and painlessly. It’s usually detected through routine eye exams and requires long-term management.

2. Angle-Closure Glaucoma

This type can come on suddenly and is a medical emergency. Symptoms include intense eye pain, headaches, nausea, and blurred vision.

3. Normal-Tension Glaucoma

Despite having normal eye pressure, optic nerve damage occurs. It may be linked to poor blood flow or other factors affecting the optic nerve.

4. Congenital Glaucoma

A rare form found in infants due to improper eye development. Symptoms include large, cloudy eyes, excessive tearing, and light sensitivity.

5. Secondary Glaucoma

This results from an identifiable cause such as inflammation, trauma, or use of steroids.

Diagnosis of Glaucoma

Early diagnosis is critical. Regular comprehensive eye exams are the most effective way to detect glaucoma in its early stages. Diagnostic methods include:

• Tonometry – Measures eye pressure.
• Ophthalmoscopy – Evaluates the shape and color of the optic nerve.
• Perimetry – Tests for visual field loss.
• Gonioscopy – Examines the angle in the eye where the iris meets the cornea.
• Pachymetry – Measures corneal thickness.

Treatment Options for Glaucoma

There is currently no cure for glaucoma, but early treatment can prevent or slow the progression of vision loss.

1. Medications

Eye drops are often the first line of treatment. They work by reducing eye pressure, either by decreasing fluid production or improving drainage.

Common medications include:

• Prostaglandin analogs – Increase outflow of fluid.
• Beta blockers – Reduce fluid production.
• Alpha agonists – Decrease production and increase drainage.
• Carbonic anhydrase inhibitors – Lower fluid production.
• Rho kinase inhibitors – Enhance fluid outflow through the eye’s drainage system.

2. Laser Treatment

Laser procedures can help reduce eye pressure and are often used when medications are ineffective.

• Laser trabeculoplasty: Improves fluid drainage in open-angle glaucoma.
• Laser iridotomy: Creates a small hole in the iris to relieve pressure in angle-closure glaucoma.

3. Surgery

Surgical procedures may be necessary for patients who do not respond to other treatments.

• Trabeculectomy: Creates a new drainage pathway.
• Glaucoma drainage implants: Tube shunts to help fluid exit the eye.
• Minimally Invasive Glaucoma Surgery (MIGS): Newer, less invasive options with faster recovery times.

Living with Glaucoma

While glaucoma can be a lifelong condition, many people manage it effectively through regular monitoring and treatment. Here are some ways to live well with glaucoma:

1. Regular Eye Exams

Frequent check-ups help track eye pressure and optic nerve health.

2. Medication Compliance

Missing doses or stopping medication can lead to rapid vision loss. Set reminders to stay consistent.

3. Healthy Lifestyle

A diet rich in leafy greens, regular exercise, and avoiding smoking can support eye health.

4. Protect Your Eyes

Wear protective eyewear when engaging in sports or using power tools.

Preventive Measures

Although some risk factors like age and genetics cannot be changed, there are ways to reduce your overall risk:

• Schedule comprehensive eye exams every 1–2 years.
• Inform your doctor of any family history of glaucoma.
• Manage chronic conditions like diabetes and hypertension.
• Avoid overuse of corticosteroid medications.
• Maintain a healthy body weight and stay active.

Conclusion

Glaucoma remains one of the leading causes of irreversible blindness worldwide. Because it often advances without warning, awareness and regular eye screenings are essential for early detection and preservation of vision. With timely intervention through medications, laser therapy, or surgery, many people with glaucoma continue to lead normal, fulfilling lives. Take the initiative—protect your vision before symptoms arise.