Glaucoma
Glaucoma refers to a group of eye conditions that lead to vision loss by damaging the optic nerve, which is essential for vision. Often, there are no early symptoms of the eye condition.
The main concern in glaucoma is the increased pressure of the fluid inside the eye (a rise in intraocular pressure (IOP)), which can damage the optic nerve. This pressure threshold varies among individuals.
Since glaucoma cannot be self-detected and those with the condition may not notice vision loss, regular eye exams are important. While there’s no cure and lost vision can’t be restored, early detection and treatment can slow or stop its progression.
If it’s time for your next eye exam, we recommend discussing the glaucoma eye condition with one of our ophthalmologists If you:
- Have a family history of glaucoma
- Are over the age of 50
- Have diabetes or high or low blood pressure
- Have experienced eye injuries or trauma
- Have used corticosteroid medications for extended periods
- Are short or long-sighted
- Are experiencing symptoms such as blurred vision, eye pain, or headaches
Contact our team to book your eye exam at Valley Eye Specialists in Brisbane.
What is glaucoma?
Glaucoma is a set of eye diseases that can lead to permanent vision loss from optic nerve damage. Vision loss is typically gradual, with significant peripheral vision loss occurring before the condition is detected.
There are different types of glaucoma eye condition, including Primary Open-Angle Glaucoma (where the drain of the eye is wide open), and Acute Angle-Closure Glaucoma (where the drain of the eye is partially or fully obstructed).
Within these types, the causes of the condition can be primary (with no known cause, occurring in susceptible individuals) or secondary (caused by another disorder or problem within the eye).
What causes glaucoma?
The glaucoma eye condition is typically caused by elevated intraocular pressure (IOP), which may cause damage to the optic nerve. The IOP pressure level that causes optic nerve damage will vary from person to person – some may have high eye pressure without glaucoma (ocular hypertension), while others may have normal pressure with glaucoma (normal tension glaucoma).
Slowly, the elevated pressure will cause damage to the optic nerve. Sitting at the back of the eye, the optic nerve is made of about one million nerve fibres, that connect the eyes to the brain. When the optic nerve is significantly damaged, it will unfortunately cause permanent vision loss.
How does intraocular pressure (IOP) become elevated?
Symptoms of glaucoma
The most common type of the glaucoma eye condition is Primary Open-Angle Glaucoma, which has no obvious symptoms in its early stages. Peripheral vision is usually the first area to be affected, which can go unnoticed until further damage has been caused to the optic nerve.
However, the second type of glaucoma, Acute Angle-Closure Glaucoma, can have the following symptoms:
- Severe eye pain
- Nausea and vomiting
- Headache
- Watery eyes
- Blurred vision
- Seeing halos around light
If you experience any of these symptoms, you will need immediate medical treatment, as it will be considered a medical emergency.
Early detection of the glaucoma eye condition is highly important – although any vision loss that has already occurred cannot be restored, early detection and treatment may prevent the condition from worsening.
If you are experiencing any concerning eye symptoms that may not be considered a medical emergency, we recommend booking an eye exam with one of our ophthalmologists at Valley Eye Specialists.
Located in Brisbane, Valley Eye Specialists has a team of experienced ophthalmologists who can perform a variety of eye tests and assessments.
What are the types of glaucoma eye condition?
Glaucoma can generally be divided into two categories: Primary Open-Angle Glaucoma (where the drain of the eye is wide open), and Acute Angle-Closure Glaucoma (where the drain of the eye is partially or fully obstructed). There are then different variants of these types of glaucoma, which can be categorised by their cause.
Primary glaucomas have no known cause and occur in susceptible individuals, while secondary glaucomas are usually caused by another issue within the eye, such as other health conditions or eye injuries.
Types of primary glaucomas
Primary Open Angle Glaucoma (POAG)
Primary Open-Angle Glaucoma (POAG), the most common type of glaucoma in Australia, leads to optic nerve damage and peripheral vision loss.
Elevated intraocular pressure (IOP), often due to impaired eye fluid drainage, typically triggers this damage, which progresses without symptoms in many cases.
Treatment options are available to slow the progression of the condition. Diagnosis involves thorough eye assessments, including optic disc examination and visual field testing. While glaucoma damage is irreversible, management through eye drops or interventions such as laser or surgery can help to control IOP. Regular monitoring by an eye specialist is highly important, especially for those over 40 with a family history of glaucoma.
Acute Angle-Closure Glaucoma
Acute Angle-Closure Glaucoma, the second most common type of glaucoma, involves a narrow drainage angle, with the iris obstructing the fluid passage. The narrow angle is typically inherited and exacerbated as the eye’s lens grows larger with age. If the condition occurs suddenly, it can cause a sudden rise in intraocular pressure (IOP) and lead to an acute angle-closure glaucoma attack, which is considered a medical emergency.
Factors such as long-sightedness, older age, and Asian ethnicity can mean that an individual may be at higher risk of the condition. Females may also be more likely to experience the condition. Symptoms of sudden pressure increase include blurred vision, coloured rings around lights, severe eye pain, nausea, and vomiting. While both eyes are at risk, simultaneous acute attacks are rare.
Diagnosis requires prompt medical attention, with treatment focusing on rapidly reducing pressure using eye drops, tablets, or intravenous medications. Laser procedures like peripheral iridotomy or iridoplasty may be necessary to alleviate blockage. Regular eye checks will be highly important after treatment, to monitor eye health and manage any long-term pressure issues.
Primary Angle-Closure (PAC) and Primary Angle-Closure Glaucoma (PACG)
Primary Angle-Closure (PAC) is the appositional or synechial closure of the eye’s anterior chamber angle, obstructing fluid drainage and elevating eye pressure, without glaucomatous optic neuropathy. The condition, often bilateral, can progress to Primary Angle-Closure Glaucoma (PACG) due to the damage it causes to the optic nerve.
Factors like age, long-sightedness, and Asian ethnicity can heighten a person’s risk of experiencing the condition, and it can be more common in females. PAC and PACG typically develop gradually, with acute rises in intraocular pressure leading to emergencies, in some cases.
The correct diagnosis of the condition will guide treatment. Management of the condition aims to control pressure and prevent further angle closure through procedures like laser iridotomy or iridoplasty. In some cases, surgery like trabeculectomy may be necessary. Regular eye checks are important to monitor and manage the condition.
Normal Tension Glaucoma
While elevated intraocular pressure is a primary risk factor of glaucoma, normal tension glaucoma is possible, which highlights that optic nerve changes can occur even with normal pressure. Factors such as a history of migraines, or Raynaud’s phenomenon may increase the risk of developing the condition. Ongoing research aims to identify and address other factors that contribute to the development of glaucoma.
Diagnosis involves assessing optic nerve and visual field changes, requiring thorough evaluation, especially for individuals over 40 with a family history of glaucoma and additional risk factors. Although many cases are asymptomatic initially, early detection through eye exams will be essential. Lowering intraocular pressure, typically through eye drops or procedures like laser or surgery, can help to slow vision loss down. Regular monitoring is important to prevent significant visual impairment.
Childhood Glaucoma
There are various types of childhood glaucoma including congenital, Infantile, or Juvenile glaucoma, characterised by abnormal development of the eye’s fluid drainage system. Although uncommon, it can have devastating effects on vision, often requiring early diagnosis and appropriate treatment to preserve sight. Different types and severity levels exist, with symptoms ranging from dislike of light to cloudy corneas.
Diagnosis, typically requiring examination under anaesthesia for younger children, involves measuring eye size and pressure and assessing eye structures. Treatment depends on the cause and may include drops, liquids, or surgery to improve drainage. Success is monitored through regular check-ups, aiming for normal eye pressure and clear corneas, with interventions adjusted as needed. Treatment complexity and outcomes vary, emphasising the importance of ongoing care and individualised management.
Types of secondary glaucomas
Pigment-Dispersion Syndrome
The increased intraocular pressure (IOP) that damages the optic nerve and causes glaucoma can sometimes be elevated if trabecular drainage tissues are blocked by pigment particles. This occurs when the iris rubs against the zonules, dislodging pigment granules that obstruct the drainage system, leading to pressure elevation.
Eyes with moderate shortsightedness are most susceptible, potentially due to their shape facilitating iris-zonule contact. The condition has also been found to be more common in men than women and typically occurs before the age of 35.
Symptoms, like blurred vision and coloured rings around lights, may occur suddenly, especially after pupil dilation or jarring.
Treatment, typically initiated once pressure rises, may involve drops, laser procedures or medication. Regular monitoring by an ophthalmologist will be required to prevent significant vision loss, with surgical intervention considered if other treatments fail to adequately control pressure levels.
Pseudo-Exfoliation Syndrome and Glaucoma
In some cases of elevated intraocular pressure (IOP) and glaucoma, small white flakes resembling microscopic dandruff may be visible around the pupil and on the lens surface when examined with a slit lamp microscope. These flakes, typically accompanied by a mild dispersion of pigment granules, often accumulate on the trabecular meshwork, hindering the drainage of aqueous fluid from the eye and leading to pressure elevation.
Known as pseudo-exfoliation syndrome, it is more common in Northern Europeans, especially those of Scandinavian descent, and individuals over 60 years old. While early-stage glaucoma typically presents without symptoms, some may experience eye aches, headaches, or blurry vision as the condition progresses. Patients will need regular monitoring by an ophthalmologist, as pseudo-exfoliation syndrome increases the risk of glaucoma development, even with normal pressure.
Treatment aims to lower pressure through medical treatment or selective laser trabeculoplasty (SLT. Surgical options may be considered if other treatments fail. Regular specialist reviews are needed to prevent significant vision impairment.
Neovascular (Rubeotic) Glaucoma
Neovascular (rubeotic) glaucoma is caused by intraocular neovascularization (NV). The condition, often seen in individuals over 40 with diabetes, high cholesterol, or high blood pressure, involves the growth of new blood vessels on the iris, leading to a sudden rise in intraocular pressure and severe eye pain.
Treatment focuses on controlling pressure and addressing the underlying cause of neovascularisation. Medications, laser therapy, or surgery may be necessary to manage pressure and halt the growth of abnormal blood vessels. Regular monitoring can help to preserve the remaining vision and support the patient’s comfort levels.
Mixed Mechanism Glaucomas
Mixed mechanism glaucomas occur when an eye has elevated pressure due to both open-angle and angle closure glaucoma mechanisms.
Typically seen in long-sighted eyes, older individuals, women, and Asian populations, this condition often presents with symptoms like blurred vision, coloured rings around lights, severe eye pain, and nausea.
Treatment usually involves a peripheral iridotomy procedure to allow fluid access to the drain, but if the drainage system remains impaired, long-term drops, laser treatment, or drainage surgery may be necessary to preserve sight.
Traumatic Glaucoma
Traumatic glaucoma occurs when direct injury to the eye leads to glaucoma. Blunt or penetrating trauma, such as punches or car accidents, can harm the eye’s drainage mechanism or optic nerve, leading to glaucoma either immediately or over time. Symptoms may include eye pain, headaches, or blurry vision as the condition progresses.
Treatment involves regular eye monitoring, eye drops, laser therapy, or surgery to manage pressure and prevent further optic nerve damage. Signs of retinal detachment, another risk after eye trauma, such as black spots or flashes of light, will also need to be monitored as this will require immediate medical attention.
Iridocorneal Endothelial Syndrome
Iridocorneal endothelial syndrome affects the cornea’s endothelium, the inner layer responsible for pumping fluid out of the cornea. Instead of remaining a single layer, these cells replicate and spread, leading to further eye issues. The cornea can become waterlogged, impairing vision. It can damage the angle of the eye where fluid drains, causing glaucoma due to increased eye pressure. It can also harm the iris, potentially affecting pupil function and causing glare.
The syndrome’s cause is uncertain, often affecting one eye and more common in women aged 20 to 50. Symptoms include eye pain, blurry vision, or iris changes.
Diagnosis involves a comprehensive eye examination. Treatment aims to lower eye pressure using drops, laser, or surgery, similar to other glaucoma types.
Steroid-Induced Glaucoma
Treatment with steroids can sometimes increase eye pressure, leading to Steroid-Induced Ocular Hypertension and potentially Steroid-Induced Glaucoma, causing optic nerve damage and vision loss. Steroids, used for a variety of inflammatory conditions such as asthma and arthritis, come in different forms, such as tablets, inhalers, eye drops, creams, and injections. While topical steroids like eye drops and creams are more likely to raise eye pressure, nasal sprays may not have the same effect.
Eye pressure usually rises two to four weeks after steroid use, but often returns to normal after stopping the medication. If eye pressure remains high, treatment options include stopping steroids, using eye drops, laser treatment, or surgery. Particular caution is needed for children, the elderly, and those with glaucoma or a family history of glaucoma, as they can be more prone to eye pressure elevation with steroid use.
Uveitic Glaucoma
Uveitis refers to inflammation in the eye’s vascular tissues, with the front part often affected, known as iritis, or other parts like the ciliary body (which produces clear fluid) and the choroid (beneath the retina) also potentially involved. While infections can cause uveitis, the cause is often unknown.
Episodes of iritis or uveitis can lead to increased eye pressure, damaging the optic nerve and resulting in glaucoma. Treatment involves managing elevated pressure and inflammation, typically with eye drops and sometimes oral medication. If the pressure remains uncontrolled and nerve damage progresses, glaucoma drainage surgery, such as trabeculectomy or glaucoma drainage tube, may be necessary.
Uveitic glaucoma can be more severe and affect younger patients, compared to typical glaucoma cases. Treatment may be more intensive, potentially requiring surgery. Effective management involves ongoing care and personalised treatment plans.
Glaucoma in Older Children
Glaucoma in older children and adolescents is similar to the condition in adults, but is relatively rare. It is often secondary to other eye or general diseases, such as cataract surgery or iritis. Rarely, it’s inherited or associated with syndromes such as neurofibromatosis or Sturge-Weber syndrome. Unlike younger children, older children may not show symptoms, making early detection essential for treatment.
Diagnosis involves eye exams, similar to those for adults. Treatment typically starts with eye drops and may progress to surgery if needed, aiming to reduce intraocular pressure.
Who is at risk of developing glaucoma?
Treating glaucoma
There is no cure for the glaucoma eye condition, but patients may be able to manage the condition with a variety of treatment options. Sometimes, a combination of multiple treatments can be most suitable.
Prescription eye drops are the most common treatment option. To treat open-angle glaucoma, oral medication may be prescribed, although it can only be taken for a short period of time. Some types of laser treatments can be effective when treating open and closed-angle glaucoma.
If the condition cannot be controlled with drops, medications or laser, or the patient is not a suitable candidate for these treatment options, eye surgery may be necessary.
Testing for glaucoma
At Valley Eye Specialists in Brisbane, our ophthalmologists can perform a variety of eye assessments, such as measuring your eye pressure or intraocular pressure (IOP), assessing the drainage angle of your eye, examining your optic nerve, testing the quality of your central and peripheral vision, measuring the thickness of the cornea or using digital imaging.