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Glaucoma: Early Signs & How to Treat It

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Last updated July 7, 2022

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Glaucoma is caused by a buildup of fluid and pressure in the eye. It can damage the optic nerve and create blind spots in your vision and total blindness when not treated.

What is glaucoma?

Glaucoma causes fluid to build up in the eye, creating pressure in the eye. Over time, this pressure can damage the optic nerve, which is responsible for your vision and connects the eye to the brain. If not treated, glaucoma can cause a gradual decline in your central vision and even a loss of vision or blindness.

Open-angle glaucoma is the most common type. It does not usually cause pain or any other symptoms in the early stages. It happens when the drainage canal in the eye stays open, but there is a buildup of fluid that does not drain properly. This causes eye pressure to increase, damaging the optic nerve.

A less common type is closed-angle glaucoma, which is when the drainage canal is completely blocked. Symptoms include pain, pressure, and redness in the eye. It is often caused by other issues, such as trauma, inflammation, and chronic conditions like diabetes and hypertension.

During an annual eye exam, your eye doctor will do a glaucoma screening. This is the best way to diagnose glaucoma early. It can be successfully treated and you should maintain most of your central vision.

Glaucoma is usually first treated with medicated eye drops, but laser or surgical procedures may be needed to control eye pressure.

Pro Tip

Glaucoma is a silent condition, just like high blood pressure.  This means that there are often no signs of this disease and it can cause damage before it is even diagnosed.  Keep regular check ups with your eye doctor to monitor and treat for this condition. —Dr. Khushboo Agrawal

Are there early signs of glaucoma?

Open-angle glaucoma

Open-angle glaucoma is usually painless and there are no obvious signs or symptoms. It is typically diagnosed during a routine glaucoma screening.

Closed-angle glaucoma

Closed-angle glaucoma generally causes eye pain, redness, and decreased vision. The longer the drainage is blocked, the higher the pressure becomes, and the more severe the symptoms.  Unfortunately, if the symptoms last for days to weeks, there could be irreversible damage to your vision.

Symptoms

While open-angle glaucoma typically does not have any symptoms, it can eventually lead to vision loss.

Closed-angle glaucoma usually causes eye pain, redness, and decreased vision. If not treated, it can cause severe pain and vision loss. The pupil may also become dilated from damage to the iris.

Main symptoms

Causes

Glaucoma is caused by damage to the optic nerve. In the majority of cases, this damage is from elevated eye pressure. Prolonged damage to the optic nerve causes ganglion cell axons to die, which leads to vision loss.

Some families may have a higher risk of glaucoma. But it can also develop without any known reason. In a smaller number of people, it occurs because of other eye problems, such as inflammation, infection, previous eye surgery, medication usage, or trauma. It can also develop in people with poorly controlled diabetes and hypertension.

In rare cases, glaucoma is not caused by high pressure but by other factors, like loss of blood flow or damage to certain growth factors in the nerve.

Dr. Rx

There are several resources available, both in person and online, for patients with low vision or poor quality of vision, as may happen in glaucoma.  These help patients navigate their daily life with tools and other things in an effort to get the most use out of the vision they have. —Dr. Agrawal

Next steps

If you have glaucoma, you will need to see an ophthalmologist and glaucoma specialist (an ophthalmologist with special training in glaucoma).

A glaucoma diagnosis is based on two factors. You have a pattern of increased intraocular pressure (inside the eye) and have some vision loss or a blind spot in your visual field. The visual issues are directly related to the health of the optic nerve.

This can be tested by a visual field machine in an optometrist’s or ophthalmologist’s office. Your doctor will check your visual field on your annual eye visits.

Treatment

Treatment is focused on lowering the eye pressure, which can be done with medicated eye drops. But if this isn’t working, you may need a laser or surgical procedure to lower the pressure.

Medication

There are four types of eye drop medications doctors often prescribe as the first treatment:

  • Beta blockers: timolol (Timoptic)
  • Alpha agonists: brimonidine (Alphagan)
  • Carbonic anhydrase inhibitors: dorzolamide (Trusopt). The oral form, acetazolamide, is sometimes prescribed when there is extremely high eye pressure.
  • Prostaglandin analogs: latanoprost (Xalatan)

Pro Tip

If you are using eye drops, it is important to bring them with you, show the doctor how you are putting them in your eyes, and ask for refills if you need them. —Dr. Agrawal

Procedures

  • A laser may be used to change the shape of the drainage apparatus so fluid flows out of the eye better. This can be done in the doctor’s office or in an operating room under local anesthesia. This may reduce your need for glaucoma drops treatment in the future.
  • If you are not able to have the laser procedure or a laser treatment isn’t working well, you may need surgery. This is done in the operating room by a glaucoma specialist under local or general anesthesia. The surgeon makes a hole in the wall of the eye or implants a drainage tube in the eye to help fluid flow out of the eye. The recovery can be long, and you will need to use eye drops to control pain and inflammation.

Preventative tips

In the majority of people, glaucoma cannot be prevented. But it’s important to get annual screenings during your regular eye exam so you can catch it early.

If you have a family history of glaucoma, it is important to see an eye doctor regularly, who will do routine eye pressure monitoring and visual field testing.

To prevent glaucoma caused by medical conditions like diabetes and hypertension, you need to keep these conditions under control by taking any medications you have been prescribed and following your doctor’s recommendations.

Share your story
Dr. Agrawal is a board - certified Ophthalmologist and writer for Buoy Health. She received her Bachelor of Science from Vanderbilt University and Medical Degree from the University of Mississippi Medical Center. She completed a medical internship at the Mayo Clinic in Rochester, and residency at the University of Chicago. Subsequently, she completed a two year fellowship in surgical retina at the...
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