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Glaucoma is the name for a group of eye diseases that damage the
optic nerve. This nerve carries information from the eye to the
brain. When the nerve is damaged, you can lose your
Glaucoma is one of the most
common causes of legal blindness in the world. At first, people with glaucoma lose side (peripheral)
vision. But if the disease isn't treated, vision loss may get worse. This can
lead to total blindness over time.
There are three types of
The exact cause isn't known. Experts think that increased pressure in the eye (intraocular pressure) may cause the nerve damage in many cases. But some people who have glaucoma have normal eye pressure.
Some people get glaucoma after an eye injury or after eye surgery. Some medicines (corticosteroids) that are used to treat other diseases
may also cause glaucoma.
If you have OAG, the only symptom you are likely to notice
is loss of vision. You may not notice this until it is serious. That's because
the eye that is less affected makes up for the loss at first. Side vision is
often lost before central vision.
Symptoms of CAG can be mild, with symptoms like blurred
vision that last only for a short time. Severe signs of CAG
include longer-lasting episodes of blurred vision or pain in or around the eye.
You may also see colored halos around lights, have red eyes, or feel sick to
your stomach and vomit.
In congenital glaucoma, signs
can include watery eyes and sensitivity to light. Your baby may rub his or her
eyes, squint, or keep the eyes closed much of the time.
Glaucoma can be diagnosed:
Glaucoma can't be cured. But there are things you can do to help stop more damage to the optic nerve. To help keep your vision from getting worse, you'll probably need to use medicine (most likely eyedrops) every day. You may also need laser treatment or
surgery. You'll also need regular checkups with your eye doctor.
If you have vision loss, you can keep your quality of life. You can use vision aids, such as large-print items and special
video systems, to help you cope with reduced eyesight. Support groups and counseling can also help you deal with vision loss.
Learning about glaucoma:
Living with glaucoma:
Health Tools help you make wise health decisions or take action to improve your health.
The exact cause of glaucoma isn't known. Experts think that increased pressure in the eye (intraocular pressure) may cause the nerve damage in many cases. But some people who have glaucoma have normal eye pressure.
eye anatomy and function.
open-angle glaucoma (OAG), fluid in the eye (aqueous humor) doesn't drain well. When this happens, the fluid builds up. This buildup increases the intraocular pressure (IOP) and may damage the optic nerve.
Up to half of the people with OAG don't have higher-than-normal IOP. This is called normal- or low-tension glaucoma.
In closed-angle glaucoma (CAG), fluid can't drain because the drainage angle is blocked. This may occur when:
is present at birth (congenital glaucoma) or that develops in the first few years of life (infantile
glaucoma) is often caused by certain birth defects. A birth defect may occur
because of an infection in the mother during pregnancy, such as
rubella, or because of an inherited condition such as
Some people get glaucoma after an eye injury or after eye surgery. A cataract and some medicines (corticosteroids) that are used to treat other diseases may also cause glaucoma. Glaucoma caused in these ways is called secondary glaucoma.
glaucoma vary according to the type of glaucoma you
Most people with OAG have no symptoms when they are diagnosed. You may have some side vision loss, but you may not notice it until the vision loss becomes severe. This is because the less affected eye makes up for your vision loss. The loss
of sharpness of vision (visual acuity) may not become apparent until late in
the disease. By that time, significant vision loss has occurred.
CAG may cause no symptoms. Or symptoms may range from mild to severe. They usually affect only one
eye at a time.
Severe symptoms may include:
You may have short episodes of symptoms
that usually occur in the evening and are over
by morning. This is called subacute closed-angle glaucoma. CAG can also happen suddenly and require medical attention right away.
Symptoms of glaucoma present at birth (congenital glaucoma) and glaucoma that develops in the
first few years of life (infantile glaucoma) may include:
Your baby may rub his or her eyes, squint, or keep the eyes closed
much of the time.
usually affects side (peripheral) vision first. If glaucoma isn't treated,
vision loss will continue, causing total blindness over time. If glaucoma
is found early and treatment starts right away, good eyesight can usually be
any type of glaucoma may delay or prevent further vision loss. But treatment can't
reverse vision loss that has already occurred. In a few rare cases of
congenital glaucoma, treatment has reversed some damage to the optic nerve.
How much your life will be affected
depends on your lifestyle and on how bad your vision loss is. Normal use of your eyes (such as for
reading or watching TV) won't speed up vision loss or make the
condition worse. For information on
how to live with low vision, see Home Treatment.
OAG usually affects both eyes at the same
time. But one eye may be affected more than the other.
Vision changes so slowly that much of your eyesight may be affected before you
notice the condition.
Blind spots from each side of the field of vision gradually meet, increasing
the area of blindness. Central vision, used for reading and seeing details, is
CAG usually affects only one eye at a time. It can happen suddenly (acute) or be a long-term problem. If it's acute, it's an emergency. Severe and permanent vision loss can develop within
hours or days after symptoms start.
You may have short episodes of CAG.
Without treatment, these episodes will keep coming back. They can become an emergency
situation (acute closed-angle glaucoma) or a long-term problem (chronic
Congenital glaucoma may be present at birth or develop within the first few years of life. Treatment needs to start right away to help avoid further vision loss and blindness. In certain children, some of the optic nerve damage caused by the disease can be reversed with treatment.
Risk factors for
Risk factors for
Risk factors for
congenital glaucoma include:
Call 911 or other emergency services immediately if you have:
Call your doctor if you:
The following doctors can diagnose
An ophthalmologist can treat glaucoma and perform eye surgery.
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Early detection and treatment of
glaucoma are important for
controlling the condition and preventing blindness.
A doctor evaluating
glaucoma will take a
medical history and do a
physical exam. If your doctor suspects glaucoma, he or she will refer you to an eye specialist (ophthalmologist).
The eye specialist will check your eyes to help find out if you have the disease and how severe it is. He or she will look for certain signs of damage in the eye by checking things like:
After glaucoma is diagnosed, eye exams are done on a regular basis to monitor the
Your doctor may also do a
low-vision evaluation to help find ways you can make
the most of your remaining vision and maintain your quality of life.
If you are younger than 40 and have no known risk factors for glaucoma, the American Academy of Ophthalmology (AAO) recommends that you have a complete eye exam every 5 to 10 years. This includes tests that check for
glaucoma.2 The AAO suggests more frequent routine eye exams as you age, even if you aren't at increased risk for glaucoma.
Most treatment for glaucoma is aimed at lowering the pressure in the eyes (intraocular pressure, or IOP). This helps save your eyesight by slowing the damage to the optic nerve. In adults, treatment can't restore eyesight that has already been lost as a result of
glaucoma. But in certain children, some of the damage caused by
congenital glaucoma can be reversed.
Treatment options include medicines and surgery, including laser surgery. Studies show that medicine and surgery are both
effective treatments, but the risks and benefits may differ depending on the type of
glaucoma, age, race, and other factors.3
It is important to understand that treatment for glaucoma will most likely continue for the rest of your life. You will need regular eye exams by an eye doctor. Ask your doctor about the best treatment for your particular condition.
Though glaucoma can lead to a significant loss of vision, your doctor can refer you to counselors who specialize in helping people adjust to
living with low vision.
The eye doctor sets a target eye pressure for each eye and will check it regularly. If the pressure is high enough, or if the doctor sees signs of damage caused by glaucoma, the doctor may advise that you start treatment with medicine or adjust your medicine.
OAG usually starts with medicines (most likely eyedrops) to lower the pressure inside the eye. If medicines don't work, your doctor may use laser treatment or surgery. In some cases, laser treatment or surgery will be tried before medicine.
Initial treatment for CAG is usually a procedure called laser iridotomy. You may also need medicine (usually eyedrops) to help you stay at your target eye pressure.
If the pressure in your eye
stays high or if damage to the optic nerve gets worse despite
treatment, your doctor will adjust your treatment. In some cases, your doctor may need to adjust your medicines. Or, if you haven't had the laser procedure, you may need this or another surgery.
CAG can be an emergency situation
(acute closed-angle glaucoma). Blockage of fluid in the eye causes a
sudden increase in pressure, causing rapid damage to the optic nerve.
Acute closed-angle glaucoma usually causes significant pain. Laser treatment is needed right away for this problem.
Congenital glaucoma almost always requires surgery to
lower eye pressure. Medicine may sometimes be used, but it usually doesn't
work as well.
Because glaucoma can't be cured and treatment doesn't
always prevent further loss of vision, people may try alternative
unproven treatment methods, such as acupuncture or
marijuana. But most of these alternative treatments either haven't been
studied or haven't been proved to work for glaucoma. Such treatments may be expensive. And
some can be hazardous to your health.
To learn more, see Home Treatment, Medications, and Surgery.
Most of the risk factors (such as age,
race, and family history) for
glaucoma are beyond your control. Whether or not you are at increased
risk for glaucoma, it's best to get routine eye exams and tests as your eye doctor suggests. Finding and treating glaucoma early is important to help prevent blindness.
If you have high pressure in your eyes but you don't have glaucoma, your eye doctor may suggest treatment that helps lower your eye pressure. This may help delay or prevent the onset of glaucoma.
Glaucoma can affect your life. How much you are
affected depends on how bad your vision loss is, what kinds of activities
you do, and your lifestyle. You can work with your doctor to find ways to make the best
use of your remaining vision. You can:
It's common to feel sad or angry when you learn that you have glaucoma. Try building a support group of family and friends. Your doctor can also refer you to counselors who specialize in helping
people adjust to living with low vision.
Medicine is a large part of your treatment. Be sure to:
Prescription medicines to lower the pressure inside
the eye (intraocular pressure, or IOP) are used
to treat all types of
glaucoma. They work either by reducing the amount of
fluid (aqueous humor) that is produced by the eye or by
increasing the amount of fluid that drains out of the eye. These medicines may
be given as eyedrops, as pills, in liquid form by mouth, or through a vein (in emergency
situations). In most cases, eyedrops are used first.
congenital glaucoma, medicines may be used to decrease
the pressure in the eyes and reduce the cloudiness of the clear front surface
(cornea) of the child's eye. Medicines are usually only used until surgery can be done.
When glaucoma has already caused vision loss,
further vision loss may occur even after the pressure in the eye is lowered
to the normal range with medicine. Talk to your doctor about the goals of treatment, how long the
medicine will be tried, and the possible side effects. Eye medicines can cause symptoms throughout the body.
need follow-up visits with your doctor to find out whether your medicine is working as well as it should. You can also discuss any side effects or medicine schedule problems.
In most cases, medicines used to treat glaucoma must be continued daily
for the rest of your life.
Medicines that decrease the amount of fluid produced by
the eye include:
Medicines that increase the amount of fluid that drains
out of the eye include:
Some medicines have two different medicines mixed into
one bottle. Examples include Cosopt, which contains both a carbonic anhydrase
inhibitor and a beta-blocker, and Combigan, which contains both an adrenergic
agonist and a beta-blocker.
Surgery reduces the pressure in the eyes by opening blocked
drainage angles or creating a new opening that fluid can
flow through to leave the eye. In some cases surgery may be done to relieve pain caused by
Medicine will usually
be tried before surgery is considered.
Doctors can use
either a surgical cutting tool or a very focused beam of light, called a laser,
to do surgery for glaucoma.
Laser surgery is usually the first type of surgery tried. If laser surgery doesn't help, your doctor may try
It is not
unusual for some people to have both open- and closed-angle glaucoma. They may need more than one kind of procedure.
There are three basic types of surgery for glaucoma in
This type of surgery involves making a trapdoor that allows fluid to
drain from the eye.
These procedures involve making a new opening in the
colored part of the eye (iris) that allows fluid to flow through the eye. They
are used to treat sudden (acute) and long-term closed-angle glaucoma. The procedures also will prevent
closed-angle glaucoma in people who have narrow drainage angles.
iridotomy can usually be done instead of surgical iridectomy. But some people
with complicated or severe glaucoma may need to have surgical iridotomy.
When other surgery fails to improve the flow of fluid from
the eye, procedures to destroy the part of the eye that produces fluid (ciliary
body) can be done. These procedures are also used when scar tissue has formed
after a previous surgery.
glaucoma, there are two slightly different procedures that both attempt to open
the drainage angle directly. They are equally successful in children, but they
are not used for adults. If these procedures fail in a child, then
trabeculectomy or tube-shunt surgery may be tried.
Deciding whether to have surgery is difficult because:
As with any other surgery, you and your doctor should
make the decision to operate based on the risks and benefits of having the
surgery. One thing to consider is
which eye should be operated on first. There may be other
questions about glaucoma surgery that you should
discuss with your doctor before making a decision.
Cataracts may occur in people who also have glaucoma. This commonly occurs in older people. Surgery to remove the cataract may be
done at the same time as surgery for glaucoma. If
surgeries for glaucoma and a cataract are done at the
same time, you may notice improved eyesight after surgery.
This nonprofit group works to find cures, preventions, and improved treatments for age-related degenerative diseases. The website has information about Alzheimer's disease, macular degeneration, and glaucoma.
The American Optometric Association (AOA), which is a
national organization of optometrists, can provide information on eye health
and eye problems.
EyeCare America is a public service program of the
Foundation of the American Academy of Ophthalmology. This site aims to raise awareness about
eye diseases and eye care. It has information about eye conditions, treatments, and general eye health. You can check to see if you qualify for a free eye exam.
This nonprofit group supports glaucoma research and provides information about this disease and the importance of early detection to help prevent blindness. The website includes online chat groups for youth and adults.
This nonprofit organization aims to help people prevent vision loss from glaucoma. The website has information about glaucoma and how to live with and treat it. There is also information about how to get help paying for glaucoma medicines.
As part of the U.S. National Institutes of Health, the National Eye
Institute provides information on eye diseases and vision research.
Publications are available to the public at no charge. The Web site includes
links to various information resources.
CitationsAmerican Academy of Ophthalmology (2010). Primary Angle Closure (Preferred Practice Pattern). San Francisco: American Academy of Ophthalmology. Also available online: http://aao.org/ppp.American Academy of Ophthalmology (2010). Comprehensive Adult Medical Eye Evaluation (Preferred Practice Pattern). San Francisco: American Academy of Ophthalmology. Available online:Shah R, Wormald RPL (2011). Glaucoma, search date May 2010. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.Other Works ConsultedAmerican Academy of Ophthalmology (2007). Vision Rehabilitation for Adults (Preferred Practice Pattern). San Francisco: American Academy of Ophthalmology. Available online:Salmon JF (2011). Glaucoma. In P Riordan-Eva, ET Cunningham, eds., Vaughan and Asbury’s General Ophthalmology, 18th ed., pp. 222–237. New York: McGraw-Hill.See JLS, Chew PTK (2009). Angle-closure glaucoma. In M Yanoff, JS Duker, eds., Ophthalmology, 3rd ed., pp. 1162–1171. Edinburgh: Mosby Elsevier.Tan JC, Kaufman PL (2009). Primary open-angle glaucoma. In M Yanoff, JS Duker, eds., Ophthalmology, 3rd ed., pp. 1154–1158. Edinburgh: Mosby Elsevier.Trobe JD (2006). The red eye. Physician's Guide to Eye Care, 3rd ed., chap. 4, pp. 47–51. San Francisco: American Academy of Ophthalmology.Vass C, et al. (2007). Medical interventions for primary open angle glaucoma and ocular hypertension. Cochrane Database of Systematic Reviews (4).Walker RS, Piltz-Seymour JR (2009). When to treat glaucoma. In M Yanoff, JS Duker, eds., Ophthalmology, 3rd ed., pp. 1211–1215. Edinburgh: Mosby Elsevier.Yanoff M, Cameron D (2012). Diseases of the visual system. In L Goldman, A Shafer, eds., Goldman’s Cecil Medicine, 24th ed., pp. 2426–2442. Philadelphia: Saunders.
February 28, 2012
Adam Husney, MD - Family Medicine & Christopher J. Rudnisky, MD, MPH, FRCSC - Ophthalmology
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