Patient Information: Glaucoma symptoms and treatment information at the Drogheda Medical Eye Clinic

Glaucoma is a group of eye conditions where the optic nerve that connects the eye to the brain, becomes damaged due to a build up of fluid (the aqueous humour) in the eye, that leads to an intraocular pressure that is higher than the nerve can tolerate.

Glaucoma, when untreated, causes irreversible blindness. Treatment of glaucoma is life long and prevents blindness.

TYPES OF GLAUCOMA: 

Adult Glaucoma:

1. Chronic open angle glaucoma is the most common type. It is asymptomatic until very late stages. When untreated, it leads to progressive narrowing of the visual fields over the years, to tunnel vision at the end stages, followed by total blindness. There is usually a family history with this type of glaucoma. 

2. Acute angle closure glaucoma is an acute rise of eye pressure, symptomatic with eye redness, pain, headache, haloes around light, reduction of vision, nausea & vomiting.

3. Other common causes of glaucoma are: uveitis, as a complication of diabetic eye disease or blocked retinal veins or trauma.

Management of Glaucoma

Diagnosis: the earlier the diagnosis the better the prognosis.

This can be achieved by measuring the intraocular pressures, examining the angle of the eye (gonioscopy), examining the nerve to the eye, visual fields testing & OCT.

Treatment

Treatment for open angle glaucoma: 

1. Laser: Selective laser Trabeculoplasty.

2. Medical: Eye pressure lowering drops.

3. Surgical: Stents or trabeculectomy, when the first two choices fail.

4. Or a combination of the above.

Treatment for Narrow/closed angle Glaucoma:

1. In the acute phase: eye pressure lowering medications: systemic & topical.

2. When the eye pressure is lowered with medications, YAG laser peripheral iridotomy is performed to bypass the closed angle and create a drainage channel for the aqueous to prevent it from accumulating in the anterior chat of the eye.

Treatment for Complicated glaucoma: 

1. Angle neovascularisarion due to diabetes or blocked retinal vein: reduce the eye pressure with medications and treat the cause by intravitreal anti-VEGF injections, to induce regression of the the abnormal blood vessels that are blocking the angle and preventing the aqueous drainage.

2. Uveitis: pressure lowering medication and Steroids to treat the uveitis. Combined care with the rheumatologist is usually required to treat the systemic cause that lead to the uveitis.

3. Trauma: medications only.
   
   

Follow Up:

All glaucoma patients should have a regular life long follow up by the ophthalmologist to monitor the pressures, visual fields and OCT, as the eye pressure can rise or the fields may deteriorate gradually, despite the initial good response to the treatment. This necessitates a repeat of SLT, addition of pressure lowering drops or change of treatment altogether.

For more information on Selective Laser Trabeculoplasty (SLT) treatment for glaucoma at the Drogheda Medical Eye Clinic by Dr Fatima Hamroush, please follow this link.