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Glaucoma

Glaucoma is a range of diseases that are capable of damaging the eye's optic nerve. If not treated in time, it can cause permanent damage to the optic nerve, loss of vision and subsequently, blindness. Glaucoma occurs when the fluid pressure in the eye (intraocular pressure) rises. It affects 1 in 200 people aged 50 and younger and 1 in 10 over the age of 80.

Types and Symptoms of Glaucoma

Before discussing the types of Glaucoma it is imperative to understand the working of a fluid called the Aqueous Humor. This fluid fills the front of the eye and is produced in the back portion of the eye. It is constantly replenished and the old fluid leaves the eye through channels in the (front) chamber of the eye, and eventually drains into the bloodstream. The channels that drain the aqueous humor are in an area called the anterior chamber angle.
There are primarily four types of Glaucoma.

Open Angle Glaucoma

In Open Angle Glaucoma, the channels in the Anterior Chamber Angle narrow with time, and therefore make it difficult for the Aqueous Humor to drain properly leading to a buildup of fluids which cause pressure in the eye. This increased pressure leads to reduced blood supply to the optic nerve which gradually gets damaged and can lead to blind spots in the field of vision. This is the most common type of Glaucoma and tends to run in the family.

Symptoms
Mostly it has no symptoms
If not treated could lead to blindness

Angle Closure (acute) Glaucoma
This type of Glaucoma occurs when there is a shift in the position of the iris of the eye which blocks the exit of the Aqueous Humor fluid. This follows a rapid, severe, and painful rise in intraocular pressure. This is an emergency and the patient should be rushed to the doctor immediately.
Symptoms
Severe eye pain, facial pain
Cloudy vision
Red eye
Swelling of the eye
Pupil does not react to light
Nausea and vomiting (may be the major symptom in the elderly)
Congenital Glaucoma
Congenital Glaucoma is often hereditary and it is present at birth. It is the result of abnormal development of the fluid outflow channels. Surgery is required for correction.
Symptoms
Tearing
Sensitivity to light
Red eye
Enlargement of one eye or both eyes
Cloudiness of the front of the eye
Secondary Glaucomas
There are many kinds of Secondary Glaucomas. These Glaucomas may be cased by complications of other medical conditions like eye surgeries, advanced cataract, eye injuries, certain eye tumors or uveitis.

Detection
Early detection of Glaucoma is very important as a delay could have serious consequences like blindness. An examination of the eye may be used to diagnose Glaucoma. Checking the intraocular pressure alone might not prove sufficient because the eye pressure keeps changing. A complete eye examination including the following tests is needed.
Retinal examination
Intraocular pressure measurement by tonometry
Visual field measurement
Visual acuity
Refraction
Pupillary reflex response
Slit lamp examination
Optic nerve imaging (photographs of the interior of the eye)
Gonioscopy- use of a special lens to see the outflow channels of the angle

Treatment
Glaucoma can be treated by medicines, laser trabeculoplasty, conventional surgery, or a combination of any of these. These treatments may save prevent further damage but the damage already done is irreversible.
Medicines. Eye drops or/ and pills are the most common early treatments for Glaucoma. Some medicines cause the eye to make less fluid. Others lower pressure by helping fluid drain from the eye.
The dosage of Glaucoma medicines depends on the condition of the patient. Some medicines can cause headaches or other side effects. For example, drops may cause stinging, burning, and redness in the eyes. Treatment with a different dose or a new drug may be possible.
Laser trabeculoplasty. Laser trabeculoplasty helps fluid drain out of the eye. Doctors may suggest this step at any time. In many cases, one has to keep taking Glaucoma drugs after this procedure.
The laser makes several evenly spaced burns that stretch the drainage holes in the meshwork. This allows the fluid to drain better.
Laser surgery can cause side effects, such as inflammation. The doctor may prescribe some drops for any soreness or inflammation inside the eye. Follow-up visits are necessary to have the eye pressure monitored.
Studies show that laser surgery is very good at reducing the pressure in some patients. However, its effects can wear off over time. The doctor may suggest further treatment.
Conventional surgery. Conventional surgery makes a new opening for the fluid to leave the eye. Conventional surgery often is done after medicines and laser surgery has failed to control pressure. A small piece of tissue is removed to create a new channel for the fluid to drain from the eye.

Conventional surgery work best if the patient has not had previous eye surgeries, such as a cataract operation.
In some instances, the vision may not be as good as it was before conventional surgery. Conventional surgery can cause side effects, including cataract, problems with the cornea, and inflammation or infection inside the eye. The buildup of fluid in the back of the eye may cause some patients to see shadows in their vision. Bu medicines can be taken in these cases.

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