Eyes contain special systems designed to drain fluid and regulate pressure in them, but when these don’t function as planned, glaucoma develops. When this damage to optic nerve occurs, peripheral vision decreases gradually leading to total blindness over time.

Closed-angle glaucoma typically develops quickly when drainage areas become blocked, often manifesting itself with rainbow halos around lights, headaches, nausea and intense pain.

Open-angle glaucoma

Open-angle glaucoma (also referred to as primary open-angle or chronic open-angle glaucoma) is one of the leading preventable causes of blindness worldwide, accounting for at least 90% of cases in America alone. It occurs when the outflow channels for aqueous humor become blocked up, leading to eye pressure rise and gradual optic nerve damage over time. Unfortunately, its symptoms usually don’t become evident until after vision loss has already occurred; making this one of the leading preventable causes.

Symptoms of open-angle glaucoma often include peripheral visual field loss. If this is your experience, it is vital that you visit a doctor as soon as possible for evaluation and treatment. He or she will conduct a comprehensive eye exam that includes evaluation of optic nerve shape and color as well as testing your visual field with perimetry to detect early stages of glaucoma as well as measure visual acuity.

Primary open-angle glaucoma is often marked by structural changes to the optic disc and associated nerve and visual field changes, with elevated intraocular pressure (IOP) being its main risk factor; diagnosis relies on clinical examination including gonioscopy as well as measurement of IOP.

Narrow-angle glaucoma, also referred to as acute angle-closure glaucoma or closed-angle glaucoma, is characterized by an obstruction to the anterior chamber angle that may be chronic or, less often, acute in nature. Symptoms may include severe eye pain, blurred vision with colored halos around lights, nausea/vomiting/headache and profuse tearing.

Medication is usually the go-to treatment for both types of glaucoma. Pills and eye drops that inhibit production of aqueous fluid within the eye or improve drainage canal flow are available, with most opting for trabeculectomy surgery as it offers greater and sustained IOP reduction than non-penetrating procedures. If medication doesn’t control glaucoma effectively enough for you, surgery may become necessary; various laser and non-penetrating procedures exist, with laser offering faster relief than non-penetrating procedures but usually trabeculectomy offers greater and sustained IOP reduction than non-penetrating procedures can.

Closed-angle glaucoma

Closed-angle glaucoma (CAG) is an eye condition characterized by sudden or gradual narrowing of the angle between the anterior chamber and drainage channels in order to block internal fluid called aqueous humor and increase intraocular pressure (IOP), potentially damaging optic nerves and leading to increased IOP levels that increase intraocular pressure (IOP). CAG should be treated promptly or it could result in blindness if untreated immediately.

The angle of the anterior chamber is formed at the junction between cornea and iris, and aqueous fluid flows freely between these parts, passing through pupil, pupillary openings and draining into trabecular meshwork in back of eye. Under normal circumstances this fluid flows freely with no increased pressure but in rare circumstances the iris moves forward blocking this angle, increasing intraocular pressure dramatically within hours requiring urgent medical intervention such as medication or surgery to avoid vision loss.

Patients may present with symptoms including eye pain, blurred vision and headaches that worsen while sleeping (perhaps due to gravity pulling the lens forward). An ophthalmologist can evaluate this condition using gonioscopy; or more simply by holding up a penlight and looking through its lens onto their pupil for any shadow cast by nasal iris; narrow angles will often be apparent as will peripheral anterior synechiae – adhesions between the iris and angle structure that block drainage of trabecular meshwork – blocking drainage from being observed.

Glaucoma of this type is more prevalent among certain races, particularly Asian and Eskimo descent; however, anyone can develop it. People with family histories of the disease as well as those over 40 are at an increased risk for it; it also appears more frequently among those who have sustained eye injuries or taking certain medications that dilate pupil such as ophthalmic solutions or anticholinergic drugs used to treat urinary incontinence or vasoconstriction medications used in heart conditions can increase risk as well.

Acute angle-closure glaucoma

Acute angle-closure glaucoma (AAG) is an eye disease in which drainage canals become blocked, leading to sudden increases in eye pressure that must be treated immediately in order to avoid permanent blindness. AAG may either be chronic or acute and affect both eyes. Narrow angles – defined as being between the colored part (iridium) of an eye (iris) and its clear front window (cornea) – increase risk, as do adhesions between eye structure and surrounding tissue called peripheral anterior synechiae.

An acute angle-closure glaucoma typically presents with symptoms that include eye discomfort and redness, decreased vision, colored halos around light sources, headache, nausea and vomiting. These symptoms often resemble neurological or gastrointestinal ailments and may be misdiagnosed as such by nonophthalmologists, leading them down a path toward unnecessary cranial imaging studies and neurologic consultations before being sent for ophthalmic examination. Physical examination typically reveals painful engorged episcleral vessels, cloudy cornea, fixed and dilated pupil, pallor or cupping appearance of optic nerve head (as seen through gonioscopy), elevated intraocular pressure levels as well as peripheral anterior synechiae or closed angle on gonioscopy as indicators of eye disease.

Acute glaucoma is more dangerous than slow-developing chronic open-angle glaucoma because its effects can damage an optic nerve in hours, leaving patients with severe pain, blindness in one eye, and eventual permanent loss of all vision unless treated immediately. People with narrow angles are at greater risk for this form of glaucoma and should undergo frequent eye exams to determine whether it has developed into something serious. If a patient has the disease, their doctor can treat it with medications and a procedure known as laser peripheral iridotomy – this procedure creates a new channel through which fluid flows. It’s the only effective solution available for acute phase glaucoma as well as long-term vision loss prevention.

Treatment

Glaucoma occurs when fluid build-up and increased eye pressure lead to irreparable optic nerve damage, ultimately resulting in blindness. Most open-angle glaucoma sufferers develop it gradually with no symptoms until vision loss starts taking place – usually peripheral or side vision first before progressing to central field vision loss. People suffering closed-angle glaucoma often develop it rapidly with symptoms including rainbow halos around lights, blurred vision, severe eye pain, nausea and vomiting all being symptoms.

Treatments for both types of glaucoma focus on lowering pressure inside the eye. Medication and various surgical techniques may be utilized to either increase outflow of eye fluid, or decrease production of it.

Treatment begins with a thorough dilated eye examination. Based on its results, your doctor may prescribe oral medications such as beta-blockers, alpha-adrenergic agents or carbonic anhydrase inhibitors; laser therapy is another option available to improve fluid flow or lower eye pressure; surgery called “trabeculectomy” is another possibility.

Recently, there has been significant progress made in understanding genetics and glaucoma. Researchers are working towards discovering medications to protect and preserve the optic nerve from damage and prevent further cases of glaucoma from emerging.

For more information on the latest treatment innovations for eye diseases like glaucoma, reach out to Todani Eye Associates by phone or using our online scheduling tool – we look forward to meeting you! We look forward to welcoming you soon.