Glaucoma

Glaucoma is a group of diseases of the optic nerve involving loss of retinal ganglion cells in a characteristic pattern of optic neuropathy . Glaucoma refers to a group of disorders that lead to damage to the optic nerve, the nerve that carries visual information from the eye to the brain The most common form of glaucoma, primary open-angle glaucoma, develops gradually, giving no warning signs. However, with early treatment, you can often protect your eyes against serious vision loss. It occurs as a result of a buildup of fluid in the eyeball. Imagine that the inside of your eye is like a sink, with the faucet always running and the drain always open.. Acute angle-closure glaucoma is considered an emergency because optic nerve damage and vision loss can occur within hours of the onset of the problem. of your eye. An elevated IOP is the most important risk factor for the development of glaucoma Untreated glaucoma leads to permanent damage of the optic nerve and resultant visual field loss, which can progress to blindness . . Untreated glaucoma leads to permanent damage of the optic nerve and resultant visual field loss, which can progress to blindness . If left untreated, glaucoma may lead to blindness in both eyes The term glaucoma is added if glaucomatous optic neuropathy is present. In people with glaucoma, the drain in the eye is blocked and the fluid can't run out of the eyeball. Instead, the fluid builds up and causes increased pressure in the eye. But having glaucoma does mean regular monitoring and treatment for the rest of your life.

Glaucoma is not just one disease, but a group of them. Glaucoma occurs when the normal fluid pressure inside the eyes The front part of the eye is filled with aqueous humor that nourishes the lens, iris and cornea, as well as maintains the shape of the eye. Like water in the sink, the fluid in your eye moves in and out. Primary angle closure is defined as an occludable drainage angle and features indicating that trabecular obstruction by the peripheral iris has occurred (ie, peripheral anterior synechiae, increased IOP, lens opacities, excessive trabecular pigmentation deposits). The fluid nourishes your eye and keeps it healthy. Half of the people with glaucoma are usually unaware of it until a serious loss of vision has occurred. Instead, the fluid builds up and causes increased pressure in the eye After the fluid circulates, it empties through a drain in the front of your eye.The term glaucoma is added if glaucomatous optic neuropathy is present. also called acute glaucoma or angle closure glaucoma), accounts for about 9 percent of all glaucoma cases and occurs when the opening between the cornea and iris narrows, such that the fluid cannot get to the trabecular meshwork and normal drainage channels. This narrowing results in fluid build-up and intraocular pressure. The fluid build-up happens very quickly.

Causes of Glaucoma

The common causes of Glaucoma :-

• Shallower anterior chambers; anteriorly situated lens; shorter axial eye length; a thin, floppy iris; and a narrow angle lead to a higher propensity for development of AACG.
• Precipitating factors include drugs (ie, sympathomimetics, anticholinergics, antidepressants), dim light, and rapid correction of hyperglycemia.
• Elevated IOP is still considered a major risk factor for glaucoma, though, because studies have shown that the higher the IOP is, the more likely the optic nerve will be damaged.
• Increased IOP results from either increased production or decreased drainage of aqueous humor.
• In many cases this damage to the optic nerve is thought to be caused in part by increased pressure in the eye ( intraocular pressure , or IOP) that results from the buildup of fluid inside the eye
• Medical conditions, such as morning headaches, diabetes , lupus, Crohn's disease , rheumatoid arthritis , myopia (nearsightedness), and high blood pressure
• Aqueous humor exits your eye through a drainage system located at the angle formed where the iris and the cornea meet.
• It is associated with age degeneration of the outlet channels preventing fluid from escaping. This increases the pressure in the eyeball making it hard and painful.

Symptoms of Glaucoma

Some are common symptoms of Glaucoma :-

• Tiny blind spots appear at the edges of the visual field (peripheral or side vision) that slowly get larger and spread
• Repeated difficulties that new eyeglass prescriptions do not help
• Pupil does not react to light
• Nausea and vomiting (may be the major symptom in the elderly)
• Severe eye pain
• Nausea and vomiting
• Narrowing of vision (tunnel vision)
• cloudy, enlarged cornea (large eye)
• one eye may be larger than the other
• Very painful red eyeball.
• Blurred vision.

Treatment of Glaucoma

• Inflammation is an important part of the pathophysiology and presenting symptomology
• The treatment of AACG consists of IOP reduction, suppression of inflammation, and the reversal of angle closure.
• Miotics are eye drops that help open the drainage canals and increase the flow of aqueous humor out of the eye.
• Carbonic anhydrase inhibitors (available as pills or eye drops) help reduce aqueous humor flow into the eye
• If you have signs of optic nerve damage and visual field loss, even if your eye pressure is in the normal range, you may need treatment to lower eye pressure further, which may help slow the progression of glaucoma.
• Laser surgery for glaucoma slightly increases the outflow of the fluid from the eye in open-angle glaucoma or eliminates fluid blockage in angle-closure glaucoma.
• These either reduce the formation of fluid in the front of the eye or increase its outflow.
• Laser peripheral iridotomy (LPI) performed 24-48 hours after IOP is controlled is the definitive treatment for AACG.

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