Glaucoma is a condition in which the optic nerve sustains damage due to compression caused by raised pressure inside the eye, leading to decrease in the field of vision and finally loss of vision It is a hereditary disorder, occurring commonly among family members.

Progressive increase in optic cup size

Types of glaucoma :
Chronic simple glaucoma occurs in old age. It is the most common type, where the loss of vision in gradual and painless. Chronic headache, frequent change of reading glasses, and decrease in the side vision, with normal central vision may be present. Myopes are more prone to glaucomatous damage.

Acute Congestive glaucoma occurs in small eyes (Hypermetropes) with narrow angles. Sudden increase of pressure in the eye causing blurring of vision accompanied by severe pain, nausea and vomiting can occur in this type. This is an acute angle closure attack. Before or in between attacks patient would see coloured haloes around an artificial light and feel dull pain around the eye after being in the dark room like cinema theatre.

Secondary glaucoma is caused by conditions such as injuries, bleeding, inflammations, eye operations etc.,

Congenital glaucoma is present since birth.

Developmental glaucoma occurs due to developmental problems, in younger people.

Progressive field loss in glaucoma

How can glaucoma be diagnosed?
Routine annual measurement of intra-ocular pressure for all people above the age of 40 years and for people with family history of glaucoma annually above 35 years using Schiotz and / or Applanation tonometer is essential to diagnose glaucoma, early.

Fundus examination using slit lamp and 90 D ens is essential to find out the amount of cupping and damage to the optic disc.

Gonioscopy would decide the type of glaucoma and narrow angle glaucoma would need laser treatment. (Nd YAG laser peripheral iridotomy), to prevent angle closure attacks.

Field testing is essential to find out the extent of damage and for follow up.

Treatment :
Medical treatment is sufficient initially. Eye drops should be used exactly as prescribed by the ophthalmologist, and periodical follow up to assess the requirement of medicines is essential.

Laser treatment

Nd YAG laser treatment is essential in narrow angle glaucoma to prevent angle closure attacks and to treat the condition. Laser peripheral iridotomy is done to create a hole in the iris, which used to be done surgically in the pre-laser days.

Argon and Diode lasers are used in open angle glaucoma to enlarge the outlet pores (Laser trabeculoplasty). Diode laser is also used in advanced glaucoma to reduce the pressure by destroying the aqueous fluid secreting ciliary body.

Surgical treatment When the glaucoma cannot be controlled with medication or if side effects occur, then surgical treatment would be necessary. Filtering surgery is done to drain out the excess fluid. In patients with glaucoma and cataract, a Combined operation can be performed. iv.

Cryotherapy is useful in advanced glaucoma and painful blind eyes.

Proper and timely diagnosis and treatment of Glaucoma can prevent irreversible blindness!