Glaucoma

Eyes are one of the most sensitive and fragile body parts, and they’re prone to numerous diseases and disorders, which sometimes could be dangerous. Glaucoma is one of the common eye illnesses that could lead to some extremely serious complications in some cases, such as blindness.

Eyes composition

The eye is composed of several parts and layers:

• Cornea: It’s an external layer that protects the interior part of the eye. It also has a role in the vision process.
• Sclera: The white part of the eye.
• Conjunctiva: A clear layer that covers the outside of the eye.
• Aqueous humor: It’s the liquid that fills up what’s called the anterior space of the eye. Moreover, the pressure of this liquid has a role in the shape of the eye.
• Iris: It contains the pigment that colors the eye in addition to the muscles that control the pupil.
• Pupil: The black circle in the middle of the eye and it plays a role in the vision process.
• Lens: It has a main role in the vision process.
• Vitreous humor: It’s a clear gel-like liquid that fills up the space between the lens and the retina, and it has a role in the shape of the eye.
• Retina: It’s composed of light-sensitive cells and is locates in the back of the eye. Moreover, it has a role in the vision process.
• Optic nerve: It’s the path between the retina and the brain for transferring the information of the vision in order for us to be able to see.
• External muscles: They control the movement of the eye in addition to its shape.

Glaucoma

• It occurs as a result of damage or a defect in the optic nerve that is associated with problems with vision, and glaucoma is often combined with intraocular pressure, but it’s not a necessity.
• The intraocular pressure is determined through the balance between the production and excretion of the aqueous humor, so when there is a flaw in this balance, this would lead to an increase in the intraocular pressure.

Glaucoma types

It’s generally classified into two types: primary and secondary glaucoma, and each one of them has several types as well.

Primary open-angle glaucoma

It’s the most common type, and it constitutes more than 95% of glaucoma cases (1 of 200 people). It also affects males and females equally. In most cases, the cause of the condition is unknown.

Symptoms:

In the majority of cases, primary open-angle glaucoma starts without any symptoms; therefore, the patient doesn’t feel anything at the beginning of the illness. With time, the patient starts to lose the vision gradually, and this loss is irreversible (the patient starts to lose peripheral vision, then central vision).

Risk factors:

There are some factors that make the risk of this condition higher:

• The increase in intraocular pressure.
• Aging (1-2% older than 40, and 10% older than 80).
• African ethnicity.
• Genetic factors.
• Myopia (nearsightedness).
• Some diseases, such as hypertension, diabetes, and hyperthyroidism.
• Long use of corticosteroids.
• Previous eye trauma.
• Anemia and hemodynamic problems.

Treatment:

We have three ways to treat this condition:

• Medical treatment: It differs according to the patient’s condition, and it includes eye drops that reduce the intraocular pressure, like prostaglandin analogues and beta-blockers (you must pay attention when using them in asthma and cardiovascular disease patients), in addition to oral medications when needed.
• Treatment with laser.
• Surgical treatment: In severe cases.

Normal tension glaucoma

• It’s the same as primary open-angle glaucoma, in which the intraocular pressure is normal.
• It occurs mostly in females above 60 years old, but it could occur at younger ages as well.
• The damage to the optic nerve happens as a result of vascular insufficiency.
• It could cause migraines, peripheral vasospasm, systemic nocturnal hypotension, and sleep apnea.
• The treatment is the management of reversible causes.

Secondary open-angle glaucoma

It occurs due to increased intraocular pressure that is a result of other ocular or systemic disorders, such as steroid-induced glaucoma, traumatic glaucoma, pigment dispersion syndrome (the detachment of the pigment from the back part of the iris), and pseudoexfoliation (the buildup of very small dandruff-like flakes in the body).

Primary closed-angle glaucoma

It occurs in 5% of cases, and most of them are emergency ones, and it happens as a result of specific medications.

Symptoms:

The condition usually starts in one eye. However, the other eye is at risk as well.

• Red and painful eye.
• Blurred vision.
• Seeing haloes around the lights.
• Nausea, vomiting, and abdominal pain.
• Fixed, mid-dilated pupil.
• Increased intraocular pressure.

Risk factors:

There are some factors that increase the risk of this condition:

• Hyperopia (farsightedness).
• Females, particularly those over 70 years old.
• Family history.
• Asian ethnicity.
• Cataracts.
• Pupil dilation, and this could occur as a result of specific medications, stress, and darkness.

Treatment:

Urgent management is a necessity; otherwise, the patient is at risk of irreversible vision loss.

The management includes medical treatment and laser therapy (which is mandatory).

Secondary closed-angle glaucoma

It occurs due to two causes:

• An inflamed iris that is adhered to the lens.
• Neovascular glaucoma: The development of abnormal blood vessels and retinal ischemia.

Congenital glaucoma

• It might develop at birth or during the first year.
• The symptoms include: excessive tearing, photophobia, blepharospasm, the enlargement of the eyelids, increased cornea diameter that leads to myopia (nearsightedness), blurred vision, and splitting of the eye membrane.

Glaucoma diagnosis

It can be diagnosed with several tests that include total eye examination, such as intraocular pressure measurement, gonioscopy, examining the interior parts of the eye, visual field examination, and the examination of optic nerve and cornea thickness.

Glaucoma prevention

• The most important factor of treating glaucoma is early diagnosis; therefore, it’s recommended to do regular eye examination, especially with aging.
• Following a healthy lifestyle.
• Protecting the eyes from traumas while doing any activity.