Glaucoma

What is the First Sign of Glaucoma?

Glaucoma is a group of diseases that affect the optic nerve of the eye and can lead to permanent vision loss due to a build-up of pressure in the eye. Glaucoma is a leading cause of vision loss and blindness. It is important to know the early signs of glaucoma so that it may be diagnosed and treated before significant vision loss has occurred. Our Doctors in Tucson recommend yearly eye exams to check for vision changes and diseases such as glaucoma.

Glaucoma affects millions of people in the U.S., but many of those are unaware they have the disease. There is currently no cure for glaucoma, but there are treatment options if it’s detected early enough. Different types of glaucoma present alternate warning signs — and sometimes there are no symptoms, particularly in open-angle glaucoma, the most common form of the disease.

However, if you experience any of the following symptoms, you should seek immediate help:

Loss of peripheral or side vision: This is usually the first sign of glaucoma.

Seeing halos around lights: If you see rainbow-colored circles around lights or are unusually sensitive to light, it could be a sign of glaucoma.

Vision loss: Especially if it happens suddenly.

Redness in the eye: Sometimes accompanied by pain, which may be a sign of injury, infection or acute glaucoma.

Eye that looks hazy: A cloudy-looking cornea is the most common early sign of childhood glaucoma.

Nausea or vomiting: Especially when it accompanies severe eye pain.

Pain in the eye and in the head: This often occurs in angle-closure glaucoma, a type of glaucoma which can develop quickly.

Tunnel vision: You may start to lose vision around the edges of your visual field.

Though most types of glaucoma cannot be prevented, early detection and ongoing monitoring of eye health can limit the vision loss caused by the disease. If you suspect that you may have glaucoma or if you are due for an eye examination, contact Eye Associates of Tucson to schedule an appointment.

Symptoms

The symptoms of glaucoma depend on the type and stage of your condition.

Open-angle glaucoma

• No symptoms in early stages
• Gradually, patchy blind spots in your side vision. Side vision also is known as peripheral vision
• In later stages, difficulty seeing things in your central vision

Acute angle-closure glaucoma

• Severe headache
• Severe eye pain
• Nausea or vomiting
• Blurred vision
• Halos or colored rings around lights
• Eye redness

Normal-tension glaucoma

• No symptoms in early stages
• Gradually, blurred vision
• In later stages, loss of side vision

Glaucoma in children

• A dull or cloudy eye (infants)
• Increased blinking (infants)
• Tears without crying (infants)
• Blurred vision
• Nearsightedness that gets worse
• Headache

Pigmentary glaucoma

• Halos around lights
• Blurred vision with exercise
• Gradual loss of side vision

When to see a doctor

If you experience symptoms that come on suddenly, you may have acute angle-closure glaucoma. Symptoms include severe headache and severe eye pain. You need treatment as soon as possible. Go to an emergency room or call an eye doctor’s (ophthalmologist’s) office immediately.

Diagnosis

Your health care provider will review your medical history and conduct a comprehensive eye examination. Your provider may perform several tests, including:

• Measuring intraocular pressure, also called tonometry
• Testing for optic nerve damage with a dilated eye examination and imaging tests
• Checking for areas of vision loss, also known as a visual field test
• Measuring corneal thickness with an exam called pachymetry
• Inspecting the drainage angle, also known as gonioscopy

Treatment

The damage caused by glaucoma can’t be reversed. But treatment and regular checkups can help slow or prevent vision loss, especially if you catch the disease in its early stages.

Glaucoma is treated by lowering intraocular pressure. Treatment options include prescription eye drops, oral medicines, laser treatment, surgery or a combination of approaches.

Eye drops

Glaucoma treatment often starts with prescription eye drops. Some may decrease eye pressure by improving how fluid drains from your eye. Others decrease the amount of fluid your eye makes. Depending on how low your eye pressure needs to be, you may be prescribed more than one eye drop.

Prescription eye drop medicines include:

• These increase the outflow of the fluid in your eye, helping to reduce eye pressure. Medicines in this category include latanoprost (Xalatan), travoprost (Travatan Z), tafluprost (Zioptan), bimatoprost (Lumigan) and latanoprostene bunod (Vyzulta).

Possible side effects include mild reddening and stinging of the eyes, darkening of the iris, darkening of the pigment of the eyelashes or eyelid skin, and blurred vision. This class of drug is prescribed for once-a-day use.

• Beta blockers.These reduce the production of fluid in your eye, helping to lower eye pressure. Examples include timolol (Betimol, Istalol, Timoptic) and betaxolol (Betoptic S).

Possible side effects include difficulty breathing, slowed heart rate, lower blood pressure, impotence and fatigue. This class of drug can be prescribed for once- or twice-daily use depending on your condition.

• Alpha-adrenergic agonists. These reduce the production of the fluid that flows throughout the inside of your eye. They also increase the outflow of fluid in your eye. Examples include apraclonidine (Iopidine) and brimonidine (Alphagan P, Qoliana).

Possible side effects include irregular heart rate, high blood pressure, fatigue, red, itchy or swollen eyes, and dry mouth. This class of drug is usually prescribed for twice-daily use but sometimes can be prescribed for use three times a day.

• Carbonic anhydrase inhibitors.These medicines reduce the production of fluid in your eye. Examples include dorzolamide and brinzolamide (Azopt). Possible side effects include a metallic taste, frequent urination, and tingling in the fingers and toes. This class of drug is usually prescribed for twice-daily use but sometimes can be prescribed for use three times a day.
• Rho kinase inhibitor.This medicine lowers eye pressure by suppressing the rho kinase enzymes responsible for fluid increase. It is available as netarsudil (Rhopressa) and is prescribed for once-a-day use. Possible side effects include eye redness and eye discomfort.
• Miotic or cholinergic agents.These increase the outflow of fluid from your eye. An example is pilocarpine (Isopto Carpine). Side effects include headache, eye ache, smaller pupils, possible blurred or dim vision, and nearsightedness. This class of medicine is usually prescribed to be used up to four times a day. Because of potential side effects and the need for frequent daily use, these medicines are not prescribed very often anymore.

Because some of the eye drop medicine is absorbed into your bloodstream, you may experience some side effects unrelated to your eyes. To minimize this absorption, close your eyes for 1 to 2 minutes after putting the drops in. You also may press lightly at the corner of your eyes near your nose to close the tear duct for 1 or 2 minutes. Wipe off any unused drops from your eyelid.

You may have been prescribed multiple eye drops or need to use artificial tears. Make sure you wait at least five minutes in between using different drops.

Oral medications

Eye drops alone may not bring your eye pressure down to the desired level. So your eye doctor may also prescribe oral medicine. This medicine is usually a carbonic anhydrase inhibitor. Possible side effects include frequent urination, tingling in the fingers and toes, depression, stomach upset, and kidney stones.

Surgery and other therapies

Other treatment options include laser therapy and surgery. The following techniques may help to drain fluid within the eye and lower eye pressure:

• Laser therapy.Laser trabeculoplasty (truh-BEK-u-low-plas-tee) is an option if you can’t tolerate eye drops. It also may be used if medicine hasn’t slowed the progression of your disease. Your eye doctor also may recommend laser surgery before using eye drops. It’s done in your eye doctor’s office. Your eye doctor uses a small laser to improve the drainage of the tissue located at the angle where the iris and cornea meet. It may take a few weeks before the full effect of this procedure becomes apparent.
• Filtering surgery.This is a surgical procedure called a trabeculectomy (truh-bek-u-LEK-tuh-me). The eye surgeon creates an opening in the white of the eye, which also is known as the sclera. The surgery creates another space for fluid to leave the eye.
• Drainage tubes.In this procedure, the eye surgeon inserts a small tube in your eye to drain excess fluid to lower eye pressure.
• Minimally invasive glaucoma surgery (MIGS).Your eye doctor may suggest a MIGS procedure to lower your eye pressure. These procedures generally require less immediate postoperative care and have less risk than trabeculectomy or using a drainage device. They are often combined with cataract surgery. There are a number of MIGS techniques available, and your eye doctor will discuss which procedure may be right for you.

After your procedure, you’ll need to see your eye doctor for follow-up exams. And you may eventually need to undergo additional procedures if your eye pressure begins to rise or other changes occur in your eye.

Treating acute angle-closure glaucoma

Acute angle-closure glaucoma is a medical emergency. If you’re diagnosed with this condition, you’ll need urgent treatment to reduce the pressure in your eye. This generally will require treatment with medicine and laser or surgical procedures.

You may have a procedure called a laser peripheral iridotomy. The doctor creates a small hole in your iris using a laser. This allows fluid to flow through the iris. This helps to open the drainage angle of the eye and relieves eye pressure.