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37 years
Kindly tell me about glaucoma, eye disease. I have recently dev..and using eye drops, what are the precautions and complications? I'm diabetic and insulin dependent as well
Oct 19, 2014

Dr. Zakia Dimassi Pediatrics
The term Glaucoma comprises a group of diseases that damage the eye’s optic nerve and can result in vision loss and blindness. Early detection and treatment are vital to protect the eyes against serious vision loss.
In the front of the eye is a space called the anterior chamber. A clear fluid flows continuously in and out of the chamber and nourishes nearby tissues. The fluid leaves the chamber at the open angle where the cornea and iris meet. When the fluid reaches the angle, it flows through a spongy meshwork, like a drain, and leaves the eye.
In open-angle glaucoma, even though the drainage angle is "open", the fluid passes too slowly through the meshwork drain. As a result, the fluid builds up, and the pressure inside the eye rises to a level that may damage the optic nerve.
Another risk factor for optic nerve damage is associated with elevated blood pressure. It is therefore important to make sure that your blood pressure is well controlled and maintained at the normal levels.
In our population, individuals at risk for open-angle glaucoma at a young age are those with a family history of glaucoma. Other risk factors include
high eye pressure, thinness of the cornea, and abnormal optic nerve anatomy.
Early on in the course of the disease, open-angle glaucoma has no symptoms. It causes no pain. Vision stays normal. Glaucoma can develop in one or both eyes.
Without treatment, people with glaucoma will slowly lose their peripheral (side) vision. They seem to be looking through a tunnel. Over time, straight-ahead (central) vision may decrease until no vision remains.
While there is no cure for glaucoma and once vision is lost from the disease it cannot be restored, early initiation of treatment for early-stage, open-angle glaucoma can delay progression of the disease. That’s why early diagnosis is very important.
Glaucoma treatments include medicines, laser trabeculoplasty, conventional surgery, or a combination of any of these. While these treatments may save remaining vision, they do not improve sight already lost from glaucoma.

Medicines: eyedrops or pills, are the most common early treatment for glaucoma. Taken regularly, these eyedrops lower eye pressure. Some medicines cause the eye to make less fluid. Others lower pressure by helping fluid drain from the eye.

Laser trabeculoplasty: this procedure helps fluid drain out of the eye. Your doctor may suggest this step at any time. In many cases, the patient may require to keep taking glaucoma medicines after this procedure.
Studies show that laser surgery can be very good at reducing the pressure in some patients. However, its effects can wear off over time.

Conventional surgery: the principle of it is to make a new opening for the fluid to leave the eye. It is usually resorted after medicines and laser surgery have failed to control pressure. Conventional surgery is reported to be about 60- 80% effective at lowering eye pressure. If the new drainage opening narrows, a second operation may be needed. It works best in people who have not had previous eye surgery, such as a cataract operation.

Some other forms of glaucoma:
Low-tension or normal-tension glaucoma: optic nerve damage and narrowed side vision occur in people with normal eye pressure. Lowering eye pressure at least 30% with medicines slows down the progress of the disease in some people. Glaucoma may worsen in others despite low pressure. If no risk factors are identified, the treatment options for low-tension glaucoma are the same as for open-angle glaucoma.

Angle-closure glaucoma: the fluid in the anterior chamber of the eye cannot drain through the angle and leave the eye. The angle gets blocked by part of the iris. People with this type of glaucoma may have a sudden increase in eye pressure. Symptoms include severe pain and nausea, as well as redness of the eye and blurred vision. This is a medical emergency. If left untreated, vision may be lost in the affected eye.

Secondary glaucomas can develop as complications of other existing medical conditions. For example, a severe form of glaucoma is called neovascular glaucoma, and can be a result from poorly controlled diabetes or high blood pressure. Other types of glaucoma sometimes occur with cataract, certain eye tumors, or when the eye is inflamed or irritated by a condition called uveitis. Sometimes glaucoma develops after other eye surgeries or serious eye injuries. Steroid drugs used to treat eye inflammations and other diseases can trigger glaucoma in some people. There are two eye conditions known to cause secondary forms of glaucoma.

Pigmentary glaucoma occurs when pigment from the iris sheds off and blocks the meshwork, slowing fluid drainage.

Pseudoexfoliation glaucoma occurs when extra material is produced and shed off internal eye structures and blocks the meshwork, again slowing fluid drainage.

Depending on the cause of these secondary glaucomas, treatment includes medicines, laser surgery, or conventional or other glaucoma surgery.
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Dr. Pierre Mardelli Ophthalmology
Glaucoma is a disease in which the pressure inside the eye (not related to blood pressure), causes permanent, irreversible damage to the optic nerve. If adequate control of this pressure is not maintained, glaucoma gradually leads to complete blindness, and is the second leading cause of blindness in this country.
While there is no cure for glaucoma, severe visual loss is usually avoidable.
Keep using your eye drops and keep seeing your ophthalmologist at least every 3 to 4 months for a pressure check (IOP).
The treatment of glaucoma represents an important, lifelong partnership between the doctor and the patient.

Regards,
Pierre G. Mardelli
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