Glaucoma

Topic Overview

What is glaucoma?

Illustration of the anatomy of the eye Glaucoma is the name for a group of eye diseases that damage the optic nerve. The optic nerve, which carries information from the eye to the brain, is in the back of the eye. When the nerve is damaged, you can lose your vision.

At first, people with glaucoma lose side (peripheral) vision. But if the disease is not treated, vision loss may get worse. This can lead to total blindness over time.

There are three types of glaucoma.

  • Open-angle glaucoma is the most common form in the United States. In this type of glaucoma, the optic nerve is damaged bit by bit. This slowly leads to loss of eyesight. One eye may be affected more than the other. Sometimes much of your eyesight may be lost before you notice it.
  • Closed-angle glaucoma is less common. About 10% of all glaucoma cases in the United States are closed-angle. In this type of glaucoma, the colored part of the eye (iris) and the lens block movement of fluid between the chambers of your eye. This causes pressure to build up and the iris to press on the drainage system of the eye. (See a picture of the iris and lens.) A related type is sudden (acute) closed-angle glaucoma. It is often an emergency. If you get this acute form, you will need medical care right away to prevent permanent damage to your eye.
  • Congenital glaucoma is a rare form of glaucoma that some infants have at birth. Some children and young adults can also get a type of the disease.

Finding and treating glaucoma early is important to prevent blindness. If you are at high risk for the disease, be sure to get checked by an eye specialist (ophthalmologist) even if you have no symptoms.

Your risk for glaucoma rises after age 40 and even more quickly after age 70. Race is also a factor. Blacks are more likely than whites to get the disease. You are also at risk if you have diabetes or if a close family member has had glaucoma.

What causes glaucoma?

Damage to the optic nerve is often caused by increased pressure in the eye (intraocular pressure). This can happen when extra fluid builds up in the eye, such as when the eye makes too much fluid or does not drain well. But some cases of glaucoma aren't caused by increased pressure. In these cases, the cause may not be found.

You can get glaucoma after an eye injury, after eye surgery, or because of an eye tumor. Some medicines (corticosteroids) that are used to treat other diseases may cause glaucoma.

What are the symptoms?

If you have open-angle glaucoma, the only symptom you are likely to notice is loss of vision. You may not notice this until it is serious. That’s because, at first, the eye that is not affected makes up for the loss. Side vision is often lost before central vision.

Symptoms of closed-angle glaucoma can be mild, with symptoms like blurred vision that last only for a short time. Severe signs of closed-angle glaucoma include longer-lasting episodes of blurred vision or pain in or around the eye. You may also see colored halos around lights, have red eyes, or feel sick to your stomach and vomit. In congenital glaucoma, signs can include watery eyes and sensitivity to light. Your baby may rub his or her eyes, squint, or keep the eyes closed much of the time.

How is glaucoma diagnosed?

Your doctor will ask questions about your symptoms and do a physical exam. If your doctor thinks you have glaucoma, you will be sent to an ophthalmologist for more tests. This may take more than one visit.

An ophthalmologist or an optometrist can diagnose and treat glaucoma. An optician cannot diagnose or treat this disease.

See your doctor if you notice blind spots in your vision or if over time you are having more trouble seeing. It's also a good idea to be checked for the disease if you have a family history of open-angle glaucoma, are over age 70, or have diabetes.

How is it treated?

Glaucoma is usually treated with medicine such as eyedrops. Be sure to follow a daily schedule for your eyedrops so that they work the way they should. You will likely need to take medicine for the rest of your life. You may also need laser treatment or surgery.

In adults, treatment can't bring back vision that has been lost, but it can keep your vision from getting worse. Treatment aims to stop more damage to the optic nerve by lowering the pressure in the eyes.

How do you cope with glaucoma?

Learning that you have glaucoma can be hard, since much of your vision may be gone by the time it is detected. With counseling and training, you can find ways to keep your quality of life. You can use vision aids, such as large-print items and special video systems, to help you cope with reduced eyesight. You can also create a support group of people who can help with tough tasks.

Frequently Asked Questions

Learning about glaucoma:

Being diagnosed:

Getting treatment:

Ongoing concerns:

Living with glaucoma:

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  Glaucoma: Living with reduced vision

Cause

Glaucoma is a group of eye diseases that cause blindness by damaging the nerve cells located in the back of the eye (the optic nerve). 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. But damage often occurs without increased IOP.

Get more information on eye anatomy and function.

Open-angle glaucoma

In open-angle glaucoma (OAG), the cause of damage to the optic nerve is not well understood. Normally, the shape of the front part of the eye (anterior chamber) is maintained by a fluid called aqueous humor, which is produced in and removed from the eye to maintain a constant pressure. Sometimes the aqueous humor does not drain out of the eye normally, but the reason this occurs is not known. When this happens, fluid builds up inside the eye, causing increased pressure within the eye (IOP). Most people with open-angle glaucoma have higher-than-normal IOP. The increased pressure inside the eye damages the optic nerve, resulting in progressive loss of vision.

But not all people with open-angle glaucoma have increased pressure inside the eye. Estimates vary, but as many as 40% to 50% of people with OAG may occur without increased IOP, and most people with elevated pressures will never get glaucoma.1, 2 The first signs of this type of glaucoma, referred to as normal or low-tension glaucoma, are changes within the eye (enlarged cup-disc ratio) rather than increased pressure in the eye and side (peripheral) vision loss.

Closed-angle glaucoma

Closed-angle glaucoma (CAG) occurs when an already narrow drainage angle for fluid in the eye becomes blocked. This may occur when:

  • The colored part of the eye (iris) and the lens block the movement of fluid between the chambers of the eye. The blockage of fluid causes pressure to build up in the eye and makes the iris press on the eye's drainage system (trabecular meshwork). (See a picture of the iris and lens.) The increased pressure can cause damage to the optic nerve, leading to vision loss and possible blindness.
  • Defects in the iris cause it to fall forward, blocking the drainage angle. Other factors, such as a tumor, can force the iris forward, closing the drainage angle.

See a picture of closed-angle glaucoma.

Congenital and infantile glaucoma

Glaucoma that is present at birth (congenital glaucoma) or that develops in the first few years of life (infantile glaucoma) is often caused by certain birth defects. A birth defect may develop because of an infection in the mother during pregnancy, such as rubella, or because of an inherited condition such as neurofibromatosis.

Secondary glaucoma

Glaucoma may also develop as a result of another condition; this is called secondary glaucoma.

  • Glaucoma may develop after an eye injury, after eye surgery, from the growth of an eye tumor, or as a complication of a medical condition such as diabetes.
  • Certain medicines (corticosteroids) used to treat eye inflammation or other diseases may cause glaucoma.
  • Glaucoma may develop as a result of the breakdown and flaking off of the colored material (pigment) found in the colored part of the eye (iris). This type of secondary glaucoma is called pigmentary glaucoma. Another flaky material (of unknown origin) that can deposit in the anterior part of the eye can cause a similar type of secondary glaucoma called exfoliation syndrome (pseudoexfoliation).
  • A cataract that causes swelling of the lens can cause glaucoma (phacomorphic glaucoma). As the cataract develops, the eye's lens thickens and closes the drainage angle, leading to an increase in intraocular pressure (IOP). Medicines and possibly surgery may be used to relieve the pressure; removal of the cataract is usually necessary to treat phacomorphic glaucoma.

Symptoms

Symptoms of glaucoma vary according to the type of glaucoma you have.

If you have open-angle glaucoma (OAG), the only symptom you are likely to notice is vision loss. Side (peripheral) vision is usually lost before central vision.

You may not notice side vision loss until it becomes severe because the less affected eye makes up for the loss. The loss of sharpness of vision (visual acuity) may not become apparent until late in the disease. By that time, significant vision loss has occurred.

Closed-angle glaucoma (CAG) may cause no apparent symptoms or only mild symptoms. You may experience short episodes of symptoms (subacute closed-angle glaucoma) that usually occur in the evening and are over by morning, or you may have severe (acute) symptoms that require immediate medical attention. Symptoms of closed-angle glaucoma usually affect only one eye at a time and often include:

  • Sudden, severe blurring of vision.
  • Severe pain. The pain may occur in the eye itself or in certain areas immediately around the eye. See a picture of possible areas of pain associated with CAG.
  • Colored halos around lights.
  • Redness of the eye.
  • Nausea and vomiting.

Symptoms of glaucoma present at birth (congenital glaucoma) and glaucoma that develops in the first few years of life (infantile glaucoma) may include:

  • Watery eyes. The baby may also appear to be sensitive to light.
  • An eye or eyes that look cloudy, indicating that the clear front surface of the eye (cornea) has been damaged.
  • Eyes that look larger than normal because the eyeballs have become enlarged as a result of high pressure. This symptom does not occur in adults.
  • Rubbing the eyes, squinting, or keeping the eyes closed much of the time.

What Happens

Glaucoma usually affects side (peripheral) vision first. If glaucoma is not treated, vision loss will continue, resulting in total blindness over time. If glaucoma is identified early and treated appropriately, good eyesight can usually be maintained.

Open-angle glaucoma , the most common type of glaucoma in the United States, usually affects both eyes at the same time. But one eye may be affected more than the other. In open-angle glaucoma, vision changes so slowly that much of your eyesight may be affected before you notice the condition.

  • Increased pressure and other factors gradually damage the optic nerve.
  • Side (peripheral) vision is affected first. Blind spots from each side of the field of vision gradually meet, increasing the area of blindness. Central vision, used for reading and seeing details, is affected last.
  • If untreated, open-angle glaucoma affects central vision, leading to permanent total blindness.

Closed-angle glaucoma is less common and usually affects only one eye at a time. About half of people who have closed-angle glaucoma develop the condition in the other eye within 5 years.3

Acute closed-angle glaucoma develops suddenly and is an emergency medical situation.

  • The blockage of fluid drainage from the eye causes a sudden rise of pressure in the eye.
  • If not treated promptly, the pressure in the eye leads to rapid, permanent damage to the optic nerve.
  • Severe and permanent vision loss can develop within hours or days after symptoms develop.

You may have short episodes of closed-angle glaucoma. Without treatment, these recurrent episodes can develop into an emergency situation (acute closed-angle glaucoma) or become a long-term problem (chronic closed-angle glaucoma). If chronic closed-angle glaucoma is not treated, you will gradually lose your sight and you may become completely blind.

Glaucoma that is present at birth (congenital glaucoma) or that develops within the first few years of life (infantile glaucoma) is rare. But it can be very serious. If congenital glaucoma is left untreated, permanent blindness can develop rapidly.

Treatment for any type of glaucoma may delay or prevent further vision loss, but it cannot reverse vision loss that has already occurred. In a few rare cases of congenital glaucoma, some reversal of the damage to the optic nerve has been seen.

If you have glaucoma, normal use of your eyes (such as for reading or watching television) will not speed up vision loss or make the condition worse.

How significantly your life will be affected depends on the severity of vision loss and your lifestyle. For information on how to live with low vision, see the Home Treatment section of this topic.

What Increases Your Risk

Factors that increase your risk for glaucoma vary according to the different types of glaucoma.

Risk factors for open-angle glaucoma (OAG) include:

  • High pressure in the eyes. Open-angle glaucoma is often associated with higher-than-normal pressure in the eyes (intraocular pressure, or IOP). But not all people with open-angle glaucoma have increased pressure inside the eye. Estimates vary, but as many as 40% to 50% of people with glaucoma have normal IOP, and most people with elevated pressures will never get glaucoma. 1, 2High pressure in the eyes is the one treatable risk factor for open-angle glaucoma. But raised pressure in the eyes alone is not enough to diagnose glaucoma and does not always require treatment. If you have elevated pressure in your eyes but you do not have glaucoma, you will still need to be followed carefully by your doctor.
  • Age. The risk for glaucoma increases rapidly after age 40. People age 70 and older are about 4 to 7 times more likely to develop glaucoma than people 40 to 50 years old.4
  • Race. In the United States, blacks are 4 times more likely than whites to have glaucoma.4
  • Family history of glaucoma. Relatives of people with open-angle glaucoma that is not caused by another condition (called primary open-angle glaucoma) have about a 9 times greater risk of developing glaucoma.5 Changes within the eye (enlarged cup-disc ratio)—not increased pressure in the eye—may be the first sign of glaucoma in these cases.
  • Prior loss of vision in one eye from glaucoma. Damage in one eye from glaucoma is associated with a higher risk of future damage in the other eye. If glaucoma is not treated, the risk that damage will occur in the other eye within 5 years is about 29%.5
  • Diabetes. People with diabetes tend to have higher pressure in their eyes than those without the disease. People with diabetes are also at risk for a type of secondary glaucoma where new blood vessels grow into and block the drainage angle of the eye (trabecular meshwork).

Risk factors for developing closed-angle glaucoma include:

  • Race. People from East Asia or with East Asian ancestry, as well as Canadian, Alaskan, and Greenland Inuit peoples, are more likely than other people to develop closed-angle glaucoma.3
  • Age. People over age 40 are at increased risk for closed-angle glaucoma.
  • Sex. Older women are more likely than older men to develop closed-angle glaucoma.
  • Birth defects. People who are born with narrow drainage angles in their eyes may develop closed-angle glaucoma if their pupils stay wide open (dilated). How much the pupil is dilated and how long it stays dilated, causing an attack of closed-angle glaucoma, varies from person to person.
  • Farsightedness. People who are farsighted are more likely to develop this condition because their eyes are smaller and the drainage angles of the eyes tend to be narrower, allowing them to become blocked more easily.
  • Family history. People with a family history of closed-angle glaucoma are more likely to develop the condition.
  • Having closed-angle glaucoma in one eye. Having closed-angle glaucoma in one eye increases the risk of developing the condition in the other eye. About half of the people who have had acute closed-angle glaucoma in one eye develop closed-angle glaucoma in the second eye within 5 years.3

Risk factors for developing congenital glaucoma include:

  • Infection in the mother during pregnancy. Babies born to mothers who have certain viral infections such as rubella during pregnancy are at a higher risk for congenital glaucoma.
  • Family history. About 10% of infants with congenital glaucoma inherit the condition.6

When To Call a Doctor

Call 911 or other emergency services immediately if you have these symptoms of sudden (acute) closed-angle glaucoma:

  • Sudden, severe blurring of vision in one eye
  • Severe pain in the affected eye
  • Redness of the affected eye
  • Nausea and vomiting
  • Colored halos surrounding light sources

Call your doctor if you:

  • Notice blind spots in your vision.
  • Notice that over time you are having more difficulty seeing.
  • Have a family history of open-angle glaucoma, are age 40 or older, and have not had an eye exam in more than a year. You may need to be examined by an eye specialist (ophthalmologist or optometrist) for signs of glaucoma.
  • Have glaucoma and develop symptoms of side effects from the glaucoma medications that you are taking. See the Medications section of this topic.

Watchful Waiting

Watchful waiting is not appropriate if you have symptoms of sudden (acute) closed-angle glaucoma. See the When to Call a Doctor section of this topic.

If your doctor detects that you have a slight increase in the pressure in your eyes (intraocular pressure, or IOP) and you have no other risk factors for glaucoma, your doctor may not treat it right away. But you will need to have the pressure in your eyes checked regularly, and you will need regular eye exams to make sure you are not developing glaucoma.

Who To See

The following health professionals can diagnose glaucoma:

Decisions about treatment for glaucoma need to be made with the help of an ophthalmologist.

An optician cannot diagnose or treat glaucoma.

To prepare for your appointment, see the topic Making the Most of Your Appointment.

Exams and Tests

A health professional evaluating possible glaucoma will take a medical history and do a physical examination. If glaucoma is suspected, you will usually be referred to an eye specialist (ophthalmologist) for further testing and treatment.

Early detection and treatment of open-angle glaucoma (OAG) are important for controlling the condition and preventing blindness. Emergency treatment may be needed for sudden (acute) closed-angle glaucoma (CAG).

The ophthalmologist will look for signs of damage caused by glaucoma in the back of the eyes to help determine whether the disease is present and to determine its severity. Your medical history and the results of the following tests help determine the severity of glaucoma:

  • Ophthalmoscopy . Ophthalmoscopy is used to examine the inside structures of the eye. In glaucoma, it is used to examine the area where the optic nerve leaves the eye (optic disc). Damage to the optic nerve related to glaucoma can be diagnosed by ophthalmoscopy. People who have damage to the optic nerve related to glaucoma will also have loss of side vision.
  • Gonioscopy . Gonioscopy uses a special lens to examine the drainage angles of the eyes. This is a very common test in the initial evaluation of suspected glaucoma.
  • Tonometry . Tonometry measures the pressure in the eye (intraocular pressure, or IOP). Normal intraocular pressure is usually between 10 and 21 millimeters of mercury (mm Hg). People with glaucoma sometimes have above-normal IOP.
  • Slit lamp exam . The slit lamp exam is used to get a magnified view of all parts of the eye. Gonioscopy and tonometry can be done as part of a slit lamp exam.
  • Vision tests . Visual acuity testing measures how clearly you are able to see details. Visual field testing (also called perimetry testing) can detect loss of side (peripheral) vision and central vision that may indicate damage to the optic nerve caused by glaucoma. This is the best test for evaluating damage caused by open-angle glaucoma. Perimetry testing is also usually done as part of follow-up exams for glaucoma. Perimetry testing is expensive and time-consuming and thus is not used as a regular screening test or performed as often as other tests for glaucoma.
  • Cornea thickness. Tests such as ultrasound pachymetry measure the thickness of the clear front surface of the eye (cornea). Cornea thickness, along with intraocular pressure, helps determine your risk of developing glaucoma.7

After glaucoma is diagnosed, eye exams (including tonometry and ophthalmoscopy) are done on a regular basis to monitor the disease. Perimetry testing is usually done once a year after open-angle glaucoma is diagnosed.

If you have glaucoma and have already experienced a significant loss of vision, your doctor may also perform a low-vision evaluation to help find ways you can make the most of your remaining vision and maintain your quality of life.

Early Detection

Because people with glaucoma may have normal pressures in their eyes, measuring eye pressure (tonometry) should not be used as the sole screening test for glaucoma. It should be combined with other tests before glaucoma can be diagnosed.

The American Academy of Ophthalmology recommends that all people be screened for glaucoma before the age of 40. 8 But the U.S. Preventive Services Task Force (USPSTF) does not make a recommendation for or against screening all adults for glaucoma.9 Still, it is especially important for people who are at increased risk for glaucoma to be screened every year. People at increased risk include those who:

  • Are over age 65.
  • Are African Americans (for OAG), East Asians, and people with East Asian ancestry (for CAG).
  • Are farsighted (greater risk of developing CAG).
  • Have had an eye injury or eye surgery, such as cataract surgery.
  • Have diabetes.
  • Have high blood pressure (hypertension).
  • Have been taking corticosteroid medications.
  • Have a family history of glaucoma.

Treatment Overview

Treatment for glaucoma focuses on preserving eyesight by slowing the damage to the nerve located in the back of the eye (optic nerve). In adults, treatment cannot restore eyesight that has already been lost as a result of glaucoma. But in certain children, some of the damage caused by congenital glaucoma can be reversed.

Currently, most treatment for glaucoma is directed at lowering the pressure in the eyes (intraocular pressure, or IOP). Optic nerve damage can occur at any level of eye pressure, even within the normal range. Lowering the IOP often can help protect the optic nerve from further damage.

Treatment options include medicines, laser treatments, and surgery. In the United States, treatment usually begins with medicines. When treatment with medicines does not successfully lower pressure in the eyes, laser or surgery treatments need to be considered. But in some instances it may be appropriate to use laser or surgical treatments first, particularly in moderate to severe cases. Studies indicate that treatment with medicine or surgery are both effective, but the risks and benefits may differ depending on the type of glaucoma, age, race, and other factors.10 If you have glaucoma, ask your doctor about all the possible treatment options and which treatments may be better for your particular condition.

Initial treatment

If you are diagnosed with glaucoma, a target eye pressure for each eye is established. The target is based on the amount of damage to the optic nerve and the pressure in the eyes (intraocular pressure, or IOP) at which the damage occurred. The target eye pressure level is approximately 20% to 30% less than the prior eye pressure. During treatment, the target eye pressure is adjusted as needed to prevent damage to the optic nerve.

If you have high IOP but no other signs of glaucoma, you will need to be checked regularly by an eye specialist (ophthalmologist). If the pressure is high enough, you may be treated with medicines to lower the pressure and prevent vision loss. But the decision to start treatment in the absence of optic nerve damage is a serious one, as it exposes you to the risks and expenses of long-term treatment.

Treatment for open-angle glaucoma may involve medicines (eyedrops) that lower the pressure inside the eye, laser treatment, or other surgery. In the United States, eyedrops that lower the IOP are usually tried first. Decreasing eye pressure in open-angle glaucoma slows the progression of the disease and helps prevent further vision loss. But other treatments (laser or surgery) may sometimes be considered as an initial form of treatment if you have moderate or severe open-angle glaucoma.

Closed-angle glaucoma can be an emergency situation (acute closed-angle glaucoma) because blockage of fluid in the eye causes a sudden increase in pressure, resulting in rapid damage to the optic nerve. Acute closed-angle glaucoma usually causes significant pain in the eye. Acute closed-angle glaucoma needs immediate care, including medications to lower IOP, monitoring of the drainage angle, and often surgery. If it is not treated immediately, blindness can develop rapidly.

Congenital glaucoma almost always requires surgery to correct the defect. Medicine may sometimes be used, but it usually does not work over time.

If you have already experienced a significant vision loss from glaucoma, your doctor will also conduct a low-vision evaluation. The evaluation will help you and your doctor find ways to make the best use of your remaining vision. It also can include suggestions for counseling and training on dealing with reduced vision.

Because glaucoma can lead to a significant loss of vision before it is detected, learning that you have glaucoma can be difficult. You may feel saddened and become depressed. Your doctor can refer you to counselors who specialize in helping people adjust to living with low vision.

Ongoing treatment

Once you start treatment for glaucoma, you will need regular eye exams by an ophthalmologist. During these exams, the pressure inside the eyes (intraocular pressure, or IOP) is usually measured. You may need to see the doctor every day until the target eye pressure is reached. After the target pressure is reached, you may need to see the doctor every 3 to 6 months. The ophthalmologist will examine your eyes for changes in the optic nerve that indicate the disease is getting worse despite treatment and will adjust the target eye pressure if needed.

If the pressure in the eye continues to be high or if damage to the optic nerve gets worse despite treatment with eyedrops, laser treatment may be done.

If you have narrow drainage angles, you are more likely to develop closed-angle glaucoma. If you are diagnosed with closed-angle glaucoma, you will need regular evaluations to check your drainage angles and eye pressure. You may need laser treatment to prevent sudden closure of the angle.

Medicines, usually eyedrops, are used to lower IOP by either decreasing the amount of fluid produced by the eye or increasing the amount of fluid that drains out of the eye. It is important to understand that treatment for glaucoma will most likely continue for the rest of your life.

Home treatment can help you live with the effects of glaucoma. You can use vision aids and adaptive technologies, such as video enlargement systems and large-print items, to help you function better with reduced vision; develop a support network of people who can help you with difficult tasks; and receive counseling and training to help you cope with reduced vision and maintain your quality of life.

Treatment if the condition gets worse

Surgery for glaucoma usually is needed only if you continue to lose vision and the pressure in your eyes (intraocular pressure, or IOP) cannot be lowered with medicines or laser treatment. In some countries, such as Great Britain, surgery is done early in the disease process.

Surgery may be done to make another opening for fluid to leave the eye. Sometimes, surgery to destroy part of the eye that produces the fluid (ciliary body) may also be used to decrease fluid production. This type of surgery is usually done only for advanced cases of glaucoma in which other forms of treatment have not been effective.

What To Think About

Glaucoma cannot be cured, but the pressure inside the eye (intraocular pressure, or IOP) can be controlled with medicines, surgery, or both. In adults, treatment for glaucoma cannot restore eyesight that has been lost because of the condition, but it can prevent further damage to the optic nerve and save remaining eyesight. In certain children with congenital glaucoma, some of the optic nerve damage caused by the disease can be reversed with treatment.

Medicines (most often eyedrops) are usually needed to treat glaucoma. In most cases, they have to be used every day for the rest of your life. Putting eyedrops in the eye at specific times of the day may be inconvenient. For some people, eyedrops can also cause discomfort. You will need to follow the prescribed daily schedule for your eyedrops in order for them to work properly.

Unlike some chronic diseases in which failure to take medicines causes noticeable symptoms, not using your glaucoma medicines as prescribed will not usually cause any obvious symptoms. But it may cause slow, often unnoticed loss of eyesight that is permanent and that could eventually lead to blindness.

Because glaucoma can't be cured and treatment does not always prevent further loss of vision, people may try alternative unproven treatment methods, such as acupuncture or marijuana. But most of these alternative treatments either have not been studied or have not been proven to work. Such treatments may be expensive, and some can be hazardous to your health.

Prevention

Most of the risk factors (such as age, race, and family history) for glaucoma are beyond your control. If you are older than age 20, you need to have an eye examination that includes tests for glaucoma every 3 to 5 years. These tests may be done by an optometrist or an ophthalmologist. If there is a history of glaucoma in your family or if you have other risk factors for glaucoma, talk with your health professional about having more frequent exams. If you are at increased risk, you need to have regular eye exams by an ophthalmologist.

Home Treatment

The success of treatment for glaucoma depends on your learning about the disease, using your medicines as prescribed, and getting routine checkups to monitor the condition and prevent complications. By doing so, you can decrease your chance of losing your eyesight.

  • Use your glaucoma medicines as prescribed by your doctor. Use color-coded bottle caps on your medicines to help you remember when to take them. If you need reminders for using your medicines, use alarm clocks or watches, notes on mirrors or tables, and other cues. If you have problems using your medicine according to the prescribed schedule, talk with your health professional. Some tips to decrease the side effects of glaucoma medicines, such as the proper way to insert eyedrops, may help you use your medicines as prescribed. If you notice side effects from your glaucoma medicine, notify your health professional. Your medicine may need to be changed.
  • Check with a health professional before taking any nonprescription medicines. If you have narrow drainage angles and are at risk for closed-angle glaucoma, your doctor may warn you about medicines that widen (dilate) the pupil. When the pupil dilates, the drainage angles can become blocked, causing closed-angle glaucoma. There are some medicines that you need to avoid, such as certain antihistamines and motion sickness medications. Also, tell your eye specialist what other prescription medicines you are taking. Make sure all your health professionals know that you have glaucoma.
  • Carry a wallet card or other identification that states that you have glaucoma. The card needs to list all medicines you are taking, including glaucoma medicines.

Living with reduced vision

Reduced vision from glaucoma can affect a person's life in many ways. How significantly you will be affected depends on the severity of your vision loss, what kinds of activities you do, and your lifestyle. Work with your doctor to find ways to make the best use of your remaining vision. You can use vision aids such as video enlargement systems and large-print items, develop a support network, and receive counseling and training to help you cope with reduced vision and maintain your quality of life.

Because glaucoma often leads to a significant loss of vision, learning that you have glaucoma can be difficult. You may feel anger or fear, or you may feel saddened and become depressed. These feelings are perfectly normal. If you need help in dealing with them, talk to your doctor and to your family and friends. Your doctor can also refer you to counselors who specialize in helping people adjust to living with low vision. Because glaucoma is a lifelong disease, it may be helpful for you to join a support group for people who have the disease.

Click here to view an Actionset. Glaucoma: Living with reduced vision

For additional information on support groups, products, and services related to glaucoma and living with low vision, see the Other Places to Get Help section of this topic.

Medications

Medications to lower the pressure inside the eye (intraocular pressure, or IOP) are used to treat all types of glaucoma. They work either by reducing the amount of fluid (aqueous humor) that is produced by the eye or by increasing the amount of fluid that drains out of the eye. These medicines may be given as eyedrops; as pills; in liquid form by mouth; or, in emergency situations, through a vein. In most cases, eyedrops are used first.

In a sudden (acute) attack of closed-angle glaucoma, medicines may be used to lower the pressure in the eye. Medicines that close (constrict) the pupil may be used to open the drainage angle. If medicines lower the eye pressure after an episode of acute closed-angle glaucoma, laser treatment is usually done soon afterwards to prevent such an episode from occurring again. If the medicines do not lower the pressure in the eye, laser treatment will need to be done immediately.

In congenital glaucoma, medicines may be used to reduce the pressure in the eyes and decrease the cloudiness of the clear front surface (cornea) of the eye. Medicines usually do not work over a long period of time and are usually used only until surgery can be done.

In the media, much has been said about the possibility of using marijuana to treat glaucoma. Inhaled marijuana smoke has been shown to result in an average 25% reduction in intraocular pressure (IOP), but the effect lasts only for about 3 to 4 hours. Also, not all people who use marijuana have this reduction in IOP; it only occurs in about 60% to 65% of users. The smoke also has toxic effects on other parts of the body, particularly the lungs, and substances in the smoke cause changes in mental state. The amount of marijuana a person needs to smoke to keep eye pressure down would cause significant side effects. Because of these toxic and psychoactive effects, along with the short duration of the beneficial effect of lowering pressure in the eye, marijuana is considered a poor treatment option and is not recommended for glaucoma.11

Medication Choices

Medicines used to treat glaucoma lower the pressure in the eyes (intraocular pressure, or IOP) by either decreasing the amount of fluid produced by the eyes or increasing the amount of fluid that drains out of the eyes.

Medicines that decrease the amount of fluid produced by the eye include:

Medicines that increase the amount of fluid that drains out of the eye include:

Some medicines have two different medicines mixed into one bottle. Examples include Cosopt, which contains both a carbonic anhydrase inhibitor and a beta-blocker, and Combigan, which contains both an adrenergic agonist and a beta-blocker.

What To Think About

When medicines are used to treat glaucoma, the goal is to prevent further damage to the optic nerve by lowering the pressure in the eyes. The level of pressure in the eye needed to damage the optic nerve varies from one person to another. For this reason, a single target eye pressure cannot be used for everyone. Your target pressure may need to be adjusted if the optic nerve shows further damage despite treatment.

When glaucoma has already caused vision loss, further vision loss may develop even after the pressure in the eye is lowered to the normal range with medicine.

In most cases, medicines used to treat glaucoma must be continued daily for the rest of your life. Putting eyedrops in the eye at specific times of the day may be inconvenient. Eyedrops may also cause discomfort. You need to follow the prescribed daily schedule for your eyedrops in order for them to work properly.

  • Discuss the goals of treatment, how long the medicine will be tried, and the possible side effects with your health professional. Eye medicines can cause symptoms throughout the body. Report side effects to your eye doctor.
  • Knowing how to correctly insert your eyedrops can make the medicine work better and may help you avoid side effects. A medicine card stating which medicines need to be taken at different times of the day can be helpful in reminding you to take medicines. Use multicolored bottle caps to help you tell different medicines apart.
  • You will need follow-up visits with your health professional shortly after starting a new medication to determine whether it is working as well as it should be and to discuss any side effects or medication schedule problems.

Medicines for glaucoma can be expensive. Some cost-saving tips such as using a measured-dose dispenser may help.

Let all your health professionals know that you are taking glaucoma medicines. Other medicines that you are taking may need to be adjusted or stopped to prevent side effects.

While there are fewer complications from the new surgical procedures for glaucoma, medication treatment still usually has fewer side effects than surgery. Many people who use glaucoma medicines may never need surgery for glaucoma.

Surgery

Surgery is not always necessary to treat glaucoma. Medicines can often control the pressure in the eyes, preventing further vision loss and blindness. Medicine will usually be tried first before surgery is considered.

Doctors can use either a surgical cutting tool or a very focused beam of light, called a laser, to perform surgery for glaucoma. Laser surgery is usually tried first when glaucoma medicines do not lower the pressure in the eyes (intraocular pressure, or IOP). If laser surgery does not help, your doctor may try conventional surgery.

Surgery may be needed for:

  • Sudden (acute) closed-angle glaucoma. Laser treatment can create an opening in the colored part of the eye (iris) that will let fluid drain from the eye. People who have had closed-angle glaucoma in one eye usually need to have laser treatment on the other eye to prevent the same condition from developing. Also, people who have narrow drainage angles may need laser treatment to prevent acute closed-angle glaucoma. If laser treatment is not successful, then conventional surgery, such as surgical iridectomy or trabeculectomy, would be needed.
  • Open-angle glaucoma , if the pressure in the eyes stays high or if damage to the optic nerve continues despite medication. Laser treatment may be needed early on to treat open-angle glaucoma, especially in people who have very high intraocular pressure and severe glaucoma. You may have laser surgery before you try medicine. In some cases, early surgery in open-angle glaucoma may be more effective than eyedrops at reducing the pressure in the eyes and preventing blindness.
  • Infants with congenital glaucoma. They may need surgery as soon as possible to prevent blindness.

The primary goal of surgery for glaucoma is to preserve eyesight by:

  • Maintaining the health of the optic nerve.
  • Reducing the pressure in the eyes by opening blocked drainage angles or creating a new opening that fluid (aqueous humor) can flow through to leave the eye.

In some cases surgery may be done to relieve pain caused by glaucoma.

Surgery Choices

There are three basic types of surgery for glaucoma in adults.

Surgery to increase drainage of fluid from the eye

This type of surgery involves making a trapdoor that allows fluid to drain from the eye. The surgeon can use either a laser or a surgical cutting tool to do this. In severe glaucoma, surgery also may involve putting in a filtering device (seton), usually made of plastic, that drains fluid away from the front part of the eye to a place where it can drain out of the eye. These procedures are used to treat open-angle glaucoma and long-term (chronic) closed-angle glaucoma.

  • Trabeculectomy removes a piece of tissue to allow fluid to drain from the eye.
  • Tube-shunt surgery (seton glaucoma surgery) places a tube in the eye to allow fluid to drain.
  • Laser trabeculoplasty burns tissue to create an opening that allows fluid to drain from the eye.
  • Laser sclerostomy removes a piece of the white part of the eye to allow fluid to drain.

Surgery to prevent closure of the drainage angle

Both laser and conventional surgeries can be used to prevent closure of the drainage angle. These procedures involve making a new opening in the colored part of the eye (iris) that allows fluid to flow through the eye. They are used to treat sudden (acute) closed-angle glaucoma and will prevent closed-angle glaucoma in people who have narrow drainage angles. Laser iridotomy can usually be done instead of surgical iridectomy. But some people with complicated or severe glaucoma may need to have surgical iridotomy.

Surgery to decrease the amount of fluid produced in the eye

When other surgery fails to improve the flow of fluid from the eye, procedures to destroy the part of the eye that produces fluid (ciliary body) can be done. These procedures are also used when scar tissue has formed after a previous surgery.

Destroying the ciliary body decreases the amount of fluid produced in the eye, reducing the pressure in the eye. Procedures that decrease fluid in the eye are only used for people with severe glaucoma that has not gotten better after they have tried medications or other forms of surgery.

Surgery for congenital glaucoma

For congenital glaucoma, there are two slightly different procedures that both attempt to open the drainage angle directly. They are equally successful in children, but they are not used for adults. If these procedures fail in a child, then trabeculectomy or tube-shunt (seton glaucoma) surgery may be tried.

What To Think About

Clouding of the lens (cataract) can develop after surgery for glaucoma and is one reason that surgery is not usually used first to treat open-angle glaucoma.

Cataracts may occur in people who also have glaucoma; this commonly occurs in older people. Surgery to remove the cataract may be done at the same time as surgery for glaucoma. If surgery for glaucoma and a cataract are done at the same time, you may notice improved eyesight after surgery.

The decision whether or not to have surgery is often more difficult in glaucoma than in many other conditions because:

  • In many instances, the person is not in pain and often does not notice any vision loss.
  • Surgery often causes a person's eyesight to get worse immediately after surgery. Vision may be affected for weeks or months after surgery. For some people, their eyesight is never as good as it was before the surgery. Surgery is not a complete cure for glaucoma. But surgery can decrease the chance of losing even more eyesight later on.
  • Not everyone who has laser surgery will have lower intraocular pressure after the surgery. For some people, the lower pressure will last only a few years. Others may have an increase in their eye pressure. Certain types of open-angle glaucoma respond better to laser surgery than others.
  • The effects of some laser treatments are not long-lasting. Repeat laser treatments, medicines, or other surgeries may be needed later on.

As with any other surgery, you and your doctor should make the decision to operate based on the risks and benefits of having the surgery. One factor to consider is which eye should be operated on first. There are other questions about glaucoma surgery that you should discuss with your health professional before making a decision.

Procedures to destroy the structures in the eye that produce fluid (cyclodestructive procedures) are usually used when other treatments, including other surgeries for glaucoma, have failed.5 Several treatments over time can destroy too much of the ciliary body, causing too little fluid to be produced. This can cause the eyeball to soften and lead to clouding of the lens (cataract).

Other Treatment

Glaucoma causes blindness by damaging the nerve cells located in the back of the eye and often occurs without increased pressure in the eye. Many doctors believe glaucoma is a neurodegenerative disease, rather than just a disease of high intraocular pressure. There is interest in treatments that help protect the nerve cells in the eye from damage caused by glaucoma (neuroprotective therapy). Although a number of neuroprotective therapies are being investigated, none has yet been proven to be both safe and effective in the treatment of glaucoma.

Because glaucoma can't be cured and treatment does not always prevent further loss of vision, people may try alternative unproven treatment methods, such as acupuncture or marijuana. Some alternative or complementary treatments have been tried for glaucoma, but most either have not been studied or have not been proven to work. Some unproven treatment methods for glaucoma can be expensive and time-consuming. A few, such as vitamin and nutrient supplements, may be hazardous to your health.

Other Places To Get Help

Organizations

American Academy of Ophthalmology (AAO)
P.O. Box 7424
San Francisco, CA  94120-7424
Phone: (415) 561-8500
Fax: (415) 561-8533
Web Address: www.aao.org
 

The American Academy of Ophthalmology (AAO) is an association of medical eye doctors. It provides general information and brochures on eye conditions and diseases and low-vision resources and services. The AAO is not able to answer questions about specific medical problems or conditions.


American Foundation for the Blind
11 Penn Plaza
Suite 300
New York, NY  10001
Phone: 1-800-AFB-LINE (1-800-232-5463)
(212) 502-7600
Fax: (212) 502-7777
E-mail: afbinfo@afb.net
Web Address: www.afb.org
 

The American Foundation for the Blind is dedicated to addressing the critical issues of literacy, independent living, employment, and access through technology for the 10 million Americans who are blind or visually impaired.


American Optometric Association (AOA)
243 North Lindbergh Boulevard
St. Louis, MO  63141-7881
Phone: 1-800-365-2219
Web Address: www.aoanet.org
 

The American Optometric Association (AOA), which is a national organization of optometrists, can provide information on eye health and eye problems.


Lighthouse International
111 East 59th Street
New York, NY  10022-1202
Phone: (212) 821-9200
1-800-829-0500
Fax: (212) 821-9707
TDD: (212) 821-9713 (TTY)
Web Address: www.lighthouse.org
 

Lighthouse International is a not-for-profit organization dedicated to helping people of all ages to overcome vision impairment through vision rehabilitation services, education, research, and advocacy.


National Eye Institute, National Institutes of Health
Information Office
31 Center Drive MSC 2510
Bethesda, MD  20892-2510
Phone: (301) 496-5248
E-mail: 2020@nei.nih.gov
Web Address: www.nei.nih.gov
 

As part of the U.S. National Institutes of Health, the National Eye Institute provides information on eye diseases and vision research. Publications are available to the public at no charge. The Web site includes links to various information resources.


Prevent Blindness America
211 West Wacker Drive
Suite 1700
Chicago, IL  60606
Phone: 1-800-331-2020
Web Address: www.preventblindness.org
 

Prevent Blindness America assists the visually impaired and provides consumer information on vision problems and vision aids. Its Web site has information about eye health and safety for children and adults. Many states have local affiliates.


References

Citations

  1. Shah R, Wormald R (2006). Glaucoma, search date January 2006. Online version of BMJ Clinical Evidence. Also available online: http://www.clinicalevidence.com.
  2. Trobe JD (2006). Principal ophthalmic conditions. Physician's Guide to Eye Care, 3rd ed., chap. 6, pp. 107–111. San Francisco: American Academy of Ophthalmology.
  3. American Academy of Ophthalmology (2005). Primary Angle Closure (Preferred Practice Pattern). San Francisco: American Academy of Ophthalmology. Also available online: http://www.aap.org/ppp.
  4. Coleman AL (1999). Glaucoma. Lancet, 354(9192): 1803–1810.
  5. American Academy of Ophthalmology (2005). Primary Open-Angle Glaucoma, Limited Revision (Preferred Practice Pattern). San Francisco: American Academy of Ophthalmology. Also available online: http://www.aap.org/ppp.
  6. Kipp MA (2003). Childhood glaucoma. Pediatric Clinics of North America, 50(1): 89–104.
  7. Gordon MO, et al. (2002). The ocular hypertension treatment study: Baseline factors that predict the onset of primary open-angle glaucoma. Archives of Ophthalmology, 120(6): 714–720.
  8. American Academy of Ophthalmology (2005). Primary Open-Angle Glaucoma Suspect, Limited Revision (Preferred Practice Pattern). San Francisco: American Academy of Ophthalmology. Also available online: http://www.aap.org/ppp.
  9. U.S. Preventive Services Task Force (2005). Screening for glaucoma: Recommendation statement. Annals of Family Medicine, 3(2): 171–172. Available online: http://www.ahrq.gov/clinic/uspstf05/glaucoma/glaucrs.htm.
  10. Lichter PR, et al. (2001). Interim clinical outcomes in the Collaborative Initial Glaucoma Treatment Study comparing initial treatment randomized to medications or surgery. Ophthalmology, 108(11): 1943–1953.
  11. Rhee DJ, et al. (2001). Complementary and alternative medicine for glaucoma. Survey of Ophthalmology, 46(1): 43–55.

Other Works Consulted

  • American Academy of Ophthalmology (2007). Vision Rehabilitation for Adults (Preferred Practice Pattern). San Francisco: American Academy of Ophthalmology. Also available online: http://one.aao.org/CE/PracticeGuidelines/PPP.aspx.
  • Trobe JD (2006). The red eye. Physician's Guide to Eye Care, 3rd ed., chap. 4, pp. 47–51. San Francisco: American Academy of Ophthalmology.

Credits

Author Jeannette Curtis
Editor Susan Van Houten, RN, BSN, MBA
Associate Editor Tracy Landauer
Associate Editor Pat Truman, MATC
Primary Medical Reviewer Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer Carol L. Karp, MD - Ophthalmology
Last Updated May 23, 2008

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