Glaucoma
Progressive optic neuropathy — often linked to raised eye pressure — and a leading cause of irreversible blindness.
Overview
Glaucoma is a group of conditions causing progressive damage to the optic nerve, usually associated with raised intraocular pressure. It is the leading global cause of irreversible blindness. Most cases are open-angle and silent until late; early detection and pressure-lowering treatment preserve vision.
Symptoms
- • Open-angle: typically silent, gradual peripheral visual-field loss
- • Acute angle closure: severe eye pain, blurred vision, halos around lights, nausea/vomiting, red eye
- • Advanced disease: tunnel vision
- • Congenital: large eyes, tearing, photophobia in infants
Risk factors
- • Age >60
- • Family history of glaucoma
- • African or Caribbean ancestry (open-angle); East Asian ancestry (angle closure)
- • High myopia (open-angle), hypermetropia (angle closure)
- • Long-term steroid use
- • Diabetes, hypertension
Causes
- • Open-angle: trabecular meshwork dysfunction
- • Angle closure: anatomically shallow anterior chamber
- • Secondary: trauma, uveitis, steroids, pseudoexfoliation
🚨 Red flags — seek urgent care
- • Sudden severe eye pain with red eye and visual loss — possible acute angle-closure, emergency
- • Sudden visual-field loss
- • Halos around lights with headache and vomiting
When to seek care
- • Regular eye exams from age 40 (earlier if at risk)
- • Any sudden change in vision — urgent
- • Family member diagnosed with glaucoma
Diagnosis
- • Tonometry — intraocular pressure
- • Visual-field testing (perimetry)
- • Optic-disc examination and OCT imaging of nerve-fibre layer
- • Gonioscopy to assess drainage angle
- • Pachymetry — corneal thickness
Treatment
- • Topical prostaglandin analogues (latanoprost) — first-line for most open-angle glaucoma
- • Beta-blockers (timolol), alpha-agonists, carbonic anhydrase inhibitors
- • Selective laser trabeculoplasty (SLT) — often offered as first-line
- • Surgery: trabeculectomy, minimally invasive glaucoma surgery (MIGS), tube shunts
- • Acute angle closure: pilocarpine, IV acetazolamide, urgent laser peripheral iridotomy
Prevention
- • No primary prevention, but early detection prevents vision loss
- • Adherence to drops is critical
- • Regular screening if at risk
Complications
- • Permanent visual-field loss
- • Blindness
- • Drop side effects (ocular surface disease, systemic effects from beta-blockers)
- • Surgical complications
Prognosis
With early diagnosis and adherence to treatment, most people retain useful vision for life. Vision already lost cannot be restored, making early detection essential.
Education & self-care
Glaucoma is silent until late but treatable. Regular eye tests and adherence to pressure-lowering drops preserve vision.
Frequently asked questions
Can glaucoma be cured?
No — it is a chronic disease. Treatment controls pressure and prevents further damage, but vision already lost is permanent.
How often should I have eye tests?
Adults should have an eye exam at least every 2 years, and annually if over 60 or at higher risk.
Will I go blind?
Glaucoma is the leading cause of irreversible blindness worldwide, but with early diagnosis and adherence to drops or laser most people retain useful vision for life.
How do eye drops actually help?
They lower intraocular pressure, the only modifiable risk factor proven to slow optic nerve damage. Lifelong adherence is essential even when vision feels normal.
Is laser or surgery ever needed?
Selective laser trabeculoplasty (SLT) is now often offered as first-line treatment. Surgery (trabeculectomy, MIGS, drainage devices) is considered if drops and laser do not achieve target pressure.