It is a spectrum of disease which is irreversible and the only method of treatment is preventation.
There are various types of glaucoma : acute, chronic,secondary and congenital.
The most common variant is the chronic type which has got a slow progression and the incipient does not feel the high pressure in his eyes.The high intra-ocular pressure causes damage to the optic nerve leading to loss of visual fields and blindness.
The acute variant is characterised by episodes of severe pain. The resultant increased pressure is due to a mechanism of pupillary block,wherein the ocular fluid does not circulate properly.
The damage is directly proportional to the pressure and the time of exposure.Over and above pain it also causes blurred vision,coloured haloes around light. It is more common in old women having cataract.This condition needs urgent diagnosis and treatment, if treated in time the prognosis is favourable.
In the secondary variant, the patient presents with some other pathology which triggers glaucoma. The characteristics depends on the original pathology.
The congenital variant is least common and should be diagnosed in the first few days of life. The newborn has difficulty in opening the eyes, especially in presence of light.The cornea looks lustreless, chalky white and bigger in diameter. It needs urgent treatment since the potential vision depends on the control of glaucoma.
The prognosis of glaucoma depends on early diagnosis and treatment.
The only way to avoid the consequences of glaucoma is to do periodical check-up with your ophthalmologist, he is in the best condition to examine the pressure in your eyes (fig 1) and the optic nerve(fig 2). If you are a glaucoma suspect your ophthalmologist will take your visual fields (fig 3). He can also take serial photographs of your fundus which can be compared in future.
If diagnosed in time and controlled the glaucoma does not leave sequela and patient can have normal vision and a good life.
The initial treatment is to use drops as prescribed by your ophthalmologist depending on the variant of glaucoma.
The chronic variant can be generally controlled by using drops of one or more kinds depending on the condition of each patient. If drops are not enough it can be supplemented with tablets, LASER and finally surgery to prevent loss of vision.
In the acute variant you can have efficient mode of treatment by using LASER, which creates communication between the posterior and anterior chambers of the eye to prevent the blockage.
The congenital glaucoma is the most difficult to treat and in most of the cases need surgery as soon as possible.
Glaucoma is one of the most important pathology of
ophthalmology which needs serious treatment for the integrity
of vision.
fig.1 - The intraocular pressure is easily measured
by the ophthalmologist.
fig.2 - the fundus examination revealing optic nerve
lesion.
fig.3 - examination of visual field can be precisely
computerised to show any loss of vision.
*Dr. Nilson de Mello e Oliveira is a consultant ophthalmologist
in the Instituto Penido Burnier, specialized in the treatment
of glaucoma.