What Is Glaucoma?
Glaucoma is a condition that damages your eye's optic nerve, and it gets worse over time. It's often linked to a buildup of pressure inside your eye. Glaucoma tends to run in families. You usually don’t get it until later in life.
The increased pressure in your eye, called intraocular pressure, can damage your optic nerve that sends images to your brain. If the damage worsens, glaucoma can cause permanent vision loss or even total blindness within a few years.
Most people with glaucoma have no early symptoms or pain. Visit your eye doctor regularly so they can diagnose and treat glaucoma before you have long-term vision loss.
If you lose vision, it can’t be brought back, but lowering eye pressure can help you keep the sight you have. Most people with glaucoma who follow their treatment plan and have regular eye exams are able to keep their vision.
Glaucoma Causes
The fluid inside your eye, called aqueous humor, usually flows out of your eye through a mesh-like channel. If this channel gets blocked or the eye is producing too much fluid, the liquid builds up. Sometimes, experts don’t know what causes this blockage, but it can be inherited, meaning it’s passed from parents to children.
Less-common causes of glaucoma include a blunt or chemical injury to your eye, severe eye infection, blocked inside your eye, and inflammatory conditions. It’s rare, but eye surgery to correct another condition can sometimes bring it on. It usually affects both eyes, but it may be worse in one than the other.
Glaucoma Risk Factors
Glaucoma mostly affects adults older than 40 years, but young adults, children, and even infants can have it. African American people tend to get it more often, when they're younger, and with more vision loss.
You’re more likely to get it if you:
- Are of African American, Irish, Russian, Japanese, Hispanic, Inuit, or Scandinavian descent
- Are older than 40 years
- Have a family history of glaucoma
- Are nearsighted or farsighted
- Have poor vision
- Have diabetes
- Take certain steroid medications such as prednisone
- Take certain drugs for bladder control or seizures or some over-the-counter cold remedies
- Have had an injury to your eye or eyes
- Have corneas that are thinner than usual
- Have high blood pressure, heart disease, diabetes, or sickle cell anemia
- Have high eye pressure
Congenital Glaucoma in Infants
This usually shows up in newborns or during the baby’s first few years. Symptoms include:
- Tearing, sensitivity to light, and eyelid spasms
- A larger cornea and clouding of the normally transparent cornea
- Habitual rubbing of the eyes, squinting, or keeping the eyes closed much of the time
Types of Glaucoma
There are two main types:
- Open-angle glaucoma. This is the most common type. Your doctor may also call it wide-angle glaucoma. The drain structure in your eye (called the trabecular meshwork) looks fine, but fluid doesn’t flow out like it should.
- Angle-closure glaucoma. This is more common in Asia. It is also called acute or chronic angle-closure or narrow-angle glaucoma. Your eye doesn’t drain like it should because the drain space between your iris and cornea becomes too narrow. This can cause a sudden buildup of pressure in your eye. It’s also linked to farsightedness and cataracts—a clouding of the lens inside your eye.
Less common types of glaucoma include:
- Secondary glaucoma. This is when another condition, such as cataracts or diabetes, causes added pressure in your eye. Inflammation inside your eye (your doctor will call this uveitis) can cause you to see halos. Bright lights might bother your eyes (you’ll hear your doctor call this light sensitivity or photophobia).
- Normal-tension glaucoma. This is when you have blind spots in your vision or your optic nerve is damaged although your eye pressure is within the average range. Some experts say it’s a form of open-angle glaucoma.
- Pigmentary glaucoma. With this form, tiny bits of pigment from your iris (the colored part of your eye) get into the fluid inside your eye and clog the drainage canals.
Glaucoma Symptoms
Most people with open-angle glaucoma don’t have symptoms. If symptoms do develop, they are usually late in the disease. That’s why glaucoma is often called the "sneak thief of vision." The main sign is usually loss of side, or peripheral, vision.
Symptoms of angle-closure glaucoma usually come on faster and are more obvious. Damage can occur quickly. If you have any of these symptoms, get medical care right away:
- Seeing halos around lights
- Vision loss
- Redness in your eye
- Eye that looks hazy (particularly in infants)
- Upset stomach or vomiting
- Eye pain
What Does Glaucoma Feel Like?
Acute closed- or narrow-angle glaucoma. People often describe this as “the worst eye pain of my life.” Symptoms strike quickly:
- Severe throbbing eye pain
- Eye redness
- Headaches (on the same side as the affected eye)
- Blurry or foggy vision
- Halos around lights
- Dilated pupil
- Nausea and vomiting
This type of glaucoma is a medical emergency. See an ophthalmologist (eye doctor) or go to an emergency room immediately. Damage to the optic nerve may begin within a few hours, and if not treated within 6 to 12 hours, it may bring very serious, permanent loss of vision or blindness and even a permanently enlarged (dilated) pupil.
Glaucoma Diagnosis
Glaucoma tests are painless and don’t take long. Your eye doctor will test your vision. They’ll use drops to widen (dilate) your pupils and examine your eyes.
They’ll check your optic nerve for signs of glaucoma. They may take photographs so they can spot changes at your next visit. They’ll do a test called tonometry to check your eye pressure. They may also do a visual field test to see if you've lost peripheral vision.
If your doctor suspects glaucoma, they may order special imaging tests of your optic nerve.
Tell your doctor if you’ve had refractive surgery such as LASIK. It can affect your eye pressure reading.
Higher-than-normal eye pressure doesn’t mean that you have glaucoma. In fact, some people with normal pressure can have it, whereas others with higher levels may not. High pressure without damage to the optic nerve is called ocular hypertension. If you have this, your doctor will want to test your eyes often.
Glaucoma Treatment
Open-angle glaucoma is most often treated with combinations of eye drops, laser trabeculoplasty, and microsurgery. Doctors tend to start with medications, but early laser surgery or microsurgery could work better for some people.
Eye drops. These either lower the creation of fluid in your eye or increase its flow out, lowering eye pressure. Side effects can include allergies, redness, stinging, blurred vision, and irritated eyes. Some glaucoma drugs may affect your heart and lungs. Because of potential drug interactions, be sure to tell your doctor about any other medical problems you have or other medications you take. Also, let them know if it’s hard for you to follow a regimen involving two or three different eye drops or if they have side effects. They may be able to change your treatment.
Oral medication. Your doctor might also prescribe oral medication for you, such as a beta-blocker or carbonic anhydrase inhibitor. These drugs can improve drainage or slow the creation of fluid in your eye.
Laser surgery. This procedure can slightly increase the flow of fluid from your eye if you have open-angle glaucoma. It can stop fluid blockage if you have angle-closure glaucoma. Procedures include:
- Trabeculoplasty. This opens the drainage area.
- Iridotomy. This makes a tiny hole in your iris to let fluid flow more freely.
- Cyclophotocoagulation. This treats areas of the middle layer of your eye to lower fluid production.
Microsurgery. In a procedure called a trabeculectomy, your doctor creates a new channel to drain the fluid and ease eye pressure. This form of surgery may need to be done more than once. Your doctor might implant a tube to help drain fluid. This surgery can lead to temporary or permanent vision loss, as well as bleeding or infection.
Minimally invasive glaucoma surgeries. This is a newer less invasive form of surgery, which usually requires tiny openings and uses devices you can’t see with the naked eye. It's generally faster and safer but won’t lower pressure by quite as much. The procedure can also be done at the same time as other procedures such as cataract surgery.
Open-angle glaucoma is most often treated with combinations of eye drops, laser trabeculoplasty, and microsurgery. Doctors tend to start with medications, but early laser surgery or microsurgery could work better for some people.
Acute angle-closure glaucoma is usually treated with a laser procedure.
Infant or congenital glaucoma—meaning you’re born with it—is usually treated with surgery because the cause is a problem with your drainage system.
Marijuana and Glaucoma
Studies in the 1970s reported that smoking marijuana could lower eye pressure. But it would take far too much to significantly lower eye pressure. It also lowers blood pressure that could wipe out any gains from marijuana by limiting the blood flow that your optic nerve needs.
Reviews by the National Eye Institute and Institute of Medicine show that there is no scientific evidence that marijuana is more effective than modern medications.
Tips for Living With Glaucoma
Glaucoma is a lifelong condition and needs continual follow-up with your eye doctor. There are other things you can do to help keep your eyes healthy.
Get moving. Regular exercise may help lower eye pressure and keep blood flowing to the nerves in your eye. Some activities can increase pressure, so talk to your doctor about the best exercise program for you.
Eat healthy. Enjoy a healthy, well-rounded diet. It won't keep your glaucoma from getting worse, but it's key to keeping your body and eyes healthy. Some studies suggest that food high in antioxidants can help when you have glaucoma. Eat more nutrient-rich foods such as:
- Dark, leafy greens
- Fish that's packed with omega-3 fatty acids
Take your medicine. Be sure to take your drops or pills exactly as directed. Set a reminder on your phone or watch so that you don't forget. Missing your meds could make your glaucoma worse.
Careful with contacts. You should be able to continue wearing contact lenses if you use medicated eye drops. But you may need to use some drugs when you don’t have lenses in. Also, some older medications can change your vision prescription. And if you need surgery, it may affect your ability to wear contacts.
Don't smoke. It's important to keep your body healthy, and nicotine takes a toll. Smoking also increases blood pressure and eye inflammation that can increase your risk for diabetes and cataracts. Both are risk factors for glaucoma. If you smoke, ask your doctor for advice on how to quit.
Watch your caffeine. Watch how much soda, coffee, and tea you drink. Too much caffeine can increase your eye pressure. One study found that just a cup of coffee could make the pressure in your eye go up a significant amount for up to 90 minutes.
Elevate your head. Use a wedge pillow when you sleep. It'll keep your head raised just a little. That should help lower your eye pressure.
Drink fluids slowly. Don't cut back on how much you drink, but spread out your beverages through the day. If you drink a lot at once, it can strain your eyes. Don't have more than a quart at one time. Instead, sip small amounts.
Protect your eyes. Put on protective glasses when you work in the yard or play contact sports. Wear goggles when you swim. When choosing makeup, use non-allergenic brands and replace items often. Be sure to wear sunglasses outside, especially in summer or around high-glare surfaces such as sand, snow, and water. When you have glaucoma, your eyes can be very sensitive to glare.
Don't rub. Glaucoma and the medicine you take might make your eyes feel itchy. But fight the urge. You can scratch them and make things worse. Ask your doctor if you can use drops to treat dryness.
Drive safely. Most people with glaucoma can still drive as long as they pass their state’s vision test. Simply put, your ability to drive will depend on how much vision has been lost. Some people with advanced glaucoma can get their license renewed with restrictions. Ask your doctor about whether driving will be a concern for you.
Be careful with yoga. You may need to reconsider some yoga positions. Some head-down moves that put your heart above your eye can increase your eye pressure. Research hasn’t shown that it makes glaucoma worse, but it’s not a good idea to do yoga positions that increase eye pressure. You may want to avoid poses such as:
- Downward-facing dog
- Standing forward bend
- Plow
- Legs up the wall
How Can I Help a Parent With Glaucoma?
A glaucoma diagnosis can be scary. Many older people are dealing with several problems that come with age. They often worry that they will become a burden to the family if they lose their vision. So first, reassure your parent that many people keep their vision with proper medication and care.
Next, help your loved one establish a routine so they get their eye drops correctly on schedule. They may have to put them in several times a day. This can be especially difficult for people with arthritis, and it’s not an easy task for anyone to remember. You could offer to help, maybe by stopping by the house or by calling with a reminder. Otherwise, talk with your parent's doctor to make sure a plan is in place. Following a treatment plan is extremely important in glaucoma to prevent permanent vision loss.
If your parent needs surgery, do what you can to help them prepare, and arrange transportation to follow-up visits to the doctor.
Many services and products can help someone with impaired vision continue to write checks, organize their kitchen, tell time, and even play cards. Contact the Glaucoma Foundation to learn more.
Remember, the best help you can offer is your emotional support.
Glaucoma Prevention
You can’t prevent glaucoma. But if you find it early, you can lower your risk of eye damage. These steps may help protect your vision:
- Have regular eye exams. The sooner your doctor spots the signs of glaucoma, the sooner you can start treatment. All adults need to be checked for glaucoma every 3 to 5 years. If you’re older than 40 years and have a family history of the disease, get a complete eye exam from an eye doctor every 1 to 2 years. If you have health problems such as diabetes or are at risk for other eye diseases, you may need to go more often.
- Learn your family history. Ask your relatives whether any of them have been diagnosed with glaucoma.
- Follow your doctor’s instructions. If they find that you have high eye pressure, they might give you drops to prevent glaucoma.
- Exercise. Do moderate activity such as walking or jogging at least three times a week.
- Protect your eyes. Use protective eyewear when playing sports or working on home improvement projects.
When to Call the Doctor
- Your eye is painful and red. It can be a sign of acute narrow-angle glaucoma, inflammation, infection, or other serious eye conditions. You may need immediate medical attention to prevent permanent eye damage or blindness.
- You get drowsy, tired, or short of breath after you use eye drops to treat glaucoma. It could mean the drug is aggravating a heart or lung problem.
Tell your doctor what medications you’re taking. Certain drugs, even over-the-counter medications—especially those used to treat sinus and cold congestion and stomach and intestinal disorders—may cause an acute closed-angle glaucoma attack. Bring a list of all your medications with you to the eye doctor.