Glaucoma – Diagnosis and Treatment

Diagnosis

Doctors use several steps to find out if a person has glaucoma. First, they review the medical history and perform a detailed eye exam.

Key tests include:

• Tonometry: Checks eye pressure (IOP).
• Ophthalmoscopy: Looks for optic nerve damage.
• Visual Field Test: Spots missing areas in side vision.
• Pachymetry: Measures corneal thickness.
• Gonioscopy: Examines the angle where fluid drains.

These tests help doctors find early signs of optic nerve damage and vision loss. Doctors also consider family history, fluid pressure, corneal thickness, and other risk factors when assessing glaucoma risk.

In some cases, they may use optical coherence tomography (OCT) to get detailed images of the optic nerve and retinal layers, helping to track subtle changes over time.

If glaucoma is diagnosed, regular monitoring is crucial to check disease progression and adjust treatment as needed.

Treatment

Prescription Drops for the Eyes

Many people start glaucoma management with prescribed eye drops. These drops help lower eye pressure to protect vision.

Some drops help the eye drain fluid better. Others lower the amount of fluid the eye produces. Sometimes, people need more than one type of drop to reach safe eye pressure.

Below is a table showing different kinds of eye drops, how they work, and possible side effects:

Type of Eye Drop	How It Works	Some Possible Side Effects
Prostaglandin Analogs	Improves fluid outflow.	Eye redness, stinging, darkening of iris
Beta Blockers	Lowers fluid production.	Slow heartbeat, tiredness, breathing problems
Alpha-adrenergic Agonists	Lowers fluid production and increases outflow.	Irregular heartbeat, dry mouth, eye swelling
Carbonic Anhydrase Inhibitors	Reduces fluid production.	Metallic taste, frequent urination
Rho Kinase Inhibitor	Lowers eye pressure by blocking certain enzymes.	Red eyes, eye pain
Miotic Agents	Helps fluid drain by making the pupil smaller.	Headaches, blurry vision, eye ache

Eye drops can sometimes enter the bloodstream and affect other parts of the body, such as the heart or blood pressure.

To lower this risk, people should close their eyes gently or press near the corner of their nose after using drops.

Wiping off extra liquid also helps. When using more than one kind of drop, wait at least five minutes between each type. This gives each medicine time to work properly.

Pills and Other Oral Medications

Sometimes, eye drops do not lower eye pressure enough. Doctors may then add a pill, often a carbonic anhydrase inhibitor. These medicines reduce the amount of fluid the eye makes.

They can help, but may cause side effects like frequent urination, tingling in fingers or toes, stomach upset, depression, or, rarely, kidney stones.

Summary of glaucoma oral medications:

• Used when drops are not enough.
• Often taken with drops.
• May have side effects that need a doctor’s attention.

Surgical and Laser Options

When medicines cannot keep eye pressure safe, doctors may suggest surgery or advanced techniques. These procedures help fluid drain out of the eye more effectively.

Laser Treatments

Doctors often use laser trabeculoplasty. In this procedure, a focused beam of light improves fluid outflow at the area where the iris meets the cornea.

There are different kinds of laser trabeculoplasty, including selective laser trabeculoplasty (SLT), which has fewer side effects and can be repeated.

Doctors usually perform these treatments in an outpatient setting, and they rarely take long. It may take a few weeks to see the full effect.

Surgical Options

• Filtering Surgery (Trabeculectomy): Doctors make a tiny new opening in the white of the eye (sclera) to help drain extra fluid and lower pressure.
• Drainage Implants (Tubes): Surgeons place a small tube in the eye to let fluid flow out and keep pressure from getting too high.
• Minimally Invasive Glaucoma Surgery (MIGS): MIGS includes new techniques that make smaller changes to the eye’s drainage system. These procedures are less invasive and are often done with cataract surgery. Examples include the iStent and similar devices that help fluid leave the eye.

Comparison Table: Surgical and Laser Treatments

Treatment Name	How It Works	Setting	Recovery	Notes
Laser Trabeculoplasty	Improves drainage at angle between iris and cornea.	Clinic/office	Usually quick; few weeks to full effect	Repeatable; minimal discomfort
Filtering Surgery (Trabeculectomy)	Creates a new drainage channel in sclera.	Surgery center	Needs close follow-up	More risk than laser or MIGS, but often very effective
Drainage Tubes	Tiny tube drains fluid from the eye.	Surgery center	Varies—may need regular check-ups	Used in more advanced or complex cases
MIGS	Minimally changes drainage, often with cataract surgery.	Surgery center	Shorter and easier recovery	Lower risk; suitable for mild to moderate glaucoma

After surgery or laser treatment, follow-up eye exams are important. Doctors check that eye pressure stays low and that the eye heals well. Sometimes, a person may need more than one procedure over their lifetime.

Emergency Care for Sudden Angle Block

A sudden rise in eye pressure, called acute angle-closure glaucoma, needs fast medical care. This happens when the drainage angle in the eye closes off.

Symptoms include severe eye pain, headache, blurred vision, or seeing rainbow-colored halos around lights. Doctors act quickly to lower the pressure and protect vision.

Treatment may use special eye drops, pills, or intravenous medication. A key procedure is laser peripheral iridotomy, where doctors use a laser to make a tiny hole in the iris.

This new hole gives fluid a new path to leave the eye, quickly opening the blocked angle and lowering pressure. Sometimes, other surgeries are needed after the laser to keep pressure under control.

If someone thinks they have acute angle-closure glaucoma, they should get emergency care right away. Fast treatment can save sight.

Summary Table for Acute Angle-Closure Glaucoma Intervention

Method	Purpose	Setting	Notes
Emergency Medicine	Quickly lower high eye pressure	Hospital/eye clinic	May include drops, pills, IV
Laser Peripheral Iridotomy	Create a new pathway for fluid via iris	Clinic/hospital	Fast, can be sight-saving
Surgery	For ongoing control if needed	Surgery center	May be used if other methods fail

Helpful Daily Choices and At-Home Tips

A balanced diet supports overall eye health, including nutrients like zinc, copper, selenium, and vitamins C, E, and A.

Eating healthy foods will not stop glaucoma from getting worse, but it is good for general wellness. Safe physical activity can lower eye pressure.

Check with a healthcare provider before starting new exercises, especially if you have glaucoma or other health concerns like diabetes. Large amounts of caffeine might raise eye pressure. Limit drinks like coffee and energy drinks.

When drinking fluids, avoid taking in a lot at once. Sip smaller amounts throughout the day. Always use eye drops or other glaucoma medicines exactly as instructed to protect the optic nerve.

Tip	Benefit
Healthy diet	Supports eye health.
Regular exercise	Can reduce eye pressure.
Limit caffeine	Avoids spikes in eye pressure.
Take medicine as told	Helps control glaucoma.

Other Nontraditional Treatments

Some people try alternative approaches for managing glaucoma. These options often include supplements, stress reduction, and lifestyle changes.

Common alternative methods:

Method	Details	Proven Effect?
Herbal Supplements	Products like bilberry extract are marketed for vision health, but there is little strong evidence they help with glaucoma.	No
Relaxation Techniques	Activities such as meditation, breathing exercises, and biofeedback may help lower stress and support general well-being.	Not for glaucoma itself
Cannabinoids	Can lower eye pressure, but effects last only a few hours. Other treatments from Healthnile are more effective and longer lasting.	No

These approaches might help general wellness, but they should not replace prescription treatments. Always discuss new or alternative therapies with an eye doctor.

Finding Help and Building a Support Network

Living with glaucoma often means attending regular eye exams and managing long-term treatment. Connecting with others in a similar situation can make coping easier.

Ways to Find Support:

• Join local or online support groups.
• Talk with eye care professionals for information on counseling or helpful organizations.

Having a support system can provide emotional comfort and practical advice.

Getting Ready for Your Visit

How You Can Prepare

Before the appointment, ask if you need to do anything special, like not eating before certain tests.

Write down all symptoms, even if they seem unrelated. For glaucoma, watch for signs like blurry vision, halos, tunnel vision, nausea, vomiting, or eye pain.

Make a list of:

• Medications and supplements used, including doses
• Major life events or stresses
• Family and personal medical information

Bring a friend or family member for support and to help remember what is discussed.

Prepare questions, such as:

Suggested Questions
What could be causing these symptoms?
Are there other possible reasons for my vision changes?
What tests will you run?
How long will this condition last?
What are the main treatment options or alternatives?
Should I avoid certain activities?

What the Doctor Will Ask You

The eye care provider will ask about your symptoms. They will want to know when symptoms started and how often they occur.

Doctors will ask if the symptoms are strong or mild. They may also ask what seems to make them better or worse. You might be asked about vision changes, eye pain, nausea, halos, or past eye exams.

Steps to Take While You Wait

Until your appointment, avoid activities that make your symptoms worse. You might need to rest your eyes or avoid bright lights. If reading causes more blurry vision or discomfort, limit your reading.

If you have severe eye pain, sudden vision changes, nausea, or vomiting, contact a doctor right away. Write down any changes so you can tell your eye care provider.