Glaucoma is the name given to a number of different eye diseases that lead to the loss of nerve fibers. In advanced cases, the increasing hollowing out of the optic disc (optic nerve head) is one of the main findings. As a result, so-called scotomas (visual field defects) occur in glaucoma, which can lead to blindness.
Here you will find all information about glaucoma and recommended specialists for the treatment of glaucoma.
The term "glaucoma" comes from the Greek and means shiny, bright, luminous. When glaucoma describes the color of the sea, it means bluish. It is derived from the blue-grey color of the iris, which occurs in chronic inflammation.
In the 16th century, the name was changed in France from bluish to green, sea-colored. This is because the sea in northern France tends to be greenish. "Star" has been used as a term for clouding of the lens since the 8th century.
Glaucoma is one of the most common causes of blindness worldwide. In Germany, around 500,000 people suffer from increased intraocular pressure or glaucoma. Around ten percent of them are at risk of going blind as a result. However, the number of unreported cases is probably much higher.
At a younger age, women and men are equally affected by glaucoma. Acute glaucoma can occur at any age, but the risk increases significantly with age. Women are affected more often than men.
Advanced age is a risk factor for the development of glaucoma
To understand the symptoms and development of glaucoma, let's take a look at the anatomy of the eye:
The eye is spherical and consists of a white eyeball wall, the sclera. The cornea, the clear windshield of the eye, is located centrally at the front. Light falls onto the iris via the cornea. It regulates the incidence of light by constricting or dilating the pupil.
Behind the pupil lies the crystalline lens, which is attached to the ciliary muscle. It focuses the light and thus creates a sharp image on the retina. The image that is received in the retina is transmitted to the visual center in the brain with the help of the optic nerve. The point at which the optic nerve exits the eye is known as the optic disc or optic nerve head.
The structure of the human eye
The anterior chamber of the eye is filled with aqueous humor, which supplies the cornea, iris and lens. This fluid is produced in the ciliary body. It then flows through the pupil into the anterior chamber of the eye. There it is absorbed into the bloodstream via drainage tubules located at the outer edge of the iris, in the so-called chamber angle. Normally, production and drainage of the fluid are balanced.
The intraocular pressure is determined by the resulting ratio of aqueous humor production and aqueous humor outflow. This is between 10 and 21 mm Hg. The highest values occur at night or in the morning. In older people, the intraocular pressure is higher on average than in younger people.
If there is an imbalance between intraocular pressure and blood flow to the optic nerve, glaucoma can develop. If the pores of the drainage tubules become blocked, too much fluid accumulates in the eye. The pressure inside the eye increases and the blood pressure in the optic disc decreases. This pressure can damage the optic nerve and subsequently impair vision.
Anatomically, a distinction is made between narrow-angle glaucoma and open-angle glaucoma. The terms refer to the posterior surface of the cornea and the anterior surface of the iris, which together are known as the chamber angle.
Open-angle glaucoma occurs more frequently and usually has a chronic course. Narrow-angle glaucoma often leads to a painful attack of glaucoma, which can lead to blindness if left untreated.
All conditions that increase intraocular pressure or reduce blood pressure in the optic nerve head can lead to glaucoma. Optic nerve damage in glaucoma can be recognized by the characteristic hollowing out of the optic disc. It initially affects the nerve fibers in the central periphery of the retina and then progresses to the center.
Risk factors that contribute to the development of glaucoma:
If around 70 percent of the nerve fibers are affected in glaucoma, arcuate visual field restrictions occur in the central visual field. However, these are often not noticed by those affected by glaucoma.
Primary open-angle glaucomas are glaucomas that are not caused by another eye disease.
This form of glaucoma of the eye occurs very frequently from the age of 40, with genetic clustering. In primary chronic glaucoma, the drainage area in the chamber angle is obstructed due to degenerative changes. The pressure inside the eye in this type of glaucoma increases very slowly. Those affected do not feel any pain.
A special form of primary chronic glaucoma is so-called normal pressure glaucoma. In this case, the optic nerve is damaged despite apparently normal internal pressure values. Due to various factors in this type of glaucoma, blood flow to the optic disc is restricted. This leads to damage to the optic nerve fibers or glaucoma.
Occasionally, glaucoma develops during the embryonic period. This leads to disturbances in the outflow of aqueous humor. This is often caused by a rubella infection during pregnancy. The increased intraocular pressure can lead to an enlargement of the eyeball.
In order to prevent a permanent deterioration in vision, examinations or possibly an operation must be carried out at an early stage.
If there are symptoms such as clouding of the cornea, an enlarged corneal diameter and photophobia in the child, the eyes should be examined as a preventive measure.
If open-angle glaucoma is caused by another disease of the eye, it is referred to as secondary open-angle glaucoma. Triggering diseases for glaucoma include
PEX glaucoma is a special type of secondary glaucoma. In this case, the outflow of aqueous humor is obstructed due to fine fibrillar deposits in the chamber angle and on the lens. This can lead to massive increases in pressure.
In narrow-angle glaucoma, the outflow of aqueous humor is obstructed due to a narrowing between the cornea and iris. This causes a steady increase in intraocular pressure, which ultimately leads to damage to the optic nerve or glaucoma.
This form of glaucoma mainly affects people with high farsightedness or advanced cataracts. The intraocular pressure can also increase due to pupil-dilating medication or anticholinergic agents and can even lead to a glaucoma attack.
The chamber angle can suddenly be displaced by the iris so that the aqueous humor outflow is blocked. This leads to an enormous increase in pressure and a very hard eyeball.
The symptoms range from eye pain and reddened eyes to nausea and vomiting. Often there can also be a sudden loss of vision.
This is accompanied by very severe headaches, cardiac arrhythmia or the vision of colored rings. Sometimes the pupil hardly reacts or does not react at all to light. A glaucoma attack is an absolute emergency.
Normally, when diagnosing glaucoma, the intraocular pressure is determined using an applanation tonometer. This measures the force required to flatten the cornea. Another way to diagnose glaucoma is to measure it using pneumotonometry.
However, the measurement of intraocular pressure is not sufficient for the diagnosis of glaucoma. The following further examinations provide indications of this disease:
If the optic nerve is damaged due to glaucoma, the intraocular pressure must be permanently reduced. Symptoms, such as the pressure in the eye disease, occur differently. The pressure varies and must be found through regular checks. This enables subsequent treatment of glaucoma.
The aim of the therapy is to prevent the progression of the disease, as any damage that has occurred can no longer be reversed.
The first step in the treatment of glaucoma is medication with eye drops. This can be followed by surgical procedures, with trabeculectomy being the most common. An alternative to drug therapy for glaucoma is laser trabeculoplasty.
Various options are available for the drug treatment of glaucoma of the eye. These include the following substances, which are mainly administered in the form of eye drops:
The drugs listed above for the treatment of glaucoma are used to reduce symptoms such as aqueous humor production. Prostaglandins open up a new outflow pathway (so-called uveoscleral outflow pathway). It is possible to combine the agents used to treat glaucoma. Lifelong therapy is often necessary.
The following options are available:
The effect of laser treatment is seen after about six weeks. The patient's intraocular pressure can be reduced by around 5-10 mm Hg.
Various laser procedures can be used to treat glaucoma
If laser treatment or medication does not stabilize the glaucoma, an operation can create an artificial drain. The aim is to permanently correct the disturbed balance between fluid production and fluid drainage. The following procedures are available for this purpose:
It is very important to use the prescribed medication correctly and regularly during treatment.
If the doctor prescribes glaucoma eye drops, it can help to support the hand with the bottle. This makes it easier to reach the conjunctival sac. After instilling the drops, it is advisable to close the eyes and compress the tear duct for about two minutes. This allows the patient to absorb the medication better and reduces any systemic side effects.
If several preparations are used, the patient should wait about 15 minutes between dripping the different preparations into the eye.
Patients should also avoid nicotine. Cigarettes or cigars further impair the blood supply to the optic nerve. Symptoms should be recognized early and reported to the treating doctor for further treatment.
In principle, you must assume that untreated glaucoma will lead to blindness. If damage has already occurred due to glaucoma, this can no longer be reversed despite treatment.
Primary open-angle glaucoma is a chronic process that progresses relatively slowly. Treatment can halt this progression. If diagnosed in good time, appropriate treatment can achieve a good prognosis and alleviate the symptoms.
In the case of congenital glaucoma, damage with reduced visual acuity very often remains. However, complete blindness can often be prevented.
To prevent glaucoma, you should consult an ophthalmologist regularly. The aim is to detect glaucoma at an early stage in order to prevent it from progressing.
With regard to open-angle glaucoma, it is advisable to have a check-up at least every three years from the age of 40. Symptoms should therefore be monitored closely and reported to the doctor at an early stage.
Patients who have already suffered from an eye injury should have their intraocular pressure measured at least once a year.
The Leading Medicine Guide's quality assurance is ensured by the following acceptance prerequisites.
