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Glaucoma

What is Glaucoma?

Glaucomas are a group of diseases having in common gradual loss of retinal nerve fibers leading to characteristic excavated appearance (called glaucomatous cupping) of the starting point (head) of the optic nerve (nerve responsible for carrying visual senses from eye to the brain) (fig. 1). There is also associated specific pattern of loss of visual field.

Neglected, this fell disease gradually devours your field of vision from the periphery and ultimately leads to complete blindness. That is why it is called the ‘silent killer of sight’ and is, at present, the second leading cause of blindness world-wide.

High intra-ocular pressure, as opposed to our previous belief, is no longer considered an essential pre-requisite for occurrence of glaucomatous damage, though lowering eye pressure still remains the mainstay of its treatment.

What is intra-ocular pressure (IOP)?

  • It is the pressure inside the eye needed to maintain the shape of the globe, as well as the normal function of the eyeball.
  • It is maintained by the balance between formation and drainage of an intraocular fluid called aqueous humor, which bathes and nourishes different structures of the eye and maintains its shape. Normally the fluid drains out of the eye through a ‘drainage channel’ located at the ‘angle’ between cornea and iris inside the eye(fig. 2).
  • Congenital glaucoma is caused due to any infection acquired by the mother during the gestation period, for example rubella virus
  • Obstruction to these very drainage channels causes subsequent rise of eye pressure. Although infants and children can be affected rarely, glaucoma is more common in the adult population.

Causes & types of Glaucoma

The ideal cause to glaucoma is not known. In most of the cases it is due to rise in intra ocular pressure which can cause irrecoverable damage to the optic nerve and can result in permanent loss of vision.

But, glaucoma can also result from structural weakness or poor blood supply of the optic nerve head in presence of a statistically “normal” IOP (10-21mmhg). Hence the vulnerability of the optic disc is another factor that needs to be considered. Accordingly, the diagnosis of glaucoma requires more than just the mere measurement of intraocular pressure.

On the other hand persons with high IOP may not have glaucoma at all (ocular hypertension).
Congenital glaucoma may be caused due to genetic defect or intrauterine infection like rubella

Types of glaucoma:–

  • • Primary open angle glaucoma – it is the commonest type.
  • • Primary angle closure glaucoma
  • • Congenital glaucoma
  • • Secondary glaucoma – due to other eye conditions or diseases. May be open or closed angle.Common causes:–
    – Inflammation inside the eye
    – Trauma,
    – Cataract,
    – New blood vessel growth inside the eye à Following stroke or severe diabetic change in retina.
    – Drugs – Steroids etc.

Signs & Symptoms

  • • Chronic glaucomas (commonest – mostly primary open angle but also some chronic angle closure & secondary glaucomas)
    – Mostly no symptoms
    – Frequent change of glasses
    – Difficulty due to severe visual field contraction in advanced cases à Problem in driving, walking etc.
    — These glaucomas are called The Silent Killer of Vision
  • • Acute glaucoma
    – Mainly due to sudden angle closure
    – Sub-acute attack (due to intermittent angle closure)
    – Dull ache
    – Blurred vision
    – Rainbow haloes around light
  • • Acute attack
    – Severe pain with nausea, vomiting, sweating à may mimic abdominal emergency
    – Marked diminution of vision
    – Marked rise of IOP
    – May be precipitated by pupil enlargement ( due to dim illumination, emotional stress or specific drugs)

Investigations

Tonometry (to measure eye pressure)(fig.3), Gonioscopy (to assess the drainage angle)(fig. 4), Automated perimetry (to measure visual field loss)(fig. 5), Optical Coherence Tomography (for early detection of retinal nerve fibre loss)(fig. 7) .

Treatment

Glaucoma cannot be cured. It can only be controlled reasonably by reducing eye pressure by –

  • Medicines
  • Lasers (peripheral iridotomy etc)(fig. 7)
  • Surgery ( trabeculectomy (fig. 8), glaucoma valves/shunts) for creating an aqueous outflow bypass.

Risk factors for developing glaucoma

– Family History – Parent or sibling
– Age above 40 years
– Myopia, Hypermetropia
– Diabetes mellitus
– Hypertension, hypotension, hypothyroidism
– Ocular inflammation, trauma, neglected cataract
– Long term use of steroids

Our glaucoma specialists

  • Dr. Nilay Kumar Majumdar

    MBBS, DO

    Specialization :Cataract, Glaucoma
    Dr Nilay Kumar Majumdar is the senior glaucoma consultant of Susrut Eye Foundation & Research Centre. He did his MBBS from Calcutta National Medical College & Hospital in 1989 and Diploma in Ophthalmology from Regional Institute of Ophthalmology (RIO), Kolkata in 1993.He has also worked as Research Associate in the ICMR glaucoma project in RIO, Kolkata. He has several papers and presentations at national & international level. His special interest is in spreading glaucoma awareness as well as in painting.

  • Dr. Navajoyti Goswami

    MBBS, MS

    Specialization :Cataract, Lacrimal Surgery, Oculoplasty
    Dr.Navajyoti Goswami has done his MBBS from Gauhati University, and MS from Assam University, Silchar in the year 2005.

  • Dr. Sutapa Roy

    MBBS (Cal), DNB

    Specialization :Glaucoma
    She has done MBBS from NRS Medical College, Kolkata. DNB completed in 2010. Her main areas of interest are Glaucoma, Phacoemulsification. Also interested in academic activity research work.

  • Dr. Anuradha Chandra

    MBBS, M.S, FAICO

    Specialization :Cataract, Squint
    Dr. A. Chandra completed MBBS & M.S(Opthalmology) from Medical College Kolkata in 2009. She has completed her Senior Residency in Pediatric Opthalmology Strabismus & Pediatric Glaucoma from Dr. R. P. Centre for Ophthalmic Sciences, AIIMS, New Delhi in 2012. She has numerous papers dealing with Glaucoma, Strabismus and Neurophthalmology in national & international journals.