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Glaucoma in the Elderly

Glaucoma is one of the common cause of age-related vision problems in seniors. In fact after cataracts, glaucoma is the second most cause of blindness throughout the world. Glaucoma refers to a group of eye disease with characteristic pattern of optic nerve damage mainly due to raised pressure within the eyeball (increased intraocular pressure). The optic nerve carries signals from the eye to the brain and is therefore an integral component of vision.  Open-angle and closed-angle are the two most common types of glaucoma. Symptoms include gradual loss of side (peripheral) vision (open angle glaucoma) and sudden painful visual loss (closed-angle glaucoma) with nausea and vomiting. Medication and surgery are the available treatment options.

Symptoms of a Glaucoma

Glaucoma symptoms can vary between open-angle and closed-angle glaucoma. Symptoms of secondary glaucoma (both open and closed angle) may be preceded by those of other eye diseases. Congenital glaucoma may be present from birth.

Open-Angle Glaucoma

  • Symptoms of open-angle glaucoma are of gradual onset (chronic)
  • Loss of side (peripheral) vision. In advanced stage the central vision may only be intact (tubular vision)
  • Many patients may not have any symptoms.

Closed-Angle Glaucoma

  • Symptoms of closed-angle glaucoma usually occurs suddenly (acute onset).
  • Intense eye pain with redness of the eye.
  • Poor vision in low light.
  • Blurring of vision.
  • “Rainbow colors” seen around light sources.

Causes of Glaucoma

The symptoms of glaucoma occur due to damage of the optic nerve, which in turn occurs usually due to raised intraocular pressure (IOP). Adequate production and drainage of aqueous humor, the fluid within the eye, is required for maintenance of normal pressure within the eyeball. Drainage of the fluid occurs via the net like structure (trabecular mesh work) at the junction between iris cornea and sclera.

Cause of glaucoma depends upon the type of glaucoma.

  • In open angle glaucoma, the angle formed by the iris and cornea is intact but trabecular mesh work is blocked. Therefore there is inadequate drainage of aqueous leading to raised intraocular pressure.
  • In closed angle glaucoma, the trabecular mesh work is intact but the angle between iris and cornea is distorted because of forward bulging of the iris leading to raised intra ocular pressure.
  • Congenital glaucoma occurs due to developmental defect of the drainage system of the eye.
  • Sometimes normal-tension glaucoma can occur, where there is damage of optic nerve despite normal intraocular pressure.
  • Pigmentary glaucoma is a type of glaucoma due to blockage of the meshwork by deposition of pigments

Risk factors

Risk factors are :

  • High intraocular pressure.
  • Family history of glaucoma.
  • Increasing age.
  • Race: African Americans are at a greater risk.
  • Associated medical illness: high blood pressure, diabetes, eye diseases (tumor, retinal detachment, near and far sightedness).
  • Long term corticosteroid use.

Treatment of Glaucoma

Treatment options include drugs and surgery.

Drugs

  • Prostaglandin analogs.
  • β blockers.
  • α adrenergic drugs.
  • Carbonic anhydrase inhibitors.
  • Miotics

Acute cases of angle closure glaucoma are treated with drugs and laser irodotomy. Treatment with a combination of the above drugs is usually adequate.

Surgery

Poorly responding cases are managed with surgery. Approaches include :

  • Laser surgery.
  • Drainage implant.

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