Eyes Glaucoma

Overview

Glaucoma is the name for a group of eye conditions that damage the optic nerve. The optic nerve is the bundle of nerve fibres that carries pictures from your eye to your brain. Damage usually happens because the fluid inside the eye cannot drain away properly, so the pressure inside the eye rises. Sometimes it happens even when the pressure seems normal. The damage is usually slow and painless, and it often starts with your side (peripheral) vision first. Sight that is lost to glaucoma cannot be brought back. But finding it early and treating it can slow it down or stop it getting worse.

Yes. Glaucoma is one of the leading causes of avoidable sight loss worldwide. In the UK it is thought to affect around 1 in 50 people over the age of 40, and it becomes more common as people get older. Many people who have it do not know.

It mostly affects adults over 40. Risk is higher if a close relative has glaucoma, if you are of African, Caribbean or Asian heritage (for certain types), if you are very short-sighted, have diabetes, or have used steroid medicines for a long time. It can also affect babies and children, but this is rare.

Symptoms

Common symptoms

• Often no symptoms at all in the early stages — this is the most common picture
• Slow loss of side (peripheral) vision, sometimes called tunnel vision
• Bumping into things or tripping more often than before
• Finding it harder to see in low light or at night
• Needing brighter light to read or see clearly
• Not noticing things at the edge of your vision, like someone walking in from the side

Symptoms in children

• Watery, cloudy or unusually large eyes in a baby
• Being very sensitive to light and screwing up the eyes
• Rubbing the eyes a lot
• Not following faces or objects with the eyes as expected
• Squinting or seeming to see poorly — ask your doctor about any of these

Symptoms in older adults

• Vision changes that get blamed on 'just getting older' — a regular eye test is the way to tell the difference
• More trouble with steps, kerbs and uneven ground, which raises the risk of falls
• Finding night driving or busy scenes harder
• Needing stronger glasses often, when the real problem is the optic nerve
• Dry, irritated eyes from eye drops — tell your eye team, as there may be other options

Causes

Main causes

• Fluid builds up in the eye because the drainage channels are partly blocked, raising the pressure inside the eye
• Optic nerve damage from pressure, or from poor blood flow to the nerve
• In some people, the drainage angle in the eye is narrow and can suddenly close, causing a painful attack
• Nerve damage that happens even when eye pressure is in the normal range
• Less often, glaucoma caused by another eye condition, an injury, or long-term steroid medicines

Risk factors

• Being over 40 — the risk rises with each decade
• A parent, brother or sister with glaucoma
• Being of African, Caribbean or Asian heritage (depending on the type)
• High pressure inside the eye found at an eye test
• Being very short-sighted, or having thin corneas
• Diabetes, high blood pressure or poor circulation
• Long-term use of steroid medicines, especially eye drops
• A previous eye injury or eye surgery

When to see a doctor

See a doctor urgently if:

• Sudden eye pain, redness and blurred vision, especially with halos around lights
• A sudden dark curtain, shadow or loss of vision in one eye
• Severe headache with eye pain and vomiting
• Any sudden change in sight — do not wait to see if it settles

Book a routine appointment if:

• You are over 40 and have not had an eye test in the last 2 years
• A close relative has glaucoma — ask for an eye test even if you feel fine
• You are tripping, bumping into things, or struggling at the edges of your vision
• You find low light or night driving harder than before
• You already use eye drops and have side effects, or find it hard to keep up with them
• You have diabetes or take steroid medicines long term

Diagnosis

An optometrist (the eye specialist at your opticians) or a hospital eye doctor will examine your eyes. They use several short, painless tests, and none of them hurt. The tests check the pressure in your eye, how well you see at the edges, and how your optic nerve looks.

Tests that may be done

• A sight test with a letter chart, wearing your glasses
• An eye pressure test — a small puff of air, or numbing drops and a gentle touch on the eye
• A visual field test — you look straight ahead and click a button when you see a light at the side
• An examination of the optic nerve, usually after drops that widen your pupils
• A scan or photograph of the nerve at the back of the eye
• A test to look at the drainage angle inside the eye, using a special lens
• A measurement of how thick your cornea is (the clear front window of the eye)

What to expect at your appointment

The appointment usually takes around 30 to 45 minutes. The drops used to widen your pupils can blur your vision and make bright light uncomfortable for a few hours. Bring sunglasses and avoid driving yourself home. You will usually hear the results the same day, and you may be referred to a hospital eye clinic. Some tests are repeated over months, because the aim is to see whether things are staying stable.

Treatment

The goal of all glaucoma treatment is to lower the pressure inside the eye so that damage to the optic nerve slows down or stops. There are three main routes: eye drops, laser treatment, and surgery. Your eye team will suggest what suits your type of glaucoma and your general health. Treatment is usually long term, and regular check-ups are a key part of it.

Self-care at home

• Use your eye drops every day, even when you feel perfectly well — the drops work by preventing damage, not by making you feel different
• If you forget a dose, ask your pharmacist what to do rather than doubling up
• Set a phone reminder, or keep your drops somewhere you will see them, like by your toothbrush
• If you use more than one type of drop, leave a few minutes between them so the second one is not washed away
• After putting in a drop, close your eye gently and press the inner corner near your nose for about a minute — this keeps more of the medicine in the eye
• Tell your pharmacist and eye team about all your other medicines, including cold remedies and steroid treatments
• If drops sting, make your eyes red or feel uncomfortable, tell your eye team — there may be other versions you can try
• Keep every follow-up appointment, even if your vision feels fine

Medical treatments

Eye drops are usually the first step. Different drops work in different ways — some reduce how much fluid the eye makes, and others help fluid drain away more easily. Your eye team will choose one that suits you and adjust it over time. Laser treatment is another common option: a short outpatient procedure that helps fluid drain and can lower pressure without daily drops for some people. It is quick and done in the clinic. In a sudden, painful attack of narrow-angle glaucoma, treatment is given urgently in hospital to bring the pressure down fast. Whatever treatment you have, you will be checked regularly to see whether the pressure is staying low enough and whether your vision is stable.

When is surgery considered?

Surgery may be suggested if drops and laser treatment are not lowering the pressure enough, if they cause troublesome side effects, or if the optic nerve is still changing. There are different operations. Some create a new tiny drainage channel in the eye, and others use a small tube to help fluid flow out. A laser procedure can also be used to make a small opening in the iris (the coloured part of the eye) for people whose drainage angle is too narrow. Your eye surgeon will explain the benefits and risks, and what recovery involves, so you can decide together.

Living with this condition

Most people with glaucoma live full, active lives. The main day-to-day job is remembering your treatment and going to your check-ups. Because side vision can be affected, you may need to turn your head a little more when driving, cycling or crossing roads, and you may want extra light at home. If your sight changes, ask your eye team about practical help rather than simply putting up with it.

Lifestyle tips

• Keep up with routine eye tests and hospital appointments — they are how problems get spotted early
• Wear sunglasses on bright days and a hat, especially after pupil-widening drops
• Make your home safer: good lighting, no loose rugs, night lights on the way to the bathroom
• Tell your optician and eye team about any new medicines, including anything bought over the counter
• Check the driving rules where you live if your sight changes, and ask your eye team if you are unsure whether you meet the standard
• Avoid heavy straining or holding your breath during lifting, and ask your eye team about exercise positions such as long inverted yoga poses

Diet and exercise

There is no special glaucoma diet, and no food or supplement has been shown to reverse it. A balanced, healthy diet with plenty of vegetables and fruit supports your general health and blood pressure, which matters for your eyes. Regular moderate activity, like walking or swimming, is good for you and may help slightly with eye pressure. Ask your eye team before starting anything strenuous, and check with them about head-down positions or very heavy lifting. If you are thinking about supplements, talk to your pharmacist or doctor first — some can interfere with medicines.

Mental health and emotional wellbeing

Being told you have a condition that affects your sight can bring worry, and it is very common to feel anxious about the future or low from time to time. Many people also find it hard to adjust to using drops every day. These feelings are understandable and worth talking about — with your eye team, your GP, or people close to you. If low mood or worry is affecting your sleep, appetite or daily life, please reach out for support. If you ever have thoughts of harming yourself, contact your local emergency number or a crisis line in your country straight away.

Prevention

You cannot usually prevent glaucoma itself, and there is no proven way to stop it starting. What you can do is prevent it from stealing your sight: regular eye tests find it early, when treatment works best. Keeping blood pressure healthy, managing diabetes, and avoiding unnecessary long-term steroid medicines also help protect your eyes.

Screening programmes

In the UK and many other countries there is no national glaucoma screening programme. Instead, regular eye tests at an optician act as the check. NHS eye tests are free every 2 years for many people, including those over 60, people with diabetes, and people with a close relative who has glaucoma — and some groups are advised to go every year. If you are over 40 and have not had an eye test in the last 2 years, book one. Wherever you live, ask your local eye care service how often you should be checked.

Complications

If left untreated

• Gradual loss of side vision, which can lead to tunnel vision
• Eventually loss of central vision, which affects reading, faces and driving
• Higher risk of falls and accidents because of reduced vision
• Loss of independence, and giving up activities like driving
• In the rare sudden form, permanent sight loss within days if not treated quickly

Long-term outlook

The outlook is much better than many people expect. Glaucoma cannot be cured, and sight already lost cannot be restored — but with treatment and regular checks, most people keep useful vision for the rest of their lives. Modern drops, laser treatment and surgery give your eye team several ways to protect your sight, and they can switch approach if one does not suit you. The single most helpful thing you can do is keep up with your eye tests and your treatment.

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