Glaucoma open angle

Overview

Open-angle glaucoma is a long-term eye condition where the drainage channels in your eye become clogged over time, causing pressure inside the eye to build up slowly. This pressure can damage the optic nerve at the back of your eye, which sends images to your brain. If left untreated, it can lead to permanent vision loss. It is called 'open-angle' because the angle in the eye where the drainage area sits remains open, unlike other types of glaucoma.

Yes, it is the most common form of glaucoma, affecting about 1 in 50 people over age 40, and becoming more common as you get older.

It mainly affects adults over 40, but can occur at any age. It is more common in people of African, Caribbean, or Asian descent, and if you have a family history of glaucoma.

Symptoms

Common symptoms

• In the early stages, there are usually no symptoms at all.
• As the condition progresses, you may gradually lose your side (peripheral) vision, often in both eyes.
• Eventually, you may feel like you are looking through a tunnel (tunnel vision), and central vision can also become blurry.

Symptoms in children

• Open-angle glaucoma is very rare in children, but if it occurs, symptoms may include a cloudy or enlarged eye, excessive tearing, sensitivity to light, or squinting.

Symptoms in older adults

• Same as general symptoms — gradual loss of peripheral vision, often unnoticed at first.
• Some older adults may also have difficulty adjusting to dim lighting or experience more frequent falls due to reduced side vision.

Causes

Main causes

• The exact cause is not fully understood, but it involves a slow blockage of the eye's drainage canals, leading to increased pressure inside the eye (intraocular pressure). This pressure damages the optic nerve over time.
• In some cases, the optic nerve is sensitive to normal or only slightly raised pressure, so damage can occur even without very high pressure.

Risk factors

• Age over 40
• Family history of glaucoma (especially a parent, sibling, or child)
• African, Caribbean, or Asian ethnicity
• Nearsightedness (myopia)
• Thin corneas (the clear front part of the eye)
• Past eye injury or surgery
• Long-term use of corticosteroid medications (such as eye drops, pills, or inhalers)
• Certain medical conditions like diabetes, high blood pressure, or low blood pressure

When to see a doctor

See a doctor urgently if:

• If you experience sudden loss of vision, severe eye pain, or see halos around lights — call emergency services right away.
• If you have a red, painful eye that doesn't improve quickly, see a doctor the same day.

Book a routine appointment if:

• If you are over 40 and have not had a comprehensive eye exam in the past year or two.
• If you have a family history of glaucoma, get your eyes checked every one to two years.
• If you notice any vision changes, even gradual ones, make an appointment with an optometrist or ophthalmologist.

Diagnosis

Glaucoma is detected during a comprehensive eye exam. Your eye doctor will measure the pressure inside your eye, examine the optic nerve, test your side vision (visual field), and measure the thickness of your cornea.

Tests that may be done

• Tonometry: a puff of air or a gentle probe measures the pressure inside your eye.
• Ophthalmoscopy: drops are put in your eyes to widen your pupils, then a special lens is used to look at the optic nerve.
• Perimetry (visual field test): you look at a screen and press a button when you see tiny lights, to map your side vision.
• Gonioscopy: a contact lens with mirrors is placed on your eye to check the drainage angle.
• Pachymetry: a small probe gently touches your eye to measure corneal thickness.

What to expect at your appointment

Your eyes will be numbed with drops for most tests. The drops that widen your pupils can cause blurry vision and sensitivity to light for a few hours, so bring sunglasses and arrange for someone to drive you home. The exam is painless and usually takes under an hour.

Treatment

Treatment cannot reverse vision loss that has already happened, but it can slow or stop further damage. The main goal is to lower the pressure inside your eye. Treatment is usually lifelong, and you will need regular follow-up exams.

Self-care at home

• Use your prescribed eye drops exactly as directed, even if you feel fine — skipping doses can let pressure rise.
• Keep all eye appointments to monitor pressure and nerve health.
• Tell your eye doctor about any other medications you take, especially steroids.
• Wear eye protection during sports or yard work to avoid injury.

Medical treatments

First-line treatment is usually prescription eye drops that lower eye pressure by reducing fluid production or improving drainage. You may need more than one type. Your doctor will choose the best option for you. Oral medications (pills) may be added if drops aren't enough. Laser treatment (called trabeculoplasty) can help open the drainage channels and is often done in the office. Laser can be used alone or with drops.

When is surgery considered?

If drops and laser are not enough to control pressure, surgery may be recommended. A common surgery is trabeculectomy, where a new drainage channel is created. Other procedures use tiny tubes or devices to drain fluid. Surgery is usually done when other options have failed or are not suitable.

Living with this condition

Living with open-angle glaucoma means staying on top of your treatment and monitoring. Most people can continue their normal daily activities, including driving, working, and hobbies — as long as vision is still good. Keep a list of your medications, and set reminders for drops. Talk to your doctor about any concerns with daily tasks.

Lifestyle tips

• Use your eye drops consistently — set alarms or link them to a daily habit like brushing your teeth.
• Ask your pharmacist about techniques to make putting in drops easier (like using a drop aid).
• Avoid activities that increase eye pressure temporarily, such as heavy weightlifting or holding your breath while straining.
• If you have reduced side vision, take extra care when walking in crowded places, crossing roads, or driving at night.

Diet and exercise

A healthy diet rich in green leafy vegetables (like kale and spinach) and colorful fruits may support eye health, though it cannot cure glaucoma. Regular exercise, such as walking or swimming, is generally good for overall health and may help lower eye pressure slightly. But avoid exercises that involve inverted positions (like certain yoga headstands) or heavy lifting, as these can spike pressure temporarily.

Mental health and emotional wellbeing

A diagnosis of glaucoma can bring worry about losing your sight. It's normal to feel anxious, sad, or frustrated. Remember that with treatment, most people keep useful vision for life. Talk to your healthcare provider about your feelings — they can connect you with support services. If you feel overwhelmed, reach out to a counselor or a support group.

Prevention

Open-angle glaucoma cannot be completely prevented, but you can greatly reduce your risk of vision loss by having regular eye exams and catching it early. If you are at higher risk (older age, family history, certain ethnicities), get checked every one to two years.

Vaccines

There is no vaccine for glaucoma.

Screening programmes

Eye exams that check pressure and the optic nerve are the best screening. In the UK, the NHS offers free sight tests for people over 60, those with a family history of glaucoma, and some other groups. Ask your optician if you qualify.

Complications

If left untreated

• Gradual, permanent loss of side (peripheral) vision
• Tunnel vision — only seeing what is directly in front of you
• Blindness in the affected eye(s) — this is the most serious complication

Long-term outlook

The outlook for open-angle glaucoma is generally very good when detected early and treated properly. Most people with glaucoma do not go blind. Treatment can usually keep your eye pressure under control and preserve your sight for years. Even if some vision is lost, many people adjust well and continue to live full, active lives. Regular care is key.

Find support

International organisations

• International Glaucoma Association (IGA)
• Glaucoma Research Foundation

Local organisations

• NHS Glaucoma Services · United Kingdom

Helplines

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