Aqueous humor is a liquid used to nourish the eye and is produced by the ciliary body located behind the iris. 
It passes in front of the eye where it is drained in the irido-corneal angle through an open outlet valve. When the channels block drainage, the fluid can not get out of the eye, accumulates, and the intraocular pressure (inside the eye) increases.

Physiologically, ocular pressure has a value between 10 and 20 mmHg, above this range of values, the pressure becomes higher than that tolerated by the optic nerve and glaucoma develops.

This pathology is degenerative, that is, if it is not treated in time it can cause damage to the optic nerve, compromising the individual’s ability to see correctly and even loss of vision.

 

The most common types

Glaucoma is a very common disease, affecting approximately 80 million people worldwide, of which 1 million are in Italy alone.
There are different types (some more often than others) that allow us to distinguish a glaucoma:

Open angle: is the most common form of glaucoma and indicated as chronic or primary glaucoma. In this form there is a moderate increase in intraocular pressure caused by obstruction of the gradual and partial outflow tract (hence the name open angle). If you think you have a strong hereditary component and it usually affects people between the ages of 40 and 50. It is a very insidious form of glaucoma, so it is often asymptomatic and the patient only becomes aware of the problem when the optic nerve is already compromised.

Closed angle: Also known as acute or narrow-angle glaucoma, it is the second most common form of glaucoma. It occurs acutely, drainage systems become clogged, intraocular pressure rises rapidly and the patient experiences symptoms such as pain in the eyes, severe inflammation and sudden loss of vision.
It usually occurs after age 50 and the risk increases with age but can sometimes occur even in children, causing childhood blindness.

Low pressure: also called normal pressure glaucoma, is an open angle glaucoma variant, but with low pressure. It occurs in approximately 10-30% of patients with primary glaucoma and is a form that tends to be bilateral, affecting both eyes.

Pigmentar: is a variant of open angle glaucoma due to a blockage of the drainage channels of pigment granules (small lipid molecules).

Congenital:  occurs predominantly in children aged 0 to 2 years and is caused by an erroneous conformation of the camerular angle, the structure of the eye that allows the fluid to drain properly.

Secondary: Occurs as a result of ocular diseases that cause a change in the output of the aqueous humor. It can occur acutely and has a chronic course. Examples of secondary glaucoma are the abuse of cortisone drugs , neovascular glaucoma that manifests as a consequence of diabetic retinopathy  and pigmentary glaucoma where the fragments leaving the iris block the flow of intraocular fluid.

 

Causes and risk factors of increased intraocular pressure

The main cause of glaucoma is increased intraocular pressure, caused by an imbalance between the production of the aqueous humor (which is a liquid that is located inside the eye) and its drainage. The reason this pathology is currently unknown is unknown, but there are risk factors that may predispose a person to experiencing ocular hypertension and consequently glaucoma.

Among the risk factors we have:

Age:  Although some forms of glaucoma occur from childhood, the risk of contracting this disease increases with age. The maximum risk is after age 60, when the chance of having glaucoma increases up to six times compared to younger people.

Familiarity: inheritance of the disease seems to be one of the most important risk factors. In other words, anyone who has a family member who suffers or has suffered from glaucoma, has a greater chance of contracting this disease.

Congenital Factors: Some people have congenital abnormalities of the structures of the eye that may predispose them to glaucoma. For example, individuals who have a very low corneal thickness below 500 microns are at increased risk of developing this disease.

Medications: Certain categories of medications, particularly corticosteroids , ie, cortisone medications, used systematically or topically, appear to be one of the risk factors for increased intraocular pressure and consequently for glaucoma.

Trauma: Traumatic glaucoma can be caused by eye trauma , which can occur in those who practice violent sports such as boxing or sports involving balls (such as tennis or baseball) that can end up inside the eye or also in those who hit the head due to a fall or a car or motorcycle accident.

Ethnicity : It seems that belonging to a certain ethnicity increases the risk of contracting glaucoma. In particular, people who are most affected are those of African American ethnicity, in whom glaucoma is 6-8 times more frequent than in the Caucasian population.

Eye problems: Individuals affected by farsightedness or myopes appear to be more prone to the risk of developing glaucoma. Also, eye irritation, such as uveitis, may be related to glaucoma.

Diseases: Those suffering from diseases such as diabetes or thyroid problems may be at risk for glaucoma. Diabetes is a metabolic disease that predisposes to the development of this disease, in fact diabetics often suffer from eye problems, particularly in the retina (diabetic retinopathy) and this condition may increase the risk of glaucoma.

 

Symptoms of glaucoma

Some forms of glaucoma are asymptomatic and therefore pose a serious danger to the eyesight of the patient who discovers the disease when too late. Other forms have well-defined symptoms such as:

Mydriasis: is the dilation of the pupil that occurs mainly in cases of acute glaucoma. It often accompanies the reduction of pupil reflexes. The result is a reduction in vision with obfuscation and appearance of halos and looking at a light source.

Reduction of the field of vision: one of the symptoms of glaucoma is the reduction of peripheral vision, the patient complains that they no longer see laterally.

Headache: The view is compromised and increased intraocular pressure can cause the appearance of very strong headache which is accompanied by a feeling of nausea and sometimes vomiting .

Inflammation and itching of the eyes: In some forms of glaucoma, especially in the acute ones, the eye is inflamed and reddish (the eyes appear to be full of blood) and the patient feels excruciating pain.

 

Diagnosis of glaucoma

The diagnosis of glaucoma depends on a combination of several tests.
The diagnosis of glaucoma is made by the ophthalmologist after an ophthalmological examination and a series of tests that confirm the presence of the disease. Tests that can be performed to diagnose glaucoma include:

Intraocular pressure measurement: this is the first examination done by the ophthalmologist, it is used to evaluate whether the intraocular pressure is normal or not. It is done with a tool called tonometer.

Ophthalmoscopy : performed through the ophthalmoscope, serves to assess the presence of damage to the optic nerve by checking the fixation point with the eyeball.
With this examination the retina can also be evaluated. If glaucoma is present, the optic nerve will exhibit morphological and colorimetric changes and the point where it connects to the eyeball appears thinner.

Computerized perimetry: This is an examination used to evaluate the patient’s visual field and therefore is useful to see if there is loss of sight.

Gonioscopy: an exam that evaluates a structure called the discharge angle that serves to drain the fluid from the eye. In case of glaucoma it is necessary to determine if this angle is partially or totally blocked.

Optic papule tomography: an exam used to evaluate the shape of the optic nerve and the condition of nerve fibers and nerve cells. It is useful to identify damage to the optic nerve in an earlier way.

Corneal thickness measurement: Also called corneal pachymetry, this test is used to measure the thickness of the cornea, considering that a cornea with a thickness of less than 500 microns is defined thin and increases the risk of glaucoma.

It is not always necessary to perform all the types of tests listed above, it will be the doctor to determine which exam will be performed.

 

Treatment to decrease eye pressure

Once the diagnosis is made, it is possible to prevent further loss of sight, while visual damages already present are no longer reversible. The goal of therapy is to stop the progression of glaucoma by reducing eye pressure.

Medications
Medications are used to treat glaucoma to decrease intraocular pressure, prevent optic nerve degeneration, and result in decreased vision.

The following drugs are currently used:

  • Beta-blockers are the drugs of choice for the treatment of glaucoma, especially for that of the open angle. Its action on the mechanism of the eye decreases the production of the aqueous humor and consequently reduces the intraocular pressure. It can be taken orally or as eye drops. For the treatment of glaucoma, this second option is recommended. An example of beta-blockers for use in the form of eye drops is betaxolol.
  • Prostaglandin analogs : are used when it is not possible to administer betablockers to the patient. Its action helps drainage of the intraocular fluid and decreases pressure inside the eye. It can cause hyperpigmentation of the iris as a side effect and is given as eye drops. Examples of such medications are travatan and xalatan.
  • Inhibitors of carbonic anhydrase : are used as an alternative to the use of beta-blockers or in combination with them, the action is to inhibit the formation of intraocular fluid. They are given as eye drops and Dorzolamide Hydrochloride (Cosopt) is an example.
  • Sympathomimetics: These drugs mimic the activity of catecholamines such as adrenaline to decrease intraocular pressure. They are given as eye drops and can be an alternative to beta-blockers. Examples are pilocarpine and brimonidine.

 

Laser for or glaucoma

Surgery
When drug therapy is not effective or if it is contraindicated, surgery is required.

Laser use:  One possible treatment for glaucoma is laser surgery, which depends on the type of glaucoma to be treated.

In particular: for open-angle glaucoma: using a type of ablation procedure called a laser  of  argon . Therapy aims to dilate obstructed drainage pathways by reducing intraocular pressure.

For angle-closure glaucoma : a procedure called iridectomy is used using a yag laser that has the ability to perform micro-incisions that allow the intraocular fluid to return to circulation.
This type of laser is used for the prevention of acute glaucoma in people with abnormal intraocular pressure or in place of surgery.
When it is not possible to treat with medicines or with the laser, it is necessary to intervene surgically.

Surgery
If neither pharmacological therapy nor laser therapy produce results, the physician will advise the patient to undergo surgery. This is called filtration and serves to allow better drainage of the aqueous humor creating alternative routes in place of that blocked. In particular, it is possible to implant valves made of plastic that encourage drainage, dilate the channels that are blocked or create new drainage ways. Surgery is performed under local anesthesia , but in some cases, as children, general anesthesia and patient hospitalization are preferred.

 

The postoperative period

In the postoperative period, the doctor prescribes special eye drops  that are designed to promote healing and prevent the onset of complications.
The time for healing is estimated one to two months after surgery.

 

Natural Remedies to Relieve Discomfort

Natural remedies for glaucoma are considered adjunctive therapies of other therapies and consist mainly of eating advice and the use of spices and plants to help relieve discomfort.

  • Diet:  Glaucoma sufferers should avoid certain foods, including coffee, beer and tea, as they contain substances such as caffeine and teina that cause vasoconstriction and thus impede the flow of intraocular fluid. Many liquids, such as milk, fruit juices, and excess water, should also be avoided because they increase the amount of fluid produced in the eye that is unable to flow properly, causing the symptoms to worsen.
  • Spices: such as paprika can be used to improve the flow of liquid into the eyes. In fact, it contains capsaicin, which is a vasodilator,  so it increases blood flow in the eyes, dilates blood vessels and promotes fluid flow. It may use a little (a few mg) dissolved in water, but always under medical advice.
  • Plants such as fennel and Euphrasia officinalis can be used in case of glaucoma. Fennel is a potent  anti-inflammatory because it contains active ingredients such as glycoside, and tannin. Its seeds can be used to prepare a decotion to be applied over the eyes. Euphrasia officinalis is widely used in the treatment of ophthalmological diseases such as conjunctivitis. Used in the form of decotion can be applied on the eyes.
  • Vitamins: It is also possible to use vitamin supplements, especially vitamin C and B vitamins seem to be helpful in reducing intraocular pressure.
  • Homeopathy: Another possible natural remedy for glaucoma is represented by homeopathy. The homeopathic remedy used is Kalium chloratum, for use with a dilution of 15 drops and in the form of granules. If taken three times a day.

Practical information and the latest news for the treatment of glaucoma in the eye.

Researchers are still working to find new solutions for the treatment of glaucoma.
There are currently two important innovations in treating this condition:

  • New type of surgery called canaloplástica , whose goal is to make the blocked channel again permeable through the insertion of a tiny catheter. This will allow the intraocular fluid to drain unimpeded. The surgery lasts about fifteen minutes and is performed under local anesthesia .
  • Autologous transplantation: that is, stem cells taken from the patient that serve to reduce the degeneration of the fibers of the optic nerve. The cells are collected in the olfactory epithelium and introduced directly into the optic nerve. This procedure is still being tested.

 

Frequently Asked Questions

Can we do glaucoma prevention? Yes, if you fall into one of the categories of risk, for example, if there are cases of glaucoma in the family or for individuals over 60, it is necessary to undergo an ophthalmological consultation to detect initial forms and prevent the appearance of a form acute

Can I wear contact lenses?  Usually, there are no contraindications to the use of contact lenses.

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