Overview
Glaucoma is a group of eye conditions in which the optic nerve, which connects the eye to the brain, is damaged. It is usually caused by increased pressure in the eye (intraocular pressure), though it can occur with normal pressure. It is the leading cause of irreversible blindness worldwide and typically has no symptoms until significant damage has occurred.
How common is it?
Glaucoma affects about 600,000 people in the UK. It becomes more common with age: about 1 in 50 people over 40 and 1 in 10 people over 75 are affected.
Causes and risk factors
Fluid produced inside the eye drains through a small channel. When drainage is impaired, pressure builds up and gradually damages the optic nerve fibres, starting from the peripheral visual field.
Common risk factors
- Age over 40
- Family history of glaucoma (first-degree relative)
- High intraocular pressure
- Black African or Caribbean ancestry (higher risk)
- Long-sightedness (angle closure) or short-sightedness (open angle)
- Prolonged use of steroid eye drops or medications
- Eye injury or previous eye inflammation
Symptoms
- Usually NO symptoms in the early stages
- Gradual loss of peripheral (side) vision, which may only be noticed late
- In acute angle-closure glaucoma: sudden severe eye pain, headache, blurred vision, halos around lights, nausea
When to see a doctor
Go to A&E immediately for sudden eye pain with blurred vision and halos around lights (acute angle closure, a medical emergency). Attend routine eye tests every 2 years to detect open-angle glaucoma before vision is lost.
Diagnosis
Intraocular pressure measurement, visual field testing, and optic disc assessment (ophthalmoscopy or OCT scanning) diagnose glaucoma. Gonioscopy assesses the drainage angle.
Treatments
Eye drops to lower intraocular pressure
Prostaglandin analogues (latanoprost), beta-blockers (timolol), and other drops are used daily to reduce eye pressure and slow nerve damage. Must be used consistently for life.
Laser treatment
Selective laser trabeculoplasty (SLT) improves drainage and can reduce or replace the need for eye drops in suitable patients.
Surgery (trabeculectomy or drainage implants)
Creates a new drainage channel for fluid when drops and laser fail to control pressure adequately.
Self-care and lifestyle
- Use eye drops exactly as prescribed, including on days when you feel well
- Attend all follow-up appointments as progression must be monitored
- Inform all your doctors and dentists that you have glaucoma
- Eye tests every 2 years (or annually if over 60 or high risk) give the best chance of early detection
Prevention
Glaucoma cannot be fully prevented, but early detection through regular eye tests and consistent treatment preserve vision. Family members of people with glaucoma should have regular eye screening.