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Glaucoma is a condition in which the pressure within the eye is elevated. If untreated, it can damage the optic nerve and lead to blindness. Since the optic nerve is relatively strong, it can often withstand years of elevated eye pressure before damage occurs. However, once damage is done, it is irreversible.
There are two sorts of glaucoma: gradual onset (chronic) and sudden onset (acute). Chronic glaucoma is the most common form and usually has no symptoms until an irreversible loss of vision has occurred.
Incidence; Causes & Development
Chronic glaucoma usually occurs after the age of 35 years but is sometimes seen in children.
The front of each eyeball is filled with a watery fluid called the aqueous humour, which is continually produced and drains from the front of the eye through a small channel. An increase in pressure can result either from too much fluid being produced or from too little draining away: glaucoma is almost always due to the latter.
The cause of chronic glaucoma usually is unclear.
Other causes include blockage of a vein in the eye, tumors or pupil dilation. When the pupil dilates, the drainage channel gets blocked: an attack of acute glaucoma can be brought on by anything that causes the pupil to dilate, such as dim lighting, certain eye drops and some medications such as various types of antidepressant medicine.
Signs & Symptoms
Loss of vision initially affects only the extreme edges of one's field of view; if the raised pressure is not treated, the impairment of vision spreads and can cause blindness.
Patients with chronic glaucoma experience a very gradual increase in eye pressure that slowly damages the optic nerve, resulting in a slow-but-progressive loss of vision. Usually both eyes are affected and the visual loss may not be immediately apparent since it starts at the edges of the field of vision. However, if it is not treated, it can eventually cause blindness.
In those with acute or 'closed-angle' glaucoma, symptoms start suddenly and usually affect only one eye. Initially, there may be a slight decrease in vision, the appearance of colored halos around bright objects and pain in the eye and head. After a few hours the symptoms become much more severe with rapid loss of vision and sudden, severe throbbing pain in the eye. The eyelid swells and the eye becomes red and watery, with a dilated pupil that doesn't respond to light by closing, as it should. There may be nausea and vomiting. Although most symptoms disappear after treatment with medication, there may be some remaining loss of peripheral vision. Attacks can re-occur, and if they do, each one tends to further reduce the field of vision.
Diagnosis & Tests
Glaucoma is diagnosed by measuring the pressure of the fluid in the eyeball: the intraocular pressure. This is usually done with a tonometer, of which there are two basic types. The simplest uses a puff of air blown against the surface of the eye. More commonly, a Goldman tonometer is used, as this gives more accurate measurements. To use this, the eye specialist will put some drops in the eyes. These may sting slightly to start with but then the surface of the eye becomes numb. Using a microscope, the tonometer is then brought in close so that it lightly touches the surface of the eye. The procedure takes only a moment or two and is painless. During an attack of acute glaucoma, the diagnosis is usually easily made. However, in chronic glaucoma it is sometimes necessary to make a series of measurements over time to confirm the diagnosis.
There are some other tests that may be done. Firstly, using an ophthalmoscope (an instrument with a bright light), the optic nerve at the back of the eye will be observed. Secondly, a patient's visual fields may be examined by having them look straight ahead at a central point and say when they see a spot of light appear at the side. Finally, the eye may be examined with a contact lens with a tiny mirror attached. Eye drops are used to numb the surface of the eye first. This examination may take 5 to 10 minutes.
Prognosis
Most people with glaucoma respond well to treatment. Intraocular pressure can usually be controlled by the regular and sustained use of eye drops and medication, preventing any further loss of vision.
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Signs, symptoms & indicators of Glaucoma:
Conditions that suggest Glaucoma:
Risk factors for Glaucoma: | | | | | Family History |  Glaucoma in close family members |
Personal Background |
African ethnicity | Glaucoma is more common in certain racial groups, notably Afro-Caribbeans. |
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Supplements and Medications |
Major/moderate/minor steroid use| | The use of all steroid drugs has been associated with causing "steroid glaucoma" in certain individuals. It is thought that about 5% of people using topical steroids will have a large increase in intraocular pressures. The glaucomatous damage produced is usually stopped by discontinuing use of the steroid; the intraocular pressure returns to normal in about 2 to 4 weeks. However, for those who have been on corticosteroids for more than 4 years, chronic glaucoma can develop that requires treatment. This type of glaucoma is without symptoms and thus similar to primary or low tension open angle glaucoma. The use of steroids very rarely causes a closed angle attack. Patients on these medications need to have eye exams at least twice a year. |
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Symptoms - Head - Eyes/Ocular |
 Having had eye injury or surgery| | A previous eye injury or surgery, especially if this involved bleeding into the eye, can cause glaucoma. |
Past eye infection or inflammation| | In some cases, pressure within the eye may rise suddenly after a blow to the eye or during an attack of iritis. |
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Glaucoma suggests the following may be present: | | | | | Habits |  Need For Routine Preventative Health Measures| | Regular eye tests are recommended if you are over 40 years old. The test for glaucoma must be performed by a trained person, either an ophthalmologist or a trained ophthalmic optician. The test for glaucoma may not be a part of the standard eye test given and should be requested.
Those diagnosed with glaucoma will need to attend regular follow-up appointments during which any perceived loss of vision must be reported. Those who have had an episode of acute glaucoma should be aware of the early symptoms and consult a doctor immediately should they re-occur. |
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Recommendations and treatments for Glaucoma: | | | | | Botanical |  Coleus| | Studies in healthy humans, including at least one double-blind trial, have shown that direct application of an ophthalmic preparation of forskolin to the eyes lowers eye pressure, thus reducing the risk of glaucoma. [Lancet 1983;1: pp.958-60, Klin Monatsbl Augenheilkd 1984;185: pp.522-6] Direct application of the whole herb to the eyes has not been studied and is not recommended. |
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Diet |
 Caffeine/Coffee Avoidance| | A single dose of caffeinated coffee (but not decaffeinated coffee) can increase intraocular pressure in persons with glaucoma. [Ann Pharmacother 2002;36(6): pp.992-5] |
Therapeutic Fasting |
Drug |
 Conventional Drug Use| | It is most important for those having been diagnosed with glaucoma of any sort to use any medication that they are given by an ophthalmologist as directed. Medicated eye drops, which work by increasing drainage of aqueous fluid or reducing its production, can usually control chronic glaucoma. These pressure reducing drugs may include:- A 'beta-blocker' (e.g. betaxolol)
- A 'miotic' (e.g. pilocarpine)
- Adrenaline-related drugs (e.g. apraclonidine)
- A 'carbonic anhydrase inhibitor' (which may be taken by mouth; e.g. acetazolamide)
During an attack of acute glaucoma, treatment by mouth either with a carbonic anhydrase inhibitor or with glycerine solution can abort the attack, if taken early enough. In a severe attack, an intravenous injection of a drug called mannitol may be necessary to bring the intraocular pressure down promptly. Beta-blocker and pilocarpine eye drops are also usually given. After an attack, treatment usually continues with eye drops and doses of a carbonic anhydrase inhibitor. |
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Nutrient |
Alpha Lipoic Acid| | 150mg per day improves visual function in people with both stage I and stage II glaucoma. |
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Surgery/Invasive |
Surgery| | In all forms of glaucoma, if the pressure cannot be controlled with medicines and eye drops, or if the side-effects are unacceptable, the drainage from the front part of the eye can be increased surgically. This can be done either by using a laser to create a hole in the iris or by using microsurgery to cut out part of the iris. Usually both eyes are treated. |
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KEY | | Weak or unproven link | | | Strong or generally accepted link | | | Proven definite or direct link | | | May do some good | | | Likely to help | | | Highly recommended |
GLOSSARY
Acute
An illness or symptom of sudden onset, which generally has a short duration.
Antidepressant (Antidepressants)
Literally, substances meant to oppose depressions or sadness, and generally heterocyclic types such as Elavil, MAO inhibitors like phenelzine, or lithium carbonate. This category of substances formerly included stuff like amphetamines and other stimulants. Botanical examples include Hypericum, Peganum and Oplopanax.
Chronic (Chronicity)
Usually referring to chronic illness: Illness extending over a long period of time.
Glaucoma
A disease of the eye characterized by vision loss due to an increase in the pressure of fluid within the eye. This rise in pressure results from a build-up of aqueous fluid and leads to progressive damage to the optic nerve that transmits visual signals to the brain. Over time, glaucoma can lead to a gradual loss in peripheral vision. There are usually no signs that you're developing glaucoma until vision loss occurs.
Herbs (Herb, Herbal)
Herbs may be used as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, teas should be made with one teaspoon herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Tinctures may be used singly or in combination as noted. The high doses of single herbs suggested may be best taken as dried extracts (in capsules), although tinctures (60 drops four times per day) and teas (4 to 6 cups per day) may also be used.
Iritis (Rheumatoid Iritis, Viral Iritis)
Inflammation of the iris, the colored part of the eye. Rheumatoid Iritis: An autoimmune (rheumatoid factor) inflammation of the iris. This is a face of rheumatoid arthritis seldom diagnosed, along with rheumatoid otitis. Viral Iritis: A viral infection of the iris. It appears red and swollen, and pupil contraction and relaxation is erratic and pulled. The usual cause is a herpes infection, often resident in the trigeminal nerve, and reoccurring during times of stress or sympathetic to a larger viral condition.
Milligram (mg, Milligrams)
0.001 or a thousandth of a gram.
Steroid (Steroids)
Any of a large number of hormonal substances with a similar basic chemical structure containing a 17-carbon 14-ring system and including the sterols and various hormones and glycosides.
Topical
Most commonly 'topical application': Administration to the skin.
Last updated: Nov 14, 2009
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