Like a ticking time bomb, blindness is waiting to explode in a glaucoma eye. Sadly however, majority of persons with glaucoma have it for years without them ever knowing. It is estimated that less than half of the patients with glaucoma are aware they have it. This is especially true for the open angle type of glaucoma, where the intraocular pressure slowly builds up over the years and pushes the frail nerves of the eye responsible for vision.
What You Don’t Know Can Blind You: Understanding Glaucoma Symptoms
Asymptomatic glaucoma is the most common type of glaucoma in the elderly. Aging and degenerative changes in the eye is thought to be the cause of primary open angle glaucoma seen in senior citizens. It is rather unfortunate that glaucoma symptoms can only begin to be obvious when it has reached its terminal stage of the disease. For the elderly who are the most at risk, it is therefore imperative to have their eyes examined even before glaucoma symptoms appear.
Glaucoma can also be caused by a variety of medical conditions from hypertension, diabetes, to defects in the normal anatomical drainage system of the eye brought about by trauma, infection or congenital defects. This vital eye structure is called the canal of Schlemm, located in the junction between the iris and sclera. It functions to drain the aqueous fluid that lubricates and cushions the eye. For acute angle closure glaucoma, It can become obstructed suddenly, raise intraocular pressure in dangerous levels and compromise vision rapidly. But for the silent majority of open angle glaucoma, it acts in stealth, slowly blocking the canal and elevating the pressure over the years.
For glaucoma, pressure reaches usually beyond 10-21mm Hg for visual impairments to be apparent. However there are certain patients with normal tension glaucoma who may show frank symptoms but still show normal intraocular pressures on eye examination. As mentioned, one may not necessarily have one or more of the following symptoms below to have glaucoma. But definitely the presence of one of the glaucoma symptoms enumerated below is enough to consider glaucoma and report it to your eye doctor or glaucoma specialist immediately.
Loss of Vision
The scariest scenario a person with glaucoma could ever experience is losing their sight out of the blue. Imagine suddenly seeing total darkness without a warning. This is one of the tell-tale symptoms of a severely obstructed canal or presence of acute angle closure glaucoma. But for the open angle glaucoma however, changes are often gradual and transient, usually affecting the peripheral vision first. A patient may describe this blind spot as some part of their visual field abruptly cut off in a shape of a crescent moon or a quarter of a pie. If left untreated over the years, vision is further compromised and progresses into a gradual tunneling of vision. A patient usually will tell you that they are looking as if into a small hole or a telescope or a curtain has been drawn into their line of sight. Some also experience sensitivity in staring at light or see a halo image around them. Although both eyes are usually affected, symptoms may initially be apparent in one eye.
Red eye
Mounting pressures inside the eyeball can also begin to manifest in the external blood vessels of the white of the eye (sclera) or transparent part of the eye (iris). Eye redness can present suddenly a day or intermittently over the months. It could often be mistaken for an eye allergy or infection, which usually do not respond well to ophthalmic antibiotic drops and disappears as mysteriously as it came. Patients may also complain of excessive tearing in the eye.
Eye pain, Nausea and vomiting
Majority of patients with open angle glaucoma will not present with eye pain Majority are silent and asymptomatic over the years. If a patient however suddenly experiences severe eye pain together with blurring of vision, nausea and vomiting, it is highly likely that the patient has open angle closure glaucoma. This is a kind of emergency type of glaucoma where the patient’s vision can be compromised. 1
If you suffer from one of the following symptoms above, it is imperative to have your eye checked for glaucoma without delay. An eye doctor or glaucoma specialist is equipped to verify glaucoma symptoms through modern diagnostic eye instruments that measure intraocular pressure and look at internal changes in the nerve of the eye. They also will do a battery of test to determine the extent of your vision loss.
Whether of the open angle or the closed angle type of glaucoma, the good news is that if it is picked up in its early stages, glaucoma can be stopped in its tracks, even before irreversible neural optic damage has occurred. There is a myriad of treatment options available to lower intraocular pressure in the glaucoma eye- from medicines, laser to surgery. Even better are the advances in the field of interventional ophthalmology which can anatomically correct the obstruction in the canals and open them up with microcatheters in non-invasive ways.
Like a ticking time bomb, blindness is waiting to explode in a glaucoma eye. Sadly however, majority of persons with glaucoma have it for years without them ever knowing. It is estimated that less than half of the patients with glaucoma are aware they have it. This is especially true for the open angle type of glaucoma, where the intraocular pressure slowly builds up over the years and pushes the frail nerves of the eye responsible for vision.
References
1. Marx: Rosen’s Emergency medicine 7th editiion Chapter 69 pages 11-12
Don’t delay getting checked for glaucoma.
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