Glaucoma : Symptoms, Causes and Treatment

Glaucoma is a condition in which there is a disruption in the eye fluid drainage system. The disruption of the drainage system will increase pressure on the eyeball and damage the optic nerve. Someone who suffers from this condition can feel symptoms such as visual disturbances, pain in the eyes, and headaches.

Basically, the eye has a drainage system that functions to drain aqueous humour liquid into the blood vessels. Aqueous humor itself is a natural liquid that functions to maintain the shape of the eyes, supply nutrients, and cleanse dirt on the eyes. When there is a disruption in the drainage system, it causes a buildup of aqueous humor and increases pressure on the eyeball. Increased pressure on the eyeball can then damage the optic nerve.

Based on disorders that occur in the eye drainage system, glaucoma is divided into several types, namely:

Open-angle glaucoma. This type of glaucoma is the most common condition. In open-angle glaucoma, the drainage channel of the aqueous humor is only partially inhibited because the trabecular meshwork is impaired. Trabecular meshwork is an organ in the form of a net that is located in the drain channel of aqueous humor.
Closed angle glaucoma. In this type, the aqueous humour liquid drain is completely closed. Acute closed-angle glaucoma or sudden onset is an emergency condition and requires immediate treatment.
Glaucoma is the second most common cause of blindness in the world after cataracts. Data compiled by WHO in 2016 showed that 285 million people in the world suffer from blindness and 39 million of them caused by glaucoma.

Although glaucoma is not a preventable condition, the symptoms will be more easily alleviated if the condition can be detected and treated early.

Symptoms of Glaucoma

Symptoms that appear in each person can vary, depending on the type of glaucoma, severity, and overall physical condition. However, glaucoma sufferers generally experience vision problems. Some visual disturbances that appear can be:

Blurred vision.
There is a rainbow-like circle when looking at bright light.
There is a blind spot on the side (peripheral) or middle (central) area of view.

There are also other symptoms commonly experienced by sufferers of closed (acute) angle glaucoma, namely:

Severe headaches.
Eye pain
Nausea
Gag
Red eye.

Symptoms of glaucoma generally require a relatively long time to appear and feel the sufferer. The best way to detect glaucoma is to do an eye exam regularly.

Causes of Glaucoma

Increased pressure that damages the optic nerve is the result of aqueous humor caused by a disruption in the drainage system or drainage channels. Aqueous humor is a liquid that functions to maintain the shape of the eyes, supply nutrients, and remove impurities in the eyes. The cause of the disruption in the drainage system itself is not known exactly. However, there are allegations that gene abnormalities are a major factor causing the condition.

In addition to gene abnormalities, there are also other conditions that are thought to cause disruption in the drainage system experienced by glaucoma sufferers. Some of them are:

Injury due to exposure to chemicals.
Infection
Blockage of arteries.
Inflammation

The risk of someone having glaucoma will also increase if:

Aged more than 60 years.
Has a history of diabetes, heart attack, high blood pressure, and sickle cell anemia.
Have a history of eye diseases, such as nearsightedness.
Have had eye surgery.
Experiencing estrogen deficiency conditions, such as those that can appear when undergoing removal of both ovaries.
Receive corticosteroid drugs for a long time.

Diagnosis of Glaucoma

Glaucoma can be detected earlier with regular eye examinations, even before symptoms appear. Eye examination is performed at least once every 1-2 years, especially for those who have high risk.

When the examination shows suspected glaucoma, several tests can be used to ascertain the condition. The test in question is:

This test uses a special tool called a tonometer. In the process, the tonometer will be attached to the eye to check the pressure. Before that, the patient will first be given drops anesthesia.
Field of view test. This test aims to examine the patient's entire eye view. The doctor will ask the patient to observe the various points displayed on a special device called the perimeter. If the eye condition is abnormal, there will be points that are not visible to the patient.
In the process, the doctor will examine the condition of the patient's eyes using a microscope or eye-specific scanner. Before that, the patient will be given drops that function so that the pupil can remain widened during the procedure.
This test aims to check the thickness of the cornea. Corneal thickness shows high and low pressure in the eye. Pachymetry includes the fastest pain-free test.
Gonioscopy is a test that aims to find out the fluid that is buried in the eye. In the process, doctors use assistive devices such as lenses and special mirrors called genioscopes.

Treatment of Glaucoma

There is no method that can restore the damage that has occurred to the optic nerve due to glaucoma. However, treatment can relieve symptoms and prevent total blindness.

In dealing with glaucoma, there are several methods that can be used. Ophthalmologists will determine the right method and adapt it to the conditions.

Giving drops

Giving drops is the first treatment done. Some of the drops commonly used to treat glaucoma are:

Miotic or cholinergic drugs, such as pilocarpine. This drug serves to facilitate the flow of fluid that is inside the eye.
Prostaglandins, such as latanoprost and bimatoprost. This drug serves to facilitate the flow of aqueous humor, so that the pressure on the eye decreases.
Beta blockers, such as timolol and betaxolol. Giving beta blockers aims to reduce the production of aqueous humor in the eyes.

Doctors will also recommend carbonic anhydrase inhibitors, such as brinzolamide. However, the use of this drug is still relatively rare.

In addition to drops, doctors can also give medication to drink. Consult further the benefits and risks of using drugs with a doctor. The type and dosage of inappropriate drugs can cause side effects.

Laser therapy

Laser therapy is divided into several types. The doctor will determine the type according to the patient's condition. Some types of laser therapy include:

Trabeculoplasty, which opens the tissue that blocks the channel, so that fluid flow can be more smooth.
Iridotomy, which is making a small hole in the iris or the rainbow of the eye so that fluid can be removed from the eye.
Cyclophotocoagulation, which is the destruction of some tissues that are responsible for producing fluids, so that fluids can be reduced.

In the process, laser therapy will generally use eye drops. The patient will feel a little pain or heat during the procedure.

Surgery

Surgery is performed when drug administration and laser therapy are not effective in dealing with the condition. The most commonly used surgery to treat glaucoma is trabeculectomy. Trabeculectomy is a surgical procedure wherein the doctor will remove trabecular meshwork in the aqueous humour fluid channel, so that the flow of the liquid can be more smooth.

In addition to trabeculectomy, there are other surgical methods that doctors can use to treat glaucoma, namely:

In this procedure, the doctor implements a special tube / hose that serves to dilute the aqueous humour liquid in the eye.
In contrast to trabeculectomy, this procedure uses a special device called a trabectome. Trabectome is used to make small incisions and lift trabecular meshwork by sending heat so that fluid flow can be smoother and the pressure decreases.

After the procedure, the patient can feel side effects such as watery eyes, redness, or blurred vision that lasts for 6 weeks. The doctor will usually prescribe a medication that can relieve the side effects of surgery during the recovery period.

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