Glaucoma is the name for a group of eye diseases that damage the
optic nerve. This nerve carries information from the eye to the
brain. When the nerve is damaged, you can lose your
Glaucoma is one of the most
common causes of legal blindness in the world. At first, people with glaucoma lose side (peripheral)
vision. But if the disease isn't treated, vision loss may get worse. This can
lead to total blindness over time.
There are three types of
Open-angle glaucoma (OAG) is the most common
form in the United States and Canada. (In other parts of the world, it's less common.) It usually affects both eyes at the same time. Your vision gradually gets worse. But it gets worse so slowly that you may not notice it.
Closed-angle glaucoma (CAG) isn't very common in the U.S. and Canada. It usually affects one eye at time. CAG can happen suddenly and be a medical emergency.
Congenital glaucoma is a rare form of
glaucoma that some infants have at birth. Some children and young adults can
also get a type of the disease.
What causes glaucoma?
The exact cause isn't known. Experts think that increased pressure in the eye (intraocular pressure) may cause the nerve damage in many cases. But some people who have glaucoma have normal eye pressure.
Some people get glaucoma after an eye injury or after eye surgery. Some medicines (corticosteroids) that are used to treat other diseases
may also cause glaucoma.
What are the symptoms?
If you have OAG, the only symptom you are likely to notice
is loss of vision. You may not notice this until it is serious. That's because
the eye that is less affected makes up for the loss at first. Side vision is
often lost before central vision.
Symptoms of CAG can be mild, with symptoms like blurred
vision that last only for a short time. Severe signs of CAG
include longer-lasting episodes of blurred vision or pain in or around the eye.
You may also see colored halos around lights, have red eyes, or feel sick to
your stomach and vomit.
In congenital glaucoma, signs
can include watery eyes and sensitivity to light. Your baby may rub his or her
eyes, squint, or keep the eyes closed much of the time.
How is glaucoma diagnosed?
Glaucoma can be diagnosed:
During routine exams with your eye doctor.
When you go to your family doctor because of an eye problem. Your doctor will ask you questions about your symptoms and do a physical exam. If your doctor thinks you
have glaucoma, you will then need to see an eye doctor for eye exams and tests.
How is it treated?
Glaucoma can't be cured. But there are things you can do to help stop more damage to the optic nerve. To help keep your vision from getting worse, you'll probably need to use medicine (most likely eyedrops) every day. You may also need laser treatment or
surgery. You'll also need regular checkups with your eye doctor.
How do you cope with glaucoma?
If you have vision loss, you can keep your quality of life. You can use vision aids, such as large-print items and special
video systems, to help you cope with reduced eyesight. Support groups and counseling can also help you deal with vision loss.
The exact cause of glaucoma isn't known. Experts think that increased pressure in the eye (intraocular pressure) may cause the nerve damage in many cases. But some people who have glaucoma have normal eye pressure.
open-angle glaucoma (OAG), fluid in the eye (aqueous humor) doesn't drain well. When this happens, the fluid builds up. This buildup increases the intraocular pressure (IOP) and may damage the optic nerve.
Up to half of the people with OAG don't have higher-than-normal IOP. This is called normal- or low-tension glaucoma.
The colored part of the eye (iris) and the lens
block the movement of fluid between the chambers of the eye. The blockage of
fluid causes pressure to build up in the eye and makes the iris press on the
eye's drainage system (trabecular meshwork). The increased pressure can cause damage to the optic nerve,
leading to vision loss and possible blindness.
You have a defect in your iris or another problem that causes the iris to fall forward and block the drainage angle.
You have scar tissue between the iris and the cornea, and it blocks the eye's drainage system.
Congenital and infantile glaucoma
is present at birth (congenital glaucoma) or that develops in the first few years of life (infantile
glaucoma) is often caused by certain birth defects. A birth defect may occur
because of an infection in the mother during pregnancy, such as
rubella, or because of an inherited condition such as
Some people get glaucoma after an eye injury or after eye surgery. A cataract and some medicines (corticosteroids) that are used to treat other diseases may also cause glaucoma. Glaucoma caused in these ways is called secondary glaucoma.
glaucoma vary according to the type of glaucoma you
Open-angle glaucoma (OAG)
Most people with OAG have no symptoms when they are diagnosed. You may have some side vision loss, but you may not notice it until the vision loss becomes severe. This is because the less affected eye makes up for your vision loss. The loss
of sharpness of vision (visual acuity) may not become apparent until late in
the disease. By that time, significant vision loss has occurred.
Closed-angle glaucoma (CAG)
CAG may cause no symptoms. Or symptoms may range from mild to severe. They usually affect only one
eye at a time.
You may have short episodes of symptoms
that usually occur in the evening and are over
by morning. This is called subacute closed-angle glaucoma. CAG can also happen suddenly and require medical attention right away.
Symptoms of glaucoma present at birth (congenital glaucoma) and glaucoma that develops in the
first few years of life (infantile glaucoma) may include:
Watery eyes. The baby may also appear to be
sensitive to light.
An eye or eyes that look cloudy. This is a sign
that the clear front surface of the eye (cornea) has been
Eyes that look larger than normal because the eyeballs
have become enlarged as a result of high pressure.
Your baby may rub his or her eyes, squint, or keep the eyes closed
much of the time.
usually affects side (peripheral) vision first. If glaucoma isn't treated,
vision loss will continue, causing total blindness over time. If glaucoma
is found early and treatment starts right away, good eyesight can usually be
any type of glaucoma may delay or prevent further vision loss. But treatment can't
reverse vision loss that has already occurred. In a few rare cases of
congenital glaucoma, treatment has reversed some damage to the optic nerve.
How much your life will be affected
depends on your lifestyle and on how bad your vision loss is. Normal use of your eyes (such as for
reading or watching TV) won't speed up vision loss or make the
condition worse. For information on
how to live with low vision, see Home Treatment.
Open-angle glaucoma (OAG)
OAG usually affects both eyes at the same
time. But one eye may be affected more than the other.
Vision changes so slowly that much of your eyesight may be affected before you
notice the condition.
Blind spots from each side of the field of vision gradually meet, increasing
the area of blindness. Central vision, used for reading and seeing details, is
Closed-angle glaucoma (CAG)
CAG usually affects only one eye at a time. It can happen suddenly (acute) or be a long-term problem. If it's acute, it's an emergency. Severe and permanent vision loss can develop within
hours or days after symptoms start.
You may have short episodes of CAG.
Without treatment, these episodes will keep coming back. They can become an emergency
situation (acute closed-angle glaucoma) or a long-term problem (chronic
Congenital glaucoma may be present at birth or develop within the first few years of life. Treatment needs to start right away to help avoid further vision loss and blindness. In certain children, some of the optic nerve damage caused by the disease can be reversed with treatment.
High pressure in the eyes. OAG is
often linked with higher-than-normal pressure in the eyes (intraocular pressure, or IOP). Not all people with OAG have high IOP. But this is one treatable risk factor that doctors look for.
Age. The risk for glaucoma increases rapidly after
Race. Blacks are
more likely than whites to have glaucoma.
Family history of glaucoma. You're at risk for OAG if a relative has primary OAG, which is OAG that's not caused by another condition.
Prior loss of vision in one eye from glaucoma. Damage in one eye from glaucoma is linked with a higher risk
of future damage in the other eye.
Diabetes. People who have diabetes tend to have higher
pressure in their eyes than those who don't have the disease. People who have diabetes are
also at risk for a type of secondary glaucoma where new blood vessels grow into
and block the drainage angle of the eye.
Race. People from East Asia or with East Asian
ancestry, as well as Inuit peoples, are more
likely than other people to develop CAG.1
Age. People over age 40 are at increased risk for
Being female. Older women are more likely than older men to
Farsightedness. People who are farsighted are more
likely to develop this condition. That's because their eyes are smaller and the
drainage angles of the eyes tend to be narrower, which allows them to become
blocked more easily.
Family history. People who have a family history of
CAG are more likely to develop the condition.
Having CAG in one eye. This increases the risk of getting the condition
in the other eye. About half of the people who have had acute closed-angle
glaucoma in one eye develop CAG in the second eye within 5
Infection in the mother during pregnancy. Babies
born to mothers who have certain viral infections such as
rubella during pregnancy are more likely to have the condition.
Family history. A small number of infants with
congenital glaucoma inherit the condition.
When To Call a Doctor
Call 911 or other emergency services immediately if you have:
Sudden, severe blurring of vision in one
Severe pain in the affected eye.
Redness of the
Nausea and vomiting.
surrounding light sources.
Call your doctor if you:
Notice blind spots in your
Notice that over time you are having more trouble
Have a family history of glaucoma, are age 40 or
older, and have not had an eye exam in more than a year. You may need to be
examined by an eye specialist (ophthalmologist or
optometrist) for signs of glaucoma.
glaucoma and have side effects from the glaucoma medicines
that you are taking.
Cornea thickness. Tests such as ultrasound
pachymetry measure the thickness of the clear front surface of the eye (cornea). Cornea thickness, along with intraocular
pressure, helps determine your risk for glaucoma.
After glaucoma is diagnosed, eye exams are done on a regular basis to monitor the
Your doctor may also do a
low-vision evaluation to help find ways you can make
the most of your remaining vision and maintain your quality of life.
If you are younger than 40 and have no known risk factors for glaucoma, the American Academy of Ophthalmology (AAO) recommends that you have a complete eye exam every 5 to 10 years. This includes tests that check for
glaucoma.2 The AAO suggests more frequent routine eye exams as you age, even if you aren't at increased risk for glaucoma.
Most treatment for glaucoma is aimed at lowering the pressure in the eyes (intraocular pressure, or IOP). This helps save your eyesight by slowing the damage to the optic nerve. In adults, treatment can't restore eyesight that has already been lost as a result of
glaucoma. But in certain children, some of the damage caused by
congenital glaucoma can be reversed.
Treatment options include medicines and surgery, including laser surgery. Studies show that medicine and surgery are both
effective treatments, but the risks and benefits may differ depending on the type of
glaucoma, age, race, and other factors.3
It is important to understand that treatment for glaucoma will most likely continue for the rest of your life. You will need regular eye exams by an eye doctor. Ask your doctor about the best treatment for your particular condition.
Though glaucoma can lead to a significant loss of vision, your doctor can refer you to counselors who specialize in helping people adjust to
living with low vision.
Target eye pressure
The eye doctor sets a target eye pressure for each eye and will check it regularly. If the pressure is high enough, or if the doctor sees signs of damage caused by glaucoma, the doctor may advise that you start treatment with medicine or adjust your medicine.
Open-angle glaucoma (OAG)
OAG usually starts with medicines (most likely eyedrops) to lower the pressure inside the eye. If medicines don't work, your doctor may use laser treatment or surgery. In some cases, laser treatment or surgery will be tried before medicine.
Closed-angle glaucoma (CAG)
Initial treatment for CAG is usually a procedure called laser iridotomy. You may also need medicine (usually eyedrops) to help you stay at your target eye pressure.
If the pressure in your eye
stays high or if damage to the optic nerve gets worse despite
treatment, your doctor will adjust your treatment. In some cases, your doctor may need to adjust your medicines. Or, if you haven't had the laser procedure, you may need this or another surgery.
Acute closed-angle glaucoma
CAG can be an emergency situation
(acute closed-angle glaucoma). Blockage of fluid in the eye causes a
sudden increase in pressure, causing rapid damage to the optic nerve.
Acute closed-angle glaucoma usually causes significant pain. Laser treatment is needed right away for this problem.
Congenital glaucoma almost always requires surgery to
lower eye pressure. Medicine may sometimes be used, but it usually doesn't
work as well.
Because glaucoma can't be cured and treatment doesn't
always prevent further loss of vision, people may try alternative
unproven treatment methods, such as acupuncture or
marijuana. But most of these alternative treatments either haven't been
studied or haven't been proved to work for glaucoma. Such treatments may be expensive. And
some can be hazardous to your health.
Most of the risk factors (such as age,
race, and family history) for
glaucoma are beyond your control. Whether or not you are at increased
risk for glaucoma, it's best to get routine eye exams and tests as your eye doctor suggests. Finding and treating glaucoma early is important to help prevent blindness.
If you have high pressure in your eyes but you don't have glaucoma, your eye doctor may suggest treatment that helps lower your eye pressure. This may help delay or prevent the onset of glaucoma.
Glaucoma can affect your life. How much you are
affected depends on how bad your vision loss is, what kinds of activities
you do, and your lifestyle. You can work with your doctor to find ways to make the best
use of your remaining vision. You can:
vision aids such as video enlargement systems and
Position lighting so that it's aimed at what you want to see and aimed away from your eyes.
Mark the areas around stairways and ramps with paint or tape.
It's common to feel sad or angry when you learn that you have glaucoma. Try building a support group of family and friends. Your doctor can also refer you to counselors who specialize in helping
people adjust to living with low vision.
Medicine is a large part of your treatment. Be sure to:
Use your glaucoma medicines as prescribed by your doctor.
Check with a doctor before taking any over-the-counter medicines if you have closed-angle glaucoma or you are at risk for it.
Carry a wallet card or other identification that states that you have glaucoma.
Prescription medicines to lower the pressure inside
the eye (intraocular pressure, or IOP) are used
to treat all types of
glaucoma. They work either by reducing the amount of
fluid (aqueous humor) that is produced by the eye or by
increasing the amount of fluid that drains out of the eye. These medicines may
be given as eyedrops, as pills, in liquid form by mouth, or through a vein (in emergency
situations). In most cases, eyedrops are used first.
congenital glaucoma, medicines may be used to decrease
the pressure in the eyes and reduce the cloudiness of the clear front surface
(cornea) of the child's eye. Medicines are usually only used until surgery can be done.
When glaucoma has already caused vision loss,
further vision loss may occur even after the pressure in the eye is lowered
to the normal range with medicine. Talk to your doctor about the goals of treatment, how long the
medicine will be tried, and the possible side effects. Eye medicines can cause symptoms throughout the body.
need follow-up visits with your doctor to find out whether your medicine is working as well as it should. You can also discuss any side effects or medicine schedule problems.
In most cases, medicines used to treat glaucoma must be continued daily
for the rest of your life.
Medicines that decrease the amount of fluid produced by
the eye include:
Beta-blockers (such as Betagan,
Betimol, Ocupress, and Timoptic).
Some medicines have two different medicines mixed into
one bottle. Examples include Cosopt, which contains both a carbonic anhydrase
inhibitor and a beta-blocker, and Combigan, which contains both an adrenergic
agonist and a beta-blocker.
About your medicines
Use your glaucoma medicines as prescribed by your doctor. If you need reminders for using your medicines, use
alarm clocks or watches, notes on mirrors or tables, and other cues.
Learn how to use eyedrops. This can help reduce side effects. If you notice side effects from your glaucoma
medicine, tell your doctor. Your medicine may need to be
If you have closed-angle glaucoma or you are at risk for it, check with a doctor before taking any over-the-counter medicines. You'll need to avoid
medicines that widen (dilate) the pupil, such as certain
antihistamines and motion sickness medicines.
Make sure all your doctors know that you have glaucoma. Tell your eye specialist
what other prescription medicines you are taking.
Carry a wallet card or other identification that states that you have glaucoma. The card needs to list all medicines you are
taking, including glaucoma medicines.
Surgery reduces the pressure in the eyes by opening blocked
drainage angles or creating a new opening that fluid can
flow through to leave the eye. In some cases surgery may be done to relieve pain caused by
Medicine will usually
be tried before surgery is considered.
Doctors can use
either a surgical cutting tool or a very focused beam of light, called a laser,
to do surgery for glaucoma.
Laser surgery is usually the first type of surgery tried. If laser surgery doesn't help, your doctor may try
It is not
unusual for some people to have both open- and closed-angle glaucoma. They may need more than one kind of procedure.
Surgery choices for adults
There are three basic types of surgery for glaucoma in
Surgery to increase drainage of fluid from the eye
This type of surgery involves making a trapdoor that allows fluid to
drain from the eye.
involves an incision to remove a piece of tissue to allow fluid to drain from the
Tube-shunt surgery (seton glaucoma surgery) involves an incision to place a
tube in the eye to allow fluid to drain.
Laser sclerostomy removes a piece of the white part of the eye to allow fluid
to drain. This type of surgery is rarely done.
Surgery to prevent closure of the drainage angle
These procedures involve making a new opening in the
colored part of the eye (iris) that allows fluid to flow through the eye. They
are used to treat sudden (acute) and long-term closed-angle glaucoma. The procedures also will prevent
closed-angle glaucoma in people who have narrow drainage angles.
glaucoma, there are two slightly different procedures that both attempt to open
the drainage angle directly. They are equally successful in children, but they
are not used for adults. If these procedures fail in a child, then
trabeculectomy or tube-shunt surgery may be tried.
Trabeculotomy removes a piece of tissue to allow fluid to drain from the eye.
Deciding about surgery
Deciding whether to have surgery is difficult because:
You may not be in pain or notice any vision loss.
Your vision may get worse right after surgery and may be affected for weeks or months. Your eyesight may not be as good as it was before the surgery.
Surgery isn't a complete cure for
glaucoma. But surgery can decrease the chance of losing even more eyesight
later on. And for some people, it can reduce or get rid of the need for eyedrops.
Not everyone who has laser surgery will have lower
IOP after the surgery. For most people, the lower pressure
will last only a few years. Others may have an increase in their eye pressure.
Certain types of open-angle glaucoma respond better to laser surgery than
The effects of some laser treatments aren't long-lasting.
Repeat laser treatments, medicines, or other surgeries may be needed later
As with any other surgery, you and your doctor should
make the decision to operate based on the risks and benefits of having the
surgery. One thing to consider is
which eye should be operated on first. There may be other
questions about glaucoma surgery that you should
discuss with your doctor before making a decision.
Cataracts may occur in people who also have glaucoma. This commonly occurs in older people. Surgery to remove the cataract may be
done at the same time as surgery for glaucoma. If
surgeries for glaucoma and a cataract are done at the
same time, you may notice improved eyesight after surgery.
Other Places To Get Help
American Health Assistance Foundation
22512 Gateway Center Drive
Clarksburg, MD 20871
This nonprofit group works to find cures, preventions, and improved treatments for age-related degenerative diseases. The website has information about Alzheimer's disease, macular degeneration, and glaucoma.
American Optometric Association
243 North Lindbergh Boulevard
St. Louis, MO 63141
The American Optometric Association (AOA), which is a
national organization of optometrists, can provide information on eye health
and eye problems.
P.O. Box 429098
San Francisco, CA 94142-9098
EyeCare America is a public service program of the
Foundation of the American Academy of Ophthalmology. This site aims to raise awareness about
eye diseases and eye care. It has information about eye conditions, treatments, and general eye health. You can check to see if you qualify for a free eye exam.
80 Maiden Lane
New York, NY 10038
This nonprofit group supports glaucoma research and provides information about this disease and the importance of early detection to help prevent blindness. The website includes online chat groups for youth and adults.
Glaucoma Research Foundation
251 Post Street
San Francisco, CA 94108
This nonprofit organization aims to help people prevent vision loss from glaucoma. The website has information about glaucoma and how to live with and treat it. There is also information about how to get help paying for glaucoma medicines.
National Eye Institute, National Institutes of
31 Center Drive MSC 2510
Bethesda, MD 20892-2510
As part of the U.S. National Institutes of Health, the National Eye
Institute provides information on eye diseases and vision research.
Publications are available to the public at no charge. The Web site includes
links to various information resources.
How this information was developed to help you make better health decisions.