Types of Glaucoma

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Prolonged elevated eye pressure increases the risk for glaucoma. This pressure originates from a buildup of aqueous humor, a fluid naturally and continuously produced in the eye.

Aqueous humor normally exits the eye through a drainage system, and the system is located at a junction where the iris and the cornea meet. When the drainage system doesn’t work properly, the aqueous humor can’t filter out of the eye at its normal rate, and pressure builds within the eye.

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Primary Open-Angle Glaucoma

In this condition the aqueous humor drains too slowly from the eye. The eye’s drain appears open, but doesn’t drain effectively. Ensuing damage to the optic nerve is painless, and a large portion of the vision can be lost before patients are even aware of a problem. The exact cause of primary open-angle glaucoma remains unknown. Treatment includes eye drops to lower eye pressure, laser treatment, or surgery.

Angle-Closure Glaucoma

Angle-closure glaucoma, also called closed-angle glaucoma, occurs when the iris bulges forward to narrow or block the drainage angle formed by the cornea and the iris. As a result, aqueous fluid can no longer reach the trabecular meshwork at the angle, so the eye pressure may increase abruptly. An attack of angle closure glaucoma is a dreadful experience and is accompanied by severe headaches, nausea, vomiting, blurred vision, and can lead to blindness. An attack is a medical emergency and requires immediate attention.

Angle-closure glaucoma usually occurs suddenly (acute angle-closure glaucoma), but it can also occur gradually (chronic angle-closure glaucoma).

People who develop closed-angle glaucoma have an abnormally narrow drainage angle, and is based on the eye’s anatomy. This narrow angle may never cause any problems, so it may go undetected for life.

With a narrow drainage angle, sudden dilation of your pupils may trigger acute angle-closure glaucoma. Pupils become dilated in response to darkness, dim light, stress, excitement, and certain medications. These medications include antihistamines, such as desloratadine (Clarinex) and cetirizine (Zyrtec). Tricyclic antidepressants, such as doxepin and protriptyline (Vivactil) are a risk. Eye drops used to dilate pupils for a thorough eye exam can also trigger an attack. Preventative treatment is key for narrow angles, and a relatively simple laser procedure is usually all that’s needed to treat this condition.

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Low-Tension Glaucoma

Another form of the disease, poorly understood but not uncommon, is low-tension glaucoma. In this form, optic nerve damage occurs even though eye pressure stays within the normal range. The exact cause is unknown, but people with low-tension glaucoma may have an abnormally sensitive optic nerve or a reduced blood supply to the optic nerve caused by atherosclerosis – an accumulation of fatty deposits (plaques) in the arteries – or another condition limiting circulation. Under these circumstances, optic nerve damage can occur even with normal pressure. Treatment includes eye drops to lower eye pressure, laser treatment, or surgery.

Pigmentary Glaucoma

Pigmentary glaucoma, a type of glaucoma that can develop in young to middle-aged adults, is associated with a dispersion of pigment granules within the eye. The pigment granules appear to arise from the back of the iris. When the granules accumulate on and in the eye’s drain, the trabecular meshwork, aqueous humor is impacted and causes a rise in pressure. Physical activities, such as jogging, sometimes stir up the pigment granules, depositing them on the trabecular meshwork and causing intermittent pressure elevations. Treatment includes eye drops to lower eye pressure, laser treatment, or surgery.

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Pseudoexfoliative Glaucoma

This form of secondary open-angle glaucoma occurs when a flaky, dandruff-like material peels off the outer layer of the lens within the eye. The material collects in the angle between the cornea and iris and can clog the drainage system of the eye, causing eye pressure to rise. Pseudoexfoliative Glaucoma is common in those of Scandinavian and Eastern European descent. Treatment includes eye drops to lower eye pressure, laser treatment, or surgery.


Traumatic Glaucoma

Injury to the eye may cause secondary open-angle glaucoma. Traumatic glaucoma can occur immediately after the injury or years later. It can be caused by blunt injuries that bruise the eye or by injuries that penetrate the eye. In addition, conditions such as severe nearsightedness, previous injury, infection, or prior surgery may make the eye more vulnerable to a serious eye injury. Treatment includes eye drops to lower eye pressure, laser treatment, or surgery.

Neovascular Glaucoma

The abnormal formation of new blood vessels on the iris and over the eye’s drainage channels can cause a form of secondary open-angle glaucoma.

Neovascular glaucoma is always associated with other abnormalities, most often diabetes. It never occurs on its own. The new blood vessels block the eye’s fluid from exiting through the trabecular meshwork (the eye’s drainage canals), causing an increase in eye pressure. This type of glaucoma is very difficult to treat. Treatment includes eye drops to lower eye pressure, laser treatment, or surgery.

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