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What is Glaucoma?

Glaucoma is a disease of the optic nerve, which is made up of approximately 2 million nerve fibers that transmit images from the eye to the brain. It usually damages the optic nerve by causing elevated intraocular pressure because of an abnormality in the drainage of the aqueous humor (a clear liquid that normally flows in and out of the eye). The elevated intraocular pressure damages the optic nerve and leads to visual loss.

The following are the different forms of glaucoma:

  • Open Angle Glaucoma- It is the most common form of glaucoma and causes no visual symptoms. In this type, the drainage canals do not allow the aqueous to flow out of the eye at a normal rate.
  • Angle Closure Glaucoma- Glaucoma in which the iris (the colored part of the eye) interferes with the drainage apparatus of the eye by closing it off and causing elevated intraocular pressure. An acute angle closer can occur suddenly and cause a severe rise in pressure which can lead to blindness within 24 hours. In this condition there are symptoms such as nausea, vomiting, halos around lights and severe eye pain.
  • Low Tension Glaucoma- This glaucoma is much less common than the others. In this condition the intraocular pressure is normal, but the optic nerve can still be damaged. Lowering the eye pressure, however, seems to help prevent the progression of optic nerve damage.
  • Congenital (Childhood) Glaucoma- This form can start in infancy, childhood, or adolescence. This is a rare form of glaucoma. Blindness can result if left untreated. Some common symptoms, especially in infancy, are clouding of the cornea, excessive tearing, and an enlarged eye.
  • Steroid Induced Glaucoma
  • Traumatic Glaucoma
  • Other Rare Types

Rise Factors for Glaucoma Include:

  • High Intraocular Pressure (IOP)
  • Family History of Glaucoma
  • African-American, Hispanic, and Asian ethnicity
  • Advanced Age

Treatment of Glaucoma

The goal is to lower intraocular pressure to prevent permanent visual loss.

  • Eye drops
    • Alpha work by decreasing production of the fluid that the eye continually makes, called the aqueous humor. They include the following:
      • Afraclonidine (Iopidine)
      • Brumoonidine (Alphagan, Alphagan P)
      • Dipivefrin (Propine)
    • Beta Blockers work to lower the eye pressure in the eye by decreasing the amount of fluid that the eye continually produces. They include the following:
      • Levobundol (Betagan, AK Beta)
      • Carteolol (Ocupness)
      • Metipronolol (Optipranolol)
      • Timolol (Timoptic, Bethimol, Istalol)
      • Timolol Gel (Timoptic XE)
      • Betaxolol (Betoptic, Betopitic S)

Patients who suffer from asthma or emphysema cannot use these types of eye drops, as they may worsen or precipitate respiratory symptoms.

  • Prostaglandin Analogs work by increasing the outflow of intraocular fluid from the eye and thereby lowering intraocular pressure. They include the following:
    • Travapost (Travatam Z)
    • Bimatoprost (Lumigan)
    • Latanoprost (Xalatan)
  • Carbonic Anhydrase Inhibitors reduce eye pressure by decreasing the production of intraocular fluid. They are available as eye drops or pills. They include the following:
    • Brizolamide (Azort)
    • Dorzolamide (Trusopt)
    • Acetazolamide (Diamont Sequels)
  • Cholinergic (Miotic) eye drops reduce the eye pressure by increasing the outflow of intraocular fluid from the eye. They include the following:
    • Pilocarpine (Isoptocarpine)
    • Carbochiol (Isoptocarbochiol)
    • Pilocarpine Gel (Pilopine HS Gel)
  • Combined Medications offer an alternative for patients who need more than one type of medication. They two that are available work by decreasing production of intraocular fluid. They include the following:
    • Brimomdine Tartrade and Timolol Maleate (Comlugon)
    • Dorzolamide HCL and Tumolol Maleate (Cosopt)


Laser for glaucoma is often recommended before filtering microsurgery unless the eye pressure is very high or the optic nerve is badly damaged.

  • Selective Laser Trabeculoplasty is a laser procedure used to lower the intraocular pressure (IOP) of patients with open angle glaucoma. It treats the eye's drainage system known as the trabecular mesh work and thereby improves the flow of fluid out of the eye helping to lower its IOP. It works at very low levels and treats specific cells selectively, leaving untreated portions of the trabecular mesh work intact. For this reason, LT can be safely repeated many times unlike other lasers. SLT is performed in the office and by an ophthalmologist (Eye M.D.) and takes about 5-10 minutes. Most patients can resume normal activities the same day of the surgery, but may have transient blurring of their vision.
  • Yag laser Peripheral Iridotomy is a laser procedure used to treat narrow or closed angle glaucoma.
    The laser creates an opening in the iris (colored part of the eye). The opening is quite small so cannot be seen by the naked eye, and it allows fluid to flow from behind channels of your eye. This laser treatment is also performed in the office, with the primary purpose of preventing an acute angle closure.

Glaucoma Surgery

If you have glaucoma and medications and laser to not adequately control intraocular pressure (IOP), the next step is to perform glaucoma surgery known as TRABECULECTOMY. In this procedure a small drainage hole is created in the sclera (white part of the eye), which allow fluid to flow out of the eye into a filtering area under the conjunctive, referred to as a Bleb. Usually this area or bleb will be underneath your upper eyelid and will not be noticeable. If successful, it will lower the IOP and prevent permanent visual damage from glaucoma.

Frequently antimetabolites are used during glaucoma surgeries to prevent scarring during the healing stages, which can later cause the filtering procedure to fail.


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