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Also see our Glaucoma FAQ! The word "glaucoma" is like the word "automobile." Many forms and types exist. Below is a discussion of the most common forms. If you have glaucoma, it is important that you know which type you have. Some forms of glaucoma, for example, can be affected by certain medications. Each of these are discussed below. Just scroll down or click on any of the items below for discussion. It will be helpful if you read the section on Primary Open-Angle Glaucoma before reading about the other types of glaucoma.
Primary Open-Angle Glaucoma (POAG) Normal or Low Tension Glaucoma (NTG of LTG) Acute Angle-Closure Glaucoma (AACG) Neovascular Glaucoma (NVG) Pigmentary Glaucoma Exfoliation Syndrome Secondary Glaucomas
In this disease, it is thought that the drainage portion of the eye and trabecular meshwork (please see our Glaucoma FAQ - What Causes Glaucoma?) does not allow outflow of internal fluid (aqueous) normally. The reasons for this are not clear, and there are several theories being considered. Because Open Angle Glaucoma aqueous continues to be formed, In this type of glaucoma, aqueous produced by the pressure within the eye increases. ciliary body cannot exit out of the eye easily because of Once a sufficient number of optic a blockage at the trabecular meshwork. As the ciliary nerve fibers are destroyed, blind body continues to produce aqueous, the fluid pressure spots begin to develop in the begins to build up in the eye. This can lead to damage of peripheral vision. This peripheral the optic nerve. field loss is often undetected by the patient, but can easily be mapped out by a visual field test (view our Diagnostic Services page for a description of a visual field test). It is important to realize that damage at any level is permanent, and that the goal of treatment is to slow or arrest the disease so that no further damage is done. (our Glaucoma FAQ talks of ways your ophthalmologist has to detect problems before they lead to visual damage.) While there is no "cure" for POAG, treatment is often highly successful is slowing or arresting the disease. Many patients do not understand the necessity for lifelong treatment, especially when they sense that their vision is good, and they "feel" nothing wrong with them. It is important however that treatment is taken according to your doctor's instructions to prevent further damage. If you are having side effects from your medicines, you need to discuss this with your doctor. If you are not confident with the recommendations or diagnosis, a second opinion may be helpful. By no means should you ignore the problem because of lack of symptoms. Remember, glaucoma treatment is a very individualized process. Please see our Glaucoma FAQ for more details about treatment.
nerve blood flow, and much has yet to be learned about this form of glaucoma. For treatment details, please see our Glaucoma FAQ.
In contrast to an open angle, a narrow angle is one in which the peripheral iris lies in very close proximity to the trabecular meshwork. In extremely narrow angles, resistance to fluid flow could lead to increased pressure behind the iris in the posterior chamber. This can result in further narrowing of the angle or even total closure, leading to dangerously high intraocular fluid pressure. What causes an attack of acute glaucoma? Please refer to our Glaucoma FAQ for details of anatomy. As discussed, the aqueous (red arrow) is drained through the trabecular meshwork located in the angle of the eye. The angle is where the iris (colored part of the eye) and the white part (called the sclera or "wall" of the eye) meet. In some individuals, the angle of the eye is very narrow. This could be as a result of the way their eye is built, or it may be due to problems such as thickened cataracts which begin to crowd the front part of the eye. Under these conditions, anything that dilates the pupil will cause the iris to crowd the angle.
Angle Closure Glaucoma In some cases, the distance between the peripheral iris and the trabecular meshwork can be extremely narrow. Under certain circumstances, the iris can completely and suddenly close the angle resulting in sudden extreme pressure elevation. This is considered an emergency since vision is immediately threatened. When crowding becomes critical, the trabecular meshwork may become completely and suddenly obstructed by iris that fluid pressure begins to build up rapidly, causing the attack. Things that can cause pupillary dilation include being in the dark, certain types of medication such as anti-histiminics, cold preparations, anti-depressants, anti-nauseants, and some others. Stress can cause pupillary dilation as well. Attacks usually occur in the evening or at night. AACG is an emergency, and must be treated promptly before optic nerve and trabecular meshwork damage occur. Permanent damage to these structures can result quickly. Treatment begins with a combination of drops to both constrict the pupil (thereby "pulling" the iris away from the trabecular meshwork) and decrease the eye's fluid production. Once the intraocular fluid pressure is within normal range, your ophthalmologist will perform a laser iridotomy. A laser iridotomy is a procedure in which a laser beam is used to create a small opening in the iris, near the angle. This allows pressure to equalize in the eye, and allows the aqueous to flow more freely. This laser treatment is a painless outpatient procedure, and can be done in less than 10 minutes. An attack usually occurs in only one eye, even though it is very common that both eyes have narrow angles. Therefore, most of the time, your ophthalmologist will recommend that the uninvolved eye also undergo a laser iridotomy procedure to prevent such an attack in that eye too. Routine comprehensive examinations can be helpful in determining if an individual is at risk for AACG. If your ophthalmologist is suspicious of narrow angles, he will perform a gonioscopy exam, a painless procedure in which a special mirrored lens is placed gently on the surface of the eye that allows visualization of the angle. (See Diagnostic Services page for a description of gonioscopy.) Patients with narrow angles can then be warned of symptoms. Your doctor may even recommend that you undergo laser iridotomy if he feels that the risk for attack is great.
PIGMENTARY GLAUCOMA
Pigmentary glaucoma is a type of open-angle glaucoma that is caused the shedding of iris pigment into the anterior chamber fluid (aqueous) which then accumulates into the drainage structures of the eye called the trabecular meshwork. (See our Glaucoma FAQ for details of the anatomy of the drainage system of the eye.) With the trabecular meshwork "clogged up," aqueous produced in the cavity of the eye cannot drain out into Schlemm's canal thereby causing increased fluid pressure in the eye. Pigmentary glaucoma is relatively uncommon and occurs more in men than women. It is an inherited form of glaucoma and begins usually in the 20's or 30's. Because it begins so early in life, it represents a real threat to long term normal vision. The vast majority of cases of pigmentary glaucoma occur in nearsighted persons. It is thought that in certain nearsighted individuals, the anterior chamber is deeper than normal causing the iris to rub up against other structures in the eye such as the lens and zonules (fibers in the eye behind the iris which hold the lens in proper position). This constant rubbing action causes the iris pigment to flake off into the aqueous. This form of glaucoma can be treated successfully (see our Glaucoma FAQ).
EXFOLIATION SYNDROME
This form of glaucoma is common, and occurs in approximately 10% of persons over the age of 50. For reasons that are not clear, a whitish dandruff-like material builds up in the eye and accumulates on the lens surface. As the pupil dilates and constricts, this material along with iris pigment is literally rubbed off the lens and is dispersed in the aqueous (see our Glaucoma FAQ for details of the anatomy). Both pigment and this exfoliative material clog the trabecular meshwork leading to a build up of fluid pressure. Not all persons with exfoliative syndrome develop glaucoma or elevated pressure. However, if you have exfoliative syndrome, your chances of developing glaucoma at some point in your life are six times higher than if you don't. It usually begins in one eye long before the other. Therefore, persons with exfoliative syndrome need to be monitored carefully for the development of glaucoma. Fortunately with this type of glaucoma, treatment is highly successful (see our Glaucoma FAQ).
SECONDARY GLAUCOMAS
These types of glaucomas are generally as a result of an insult or injury to the eye. These events can fall into several categories:
A. Trauma
Such as a hard blow to the eye, a penetrating injury, severe lye burn, etc. These mechanical factors can cause damage to the drainage structures of the eye resulting in a build up of fluid pressure.
B. Vascular
A variety of diseases that cause poor circulation to the eye can lead to NEOVASCULAR GLAUCOMA (see above).
C. Congenital
Glaucoma can be present at birth if the drainage channels of the eye are not well formed. Other birth defects of the eye can also lead to glaucoma.
D. Medications
Certain types of medications can cause glaucoma such as steroids, anti-histiminics, some types of anti-depressants, and medications for certain stomach disorders such as belladonna alkaloids. Be sure to check with your medical doctor and/or your ophthalmologist if you are taking or plan to take these types of medicines.