Diagnosis

Your doctor will review your medical history and conduct a comprehensive eye examination. He or she may perform several tests, including:

  • Measuring intraocular pressure (tonometry)
  • Testing for optic nerve damage
  • Checking for areas of vision loss (visual field test)
  • Measuring corneal thickness (pachymetry)
  • Inspecting the drainage angle (gonioscopy)

Treatment

The damage caused by glaucoma can't be reversed. But treatment and regular checkups can help slow or prevent vision loss, especially in you catch the disease in its early stage.

The goal of glaucoma treatment is to lower pressure in your eye (intraocular pressure). Depending on your situation, your options may include eyedrops, laser treatment or surgery.

Eyedrops

Glaucoma treatment often starts with prescription eyedrops. These can help decrease eye pressure by improving how fluid drains from your eye or by decreasing the amount of fluid your eye makes.

Prescription eyedrop medications include:

  • Prostaglandins. These increase the outflow of the fluid in your eye (aqueous humor) and reduce pressure in your eye. Examples include latanoprost (Xalatan) and bimatoprost (Lumigan). Possible side effects include mild reddening and stinging of the eyes, darkening of the iris, changes in the pigment of the eyelashes or eyelid skin, and blurred vision.
  • Beta blockers. These reduce the production of fluid in your eye, thereby lowering the pressure in your eye (intraocular pressure). Examples include timolol (Betimol, Timoptic) and betaxolol (Betoptic). Possible side effects include difficulty breathing, slowed heart rate, lower blood pressure, impotence and fatigue.
  • Alpha-adrenergic agonists. These reduce the production of aqueous humor and increase outflow of the fluid in your eye. Examples include apraclonidine (Iopidine) and brimonidine (Alphagan). Possible side effects include an irregular heart rate; high blood pressure; fatigue; red, itchy or swollen eyes; and dry mouth.
  • Carbonic anhydrase inhibitors. Rarely used for glaucoma, these drugs may reduce the production of fluid in your eye. Examples include dorzolamide (Trusopt) and brinzolamide (Azopt). Possible side effects include a metallic taste, frequent urination, and tingling in the fingers and toes.
  • Miotic or cholinergic agents. These increase the outflow of fluid from your eye. An example is pilocarpine (Isopto Carpine). Side effects include smaller pupils, possible blurred or dim vision, and nearsightedness.

Oral medications

If eyedrops alone don't bring your eye pressure down to the desired level, your doctor may also prescribe an oral medication, usually a carbonic anhydrase inhibitor. Possible side effects include frequent urination, tingling in the fingers and toes, depression, stomach upset, and kidney stones.

Surgery and other therapies

Other treatment options include laser therapy and various surgical procedures. Possible complications include pain, redness, infection, inflammation, bleeding, abnormally high or low eye pressure, and loss of vision. Some types of eye surgery may speed the development of cataracts.

You'll need to see your doctor for follow-up exams. And you may eventually need to undergo additional procedures if your eye pressure begins to rise or other changes occur in your eye.

The following techniques are intended to improve the drainage of fluid within the eye, lowering pressure:

  • Laser therapy. Laser trabeculoplasty (truh-BEK-u-low-plas-tee) is an option for people with open-angle glaucoma. It's done in your doctor's office. He or she uses a laser beam to open clogged channels in the trabecular meshwork. It may take a few weeks before the full effect of this procedure becomes apparent.
  • Filtering surgery. With a surgical procedure called a trabeculectomy (truh-bek-u-LEK-tuh-me), your surgeon creates an opening in the white of the eye (sclera) and removes part of the trabecular meshwork.
  • Drainage tubes. In this procedure, your eye surgeon inserts a small tube in your eye.
  • Electrocautery. Your doctor may suggest a minimally invasive procedure to remove tissue from the trabecular meshwork using a small electrocautery device called a Trabecutome.

Treating acute angle-closure glaucoma

Acute angle-closure glaucoma is a medical emergency. If you're diagnosed with this condition, you'll need urgent treatment to reduce the pressure in your eye. This generally will require both medication and laser or other surgical procedures.

You may have a procedure called a laser peripheral iridotomy in which the doctor creates a small hole in your iris using a laser. This allows fluid (aqueous humor) to flow through it, relieving eye pressure.

Emerging therapies

Researchers are evaluating the effectiveness of new drugs, drug delivery methods, surgical procedures and devices (iStent, others).

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease.

Lifestyle and home remedies

These tips may help you control high eye pressure or promote eye health.

  • Eat a healthy diet. Eating a healthy diet can help you maintain your health, but it won't prevent glaucoma from worsening. Several vitamins and nutrients are important to eye health, including those found in dark, leafy greens and fish high in omega-3 fatty acids.
  • Exercise safely. Regular exercise may reduce eye pressure in open-angle glaucoma. Talk to your doctor about an appropriate exercise program.
  • Limit your caffeine. Drinking beverages with large amounts of caffeine may increase your eye pressure.
  • Sip fluids frequently. Drink only moderate amounts of fluids at any given time during the course of a day. Drinking a quart or more of any liquid within a short time may temporarily increase eye pressure.
  • Sleep with your head elevated. Using a wedge pillow that keeps your head slightly raised, about 20 degrees, has been shown to reduce intraocular eye pressure while you sleep.
  • Take prescribed medicine. Using your eyedrops or other medications as prescribed can help you get the best possible result from your treatment. Be sure to use the drops exactly as prescribed. Otherwise, your optic nerve damage could get even worse.

    Because some of the eyedrops are absorbed into your bloodstream, you may experience some side effects unrelated to your eyes. To minimize this absorption, close your eyes for one to two minutes after putting the drops in. Or press lightly at the corner of your eye near your nose to close the tear duct for one or two minutes. Wipe off any unused drops from your eyelid.

Alternative medicine

Some alternative medicine approaches may help your overall health but none are effective glaucoma remedies. Talk with your doctor about their possible benefits and risks.

  • Herbal remedies. A number of herbal supplements, such as bilberry and ginkgo, have been advertised as glaucoma remedies. But further study is needed to prove their effectiveness. Don't use herbal supplements in place of proven therapies.
  • Relaxation techniques. Stress may trigger an attack of acute angle-closure glaucoma. If you're at risk of this condition, find healthy ways to cope with stress. Meditation and other techniques may help.
  • Marijuana. Research shows that marijuana lowers eye pressure in people with glaucoma, but only for three to four hours. Other, standard treatments are more effective. The American Academy of Ophthalmology doesn't recommend marijuana for treating glaucoma.

Coping and support

When you receive a diagnosis of glaucoma, you're facing lifelong treatment, regular checkups and the possibility of progressive vision loss.

Meeting and talking with other people with glaucoma can be very helpful, and many support groups exist. Check with hospitals and eye care centers in your area to find local groups and meeting times. Several online resources, including support groups, are available.

Preparing for your appointment

Glaucoma usually doesn't cause any noticeable symptoms until it has caused permanent damage. Ask your primary care doctor how often you need to see an eye doctor (ophthalmologist) for a comprehensive eye exam and follow that schedule.

If you have any new eye symptoms or vision problems, make an appointment with your ophthalmologist or ask your doctor for a referral.

Here's some information to help you get ready for your appointment.

What you can do

Before your appointment make a list of:

  • Symptoms you've been having, and for how long
  • All medications, supplements and vitamins you take, including the doses
  • Any eye problems you've had in the past, such as vision changes or eye discomfort
  • Questions to ask your doctor

Some basic questions to ask your doctor include:

  • Do I have signs of glaucoma?
  • What tests do I need to confirm a diagnosis?
  • What treatment approach do you recommend?
  • What are the alternatives to the primary approach you're suggesting?
  • Do I need to follow any activity restrictions?
  • What other self-care measures might help me?
  • What is the long-term outlook in my case?
  • How often do I need to return for follow-up visits?
  • Do I need to see an additional specialist?
  • I have these other health conditions. How can I best manage them together?

What to expect from your doctor

A doctor who sees you for possible glaucoma is likely to ask you a number of questions, such as:

  • Have you had any eye discomfort or vision problems?
  • Do you have any other signs or symptoms that concern you?
  • Do you have any family history of glaucoma or other eye problems?
  • What eye screening tests have you had and when?
  • Have you been diagnosed with any other medical conditions?
  • Are you using any eyedrops?
  • Are you using any vitamins or supplements?
Sept. 15, 2015
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