How Glaucoma Can be Managed?

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It is not possible to reverse the damage done by glaucoma to optic nerve and other parts. However, by using medications regularly and doing regular eye checkup can help prevent further damage and also help slow down the damage process, especially if glaucoma can be diagnosed in early stage. To detect the disease early, we all need to have eye checks regularly, especially if you have any risk factors for glaucoma.

The aim of treatment of glaucoma is to lower intraocular pressure (pressure in your eyes). To achieve this aim, your doctor may use eye drops, oral medications or surgery or combination of these.

Eye-drops for glaucoma:

Most commonly, your doctor will prescribe eye drops to lower intraocular pressure. Most common type of glaucoma is open angle glaucoma and in this type surgery is not useful and only way to manage is medications (eye drops). Eye drops help in lowering intraocular pressure by removing fluid from your eyes. Common prescription eye drops are,

  • Beta blockers: timolol, butaxolol are commonly used eye drops for glaucoma. They help to lower eye pressure by reducing production of fluid or aqueous humor in your eye.
  • Prostaglandins: latanoprost, bimatoprost etc. Are commonly used prostagnadin analogues in glaucoma. They act by increasing outflow of aqueous humor from your eye.
  • Alpha adrenergic agonists: they reduce production of aqueous humor as well as increase outflow and thereby reduce intraocular pressure. Apraclonidine, brimonidine etc. Are used in glaucoma.
  • Miotics: they cause constriction of pupil and thereby increase outflow of aqueous humor. Pilocarpine is most commonly used.
  • Carbonic anhydrase inhibitors: these drugs are rarely used in glaucoma as eye drops. They are used as oral medication more frequently.

Oral Medications in glaucoma:

If your intraocular pressure is not coming down satisfactorily with eye drops, your doctor may prescribe oral medications, commonly used are carbonic anhydrase inhibitors.

Surgery for Glaucoma:

Surgery is required if medication (eye drops and oral medication) fails to lower intraocular pressure and in case of acute closed-angle glaucoma. Acute closed-angle glaucoma is a medical emergency and need to be operated on as soon as possible to prevent vision loss. Surgery aims at increasing outflow/drainage of aqueous humor and lower intraocular pressure rapidly to prevent damage to optic nerve.

The following procedures help improve drainage of aqueous humor:

  • Trabeculectomy involves removal or part of trabecular meshwork to drain fluid.
  • Laser trabeculoplasty is used commonly to treat cases of open angle glaucoma, if medications fail to lower intraocular pressure satisfactorily. Laser beams are used to open clogged trabecular meshwork. This procedure can be done in your doctor’s clinic. However, it may take a few weeks to get the effects of the procedure.
  • Electrocautery may be used to tissues from trabecular meshwork and improve drainage. This is minimally invasive procedure.
  • Your doctor may insert a small tube to drain fluid from your eye to lower intraocular pressure.
  • For acute angle-closure glaucoma, you need emergency medical and surgical intervention. Your doctor may perform peripheral iridotomy (creating a small hole, in iris using laser beams). This procedure allow outflow of aqueous humor and lower intraocular pressure rapidly.

 

Image courtesy of [Mister GC] at FreeDigitalPhotos.net

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