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Types of Glaucoma ?

Types of Glaucoma ?

There are many different types of glaucoma. Most, however, can be classified as either open-angle glaucomas, which are conditions of long duration (chronic), or closed-angle (angle closure) glaucomas, which include conditions occurring suddenly (acute). The glaucomas usually affect both eyes, but the disease can progress more rapidly in one eye than in the other. Involvement of just one eye occurs only when the glaucoma is brought on by factors such as a prior injury, inflammation, or the use of steroids in that eye.

Open Angle Glaucoma

Chronic Open Angle Glaucoma (COAG)
Chronic open-angle glaucoma is by far the most common type of glaucoma. Moreover, its frequency increases greatly with age. This increase occurs because the drainage mechanism gradually may become clogged with aging. As a consequence, the aqueous fluid does not drain from the eye properly. The pressure within the eye, therefore, builds up painlessly and without symptoms. Furthermore, as mentioned previously, since the resulting loss of vision starts on the side (peripherally), people are usually not aware of the problem until the loss encroaches on their central visual area.

Normal Tension / Pressure Glaucoma
is a variant of open-angle glaucoma that is being recognized more frequently than in the past. It is thought to be due to decreased blood flow to the optic nerve. This condition is characterized by progressive optic nerve damage and loss of peripheral vision (visual field) despite intraocular pressures in the normal range or even below normal. This type of glaucoma can be diagnosed by repeated examinations by the eye doctor to detect the nerve damage or the visual field loss..

Congenital ( Infantile ) Glaucoma
is a relatively rare, inherited type of open-angle glaucoma. In this condition, the drainage area is not properly developed. This results in increased pressure in the eye that can lead to the loss of vision from optic nerve damage and to an enlarged eye. The eye of a young child enlarges in response to increased intraocular pressure because it is more pliable than the eye of an adult. Eye of the child enlarges and gives appearance of a larger eye like a Bull”s eye. Early diagnosis and treatment with medicine and/or surgery are critical in these infants and children to preserve their sight.

Secondary Glaucoma
is another type of open-angle glaucoma. It can result from an eye (ocular) injury, even one that occurred many years ago. Other causes of secondary glaucoma are inflammation in the iris of the eye (iritis), diabetes, cataracts, or in steroid-susceptible individuals, the use of topical (drops) or systemic (oral or injected) steroids (cortisone). It can also be associated with a retinal detachment or retinal vein occlusion or blockage. (The retina is the layer that lines the inside of the back of the eye.) The treatments for the secondary glaucoma vary, depending on the cause.

Pigmentary Glaucoma
is a type of secondary glaucoma that is more common in younger men. In this condition, for reasons not yet understood, granules of pigment detach from the iris, which is the colored part of the eye. These granules then may block the trabecular meshwork, which, as noted above, is the drainage system of the eye. Finally, the blocked drainage system leads to elevated intraocular pressure, which results in damage to the optic nerve.

Exfoliative Glaucoma ( Pseudo Exfoliation )
is another type of glaucoma that can occur with either open or closed angles. This type of glaucoma is characterized by deposits of flaky material on the front surface of the lens (anterior capsule) and in the angle of the eye. The accumulation of this material in the angle is believed to block the drainage system of the eye and raise the eye pressure. While this type of glaucoma can occur in any population, it is most prevalent in older people and people of Scandinavian descent.

Closed Angle Glaucoma

Closed-angle glaucoma is a relatively common entity in Asia.. In this condition, the patient's intraocular pressure, which ordinarily is normal, can go up very suddenly (acutely). This sudden pressure increase occurs because the filtering angle becomes closed and blocks off the drainage channels. This type of glaucoma can occur when the pupil dilates (widens or enlarges). As a result, the peripheral edge of the iris can become bunched up against its corneal attachment, thereby causing the filtering angle to close. Thus, the problem in closed-angle glaucoma is the difficulty with access of the eye fluid to the drainage system (trabecular meshwork). In contrast, remember that the problem in open-angle glaucoma is clogging within the drainage system itself.

People with small eyes are predisposed to developing closed-angle glaucoma because they tend to have narrow filtering angles. Small eyes are not obvious from their appearance, but they can be measured by an eye doctor. Thus, individuals who are farsighted or of Asian descent may have small eyes, narrow filtering angles, and an increased risk of developing closed-angle glaucoma. Furthermore, this condition may be triggered by medications that can dilate the pupils. These agents can be found in certain eye drops, cold remedies, or patches used to prevent seasickness. This condition can also occur spontaneously in a darkened room or a movie theater, wherein the pupil automatically dilates to let in more light. Sometimes, therefore, people with narrow angles are given eye drops to keep their pupils small.

A sudden glaucoma attack may be associated with severe eye pain and headache, a red (inflamed) eye, nausea, vomiting, and blurry vision. In addition, the high intraocular pressure leads to corneal swelling (edema), which causes the patient to see haloes around lights. Sometimes, acute glaucoma is treated with oral carbonic anhydrase inhibitors. An attack of acute glaucoma, however, is usually relieved by eye surgery. In this operation, the doctor makes a small hole in the iris with a laser (laser iridotomy) to allow the fluid to resume draining into its normal outflow channels.