Quick answer

What is glaucoma?

Glaucoma is a group of eye conditions damaging the optic nerve — often linked to raised eye pressure — causing gradual peripheral vision loss that can lead to blindness if untreated. Chronic open-angle glaucoma is commonest — usually no symptoms until advanced — picked up at routine optician eye tests. Acute angle-closure glaucoma is an emergency — sudden painful red eye, blurred vision, halos around lights, nausea — phone 999 or go to A&E. Treatment is daily eye drops (or laser/surgery) to lower pressure — lifelong. Over-40s should have regular optician checks every 2 years — free NHS tests if high risk.

Glaucoma — the silent sight thief

Glaucoma is progressive optic neuropathy — characteristic visual field loss — often associated with elevated intraocular pressure (IOP).

~700,000 UK — half undiagnosed — routine optician tests critical

Types

Primary open-angle glaucoma (POAG)

  • Slow drainage angle open
  • Insidious — peripheral field loss
  • Painless
  • Commonest in UK

Angle-closure glaucoma

  • Acute — iris blocks drainage — IOP spikes
  • Emergency — laser peripheral iridotomy
  • Chronic angle-closure — similar to POAG

Secondary glaucoma

  • Steroids, uveitis, trauma, pseudoexfoliation

Normal-tension glaucoma

  • Optic nerve damage at normal IOP
  • Treat to lower pressure anyway

Detection

Optician examination:

  • Tonometry
  • Gonioscopy (referral)
  • Disc assessment — cup:disc ratio
  • Visual fields
  • OCT RNFL

NICE referral criteria — IOP, disc, field thresholds

Treatment

First-line drops:

  • Prostaglandin analogues — latanoprost, tafluprost — evening dosing
  • Side effect — lash growth, iris colour change

Add-on:

  • Beta-blocker — timolol — respiratory caution
  • Carbonic anhydrase inhibitor — dorzolamide
  • Alpha agonist — brimonidine

Laser:

  • SLT — repeatable — reduces drop burden

Surgery:

  • Trabeculectomy, MIGS devices

Adherence matters

50% poor adherence — progression despite “on treatment”

Single combined bottles where possible

Remembering aids, pharmacy repeats

Driving

Notify DVLA if both eyes affected beyond monocular field standards

Visual field test — Esterman binoular

Over 40, no eye test 3 years — book optician — 10 minutes prevents tunnel vision forever.

Common questions

What are the symptoms of glaucoma?
Open-angle glaucoma — usually no symptoms early — gradual tunnel vision — peripheral loss unnoticed until advanced. Acute angle-closure — sudden severe eye pain, red eye, blurred vision, halos, headache, nausea, fixed mid-dilated pupil — emergency. Normal-tension glaucoma — optic nerve damage despite normal pressure.
How is glaucoma detected?
Optician measures eye pressure (tonometry), examines optic disc, visual field test, OCT scan of nerve fibre layer. Referral to ophthalmology if suspicious — confirms diagnosis and starts treatment. NHS eye tests detect many cases incidentally — reason for regular checks.
How is glaucoma treated?
Eye drops lowering intraocular pressure — prostaglandin analogues (latanoprost) first line, beta-blockers, alpha agonists, carbonic anhydrase inhibitors. Laser (SLT) or trabeculectomy surgery if drops insufficient. Treatment prevents further loss — cannot restore vision already lost. Lifelong monitoring.
Who is at risk of glaucoma?
Age over 40, family history, African-Caribbean ethnicity (open-angle), East Asian ethnicity (angle-closure), short-sightedness, diabetes, long-term steroid use, previous eye injury. Regular screening if risk factors.
Can glaucoma be cured?
No cure — but treatable to halt progression — many keep useful vision for life with adherence. Advanced glaucoma causes irreversible blindness — early detection at routine optician visit is key prevention.

Sources