There are several different types of glaucoma.
Treatment depends on properly identifying precisely which kind
is present and determining how the glaucoma may affect the person's
quality of life. The goal of treatment is preservation of health.
Medications
If treatment is determined to be necessary, usually
the first course of treatment with all types of glaucoma is the
use of medications. These medications work to either lower the
intraocular pressure by increasing the amount of aqueous humor
(fluid) that drains from the eye or to reduce the amount of aqueous
humor (fluid) produced by the eye. Glaucoma medications are usually
in the form of an eye drop but can also be in the form of pills
or liquid. In some rare emergency cases medications can be given
intravenously to rapidly bring the eye pressure down from dangerously
high levels. When medications are used the goal is to lower the
intraocular pressure to prevent damage to the optic nerve. The
level of intraocular pressure needed to prevent damage varies
from one individual to another. There is no magic number; your
target eye pressure (the pressure needed to prevent damage) will
be determined by your glaucoma specialist.
Medications that increase the
flow of aqueous humor:
Adrenergic agonists - Alphagan, Epifrin, Glaucon,
Iopidine, Propine
Cholinergics - Carboptic, Isopto Carpine, Phospholine
Iodide, Pilocar, Pilopine HS, Pilostat
Prostaglandin analogs - Xalatan, Lumigan, Travatan
Medications that decrease the amount of aqueous
humor produced:
Adrenergic agonists - Alphagan, Epifrin, Glaucon, Iopidine,
Propine
Beta-blockers - Betagan, Betimol, Betoptic, Cosopt, Timoptic,
Ocupress, Optipranolol
Carbonic anhydrase inhibitors - Diamox, Neptazane, Azopt, Cosopt,
Trusopt
Hyperosmotics - Ismotic, Osmoglyn, Osmitrol, Ureaphil
Medications that act by both mechanisms
Adrenergic agonists - Alphagan, Epifrin, Glaucon, Iopidine,
Propine
More information:
Glaucoma Medications
Some Medications
May Harm Glaucoma Patients
Treatment
for Glaucoma: Not to be Taken Lightly
Age-Related
Eye Disease Study
Lasers
There are many kinds of glaucoma. We classify the type of glaucoma
according to the reason for the blockage in the outflow of fluid.
Angle-closure and chronic open-angle glaucoma are by far the most
common, and the main types of glaucoma treated with laser surgery.
More information:
Laser Therapy for
Glaucoma
Nd: YAG Cyclophotocoagulation
for Difficult Glaucoma
Trabeculectomy
One way to relieve the dangerously high pressure
in an eye with glaucoma is to make a new drain in the eye, a bypass
for the blocked natural drain. This is called a trabeculectomy
and takes the form of a "flap valve" which is surgically
created in the white part of the eye hidden under the upper eyelid.
The eye pressure is relieved because fluid can now drain through
the new valve. A trabeculectomy is usually done under local and/or
topical anesthesia. An anesthetist administers intravenous medication
to relax the patient and reduce the discomfort of the local anesthetic
injections. A shot of local anesthetic numbs the eye completely
so that it will not move during surgery nor feel any pain. Alternatively,
topical anesthetic drops and jell can numb he eye adequately for
surgery. If preferred, the anesthesiologist can administer a general
anesthetic, keeping the patient asleep for the whole operation.
The surgery itself takes 35 minutes to an hour in most cases.
More information:
Trabeculectomy
A Typical
Uncomplicated TRABECULECTOMY
Shunts
Glaucoma is a disease in which the drainage mechanism
of the eye has become blocked. Since an eye normally produces
a watery fluid called aqueous throughout life, this fluid has
nowhere to go and backs up. This causes a build-up of pressure
within the eye which injures the optic nerve. The safest and simplest
type of surgery to reduce intraocular pressure is a trabeculectomy,
a procedure which makes a flap valve on top of the eye. This allows
the aqueous to seep out under this flap valve and be absorbed
under the conjunctiva, the clear layer overlying the sclera, and
into the bloodstream. There is little chance that this procedure
will work if there is existing inflammation, excessive scarring
from previous surgeries, or unusual healing is expected. In these
cases, the next step is an aqueous shunt, a tiny plastic tube
from the anterior chamber of the eye to a reservoir that is placed
halfway back around the eye. The reservoir is a plate that prevents
the top layer of the eye from sealing to the wall of the eye and
preventing drainage. Aqueous fluid is drained through the tube
to the top of these plates and then is absorbed into the lymph
and blood vessels around the eye.
More information:
Aqueous Shunt
from the Anterior Chamber of the Eye to a Posterior Reservoir
Cyclocryotherapy
One way to combat the dangerously high pressure in an eye with
one of the more difficult to control glaucomas is to cut down
on the amount of fluid produced. This is how cyclocryotherapy
works. Remember, the ciliary body produces the aqueous fluid in
the eye. Applying a freezing probe to half of the ciliary body
destroys half of the fluid-making ability of the eye. Hopefully,
with less fluid being made, medications can keep the amount of
fluid produced equal to the amount of fluid drained - thus, the
pressure remains controlled.
More information:
Cyclocryotherapy for Endstage
Glaucoma
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