EYE HEALTH Table 1: Types of glaucoma and their causes2,4,5,6 TYPE OF GLAUCOMA CAUSES


Chronic open-angle glaucoma (COAG)


Acute angle-closure glaucoma (AACG)


Secondary glaucoma Childhood glaucoma


Normal-tension / low- tension glaucoma


aged over 75 at diagnosis


• People of African, Afro-Caribbean or Asian descent are at increased


risk of developing certain types of glaucoma


• Raised IOP • Myopia (short sightedness) • Diabetes • Female gender


• Conditions that significantly restrict blood flow to eye eg, diabetic retinopathy


• Prolonged use of steroids • Eye trauma • Systemic hypertension2


There are several different types of glaucoma. Table one outlines the most common types.


CHRONIC OPEN ANGLE GLAUCOMA (COAG): This is the most common type of glaucoma accounting for over 70 per cent of cases. As there is a chronic degenerative obstruction that does not allow the aqueous humour to properly drain away from the eye, IOP is increased2


. The condition


usually develops slowly and painlessly over many years, so that damage to the optic nerve and loss of sight are gradual. A patient will often not realise they have COAG as the peripheral vision is affected first. Without treatment, vision towards the centre of the eye may also be lost and patients may present with significant loss of sight4,5


.


In the UK, around one in 50 people aged over 40 have COAG, rising to around one in ten people aged over 75. It is unusual in those aged under 35. If left completely untreated, progression to severe sight impairment typically takes between 25 to 70 years from onset, with those of African descent more likely to become blind2


.


A partial blockage within the trabecular meshwork restricts the drainage of aqueous humour from eye


Bowing of the iris against the trabecular meshwork blocks the drainage of aqueous humour from eye


Caused by another eye problem eg, uveitis, eye trauma, ocular tumour or steroid-induced


Incorrect development of the eyes drainage system before birth


Unknown. Some evidence to suggest vascular dysregulation is a contributing factor


With an ageing population and longer life expectancy, the number of patients with COAG is predicted to rise, increasing the social and economic burden of this disease1


.


ACUTE ANGLE-CLOSURE GLAUCOMA (AACG):


As the drainage of aqueous humour is blocked by the bowing of this iris against the trabecular meshwork, pressure in the eye builds up. This type of glaucoma is a medical emergency that requires urgent reduction of IOP to prevent loss of vision. Symptoms can include intense eye pain and redness, headache, tenderness around the eyes, blurred vision and nausea. Patients presenting with these types of symptoms should be immediately referred for specialist assessment and treatment4,5


.


SECONDARY GLAUCOMA: This is an uncommon type of glaucoma caused by another eye problem. Symptoms vary considerably but may include a gradual loss of peripheral sight, blurred vision, eye pain, eye redness and seeing halos around lights5


. Steroid-induced


glaucoma is a form of secondary glaucoma that is usually associated with topical steroid use, though it may develop with inhaled, oral, intravenous, or intravitreal steroid administration. Steroid-induced glaucoma typically occurs within a few weeks of starting steroid therapy and spontaneously resolves in most cases within a few weeks or months after stopping the steroid. In rare cases, intra-ocular pressure remains raised7


.


CHILDHOOD GLAUCOMA: Also referred to as congenital glaucoma, this is a type of glaucoma affecting babies and young children typically diagnosed within the first year of life. It is a rare condition that causes ocular fluid and pressure build up resulting from developmental eye defects. This in turn damages the


Table 2: Eye drop instillation advice,5 • Use your finger to gently pull down lower eyelid


• Hold bottle over eye and allow a single drop to fall into pocket you have created in the lower lid


• Close your eye and keep it closed for at least two to three minutes


• If using more than one type of eye drop, leave at least five minutes between instillations


optic nerve. Symptoms can be difficult to identify, but can include unusually large eyes, excessive tearing, light sensitivity and red or cloudy eyes. Surgery is often needed to correct structural defects within the eye5,8


.


NORMAL-TENSION GLAUCOMA: Patients with a normal IOP who


develop optic nerve damage and visual field defects are defined as having normal-tension glaucoma, also referred to as low-tension glaucoma. Around 20 per cent of patients with glaucoma have normal IOP (typically defined as being between 12 – 22mmHg). The causes are still unknown and research continues


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.


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1. Schmidl D. et al. 2016. Int. Conf. on Tear Film and Ocular Surface 2. Pinto-Bonilla JC et al. Ther Clin Risk Manag 2015;11:595-603 3. Doan S et al. Acta Ophthamologica 2015; 93, Supplement S255 4. Schmidl D et al. Cornea 2015;34(4):421-6 5. Schmidl D. et al. Ophthalmology & Visual Science 2015: 57: 2881


SCOTTISH PHARMACIST - 33


This prolonged effect makes it ideal for night time use, in conjunction with Thealoz Duo for use through the day.


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