Acute glaucoma suddenly closes the fluid flow between the cornea and the iris. It mostly affects older people with long-sightedness. In the case of long-sightedness, the spacing between the cornea and the iris is shorter than usual, so the fluid flow angle is narrowed. With age, the lens of the eye increases and pushes the iris forward, which further reduces the angle. When the angle is completely narrowed, it can lead to blockage in fluid flow. The angle blocks the iris when it is pulled to increase the pupil in dim light or during some emotional reaction. The aqueous humour, which is created in the chamber behind the iris, can not flow in this case, so the pressure in the eyeball grows. The iris can withdraw from the flow of liquids by itself and reduce the pupil. If the iris does not withdraw and, instead, is pinched in the corner, the pressure in the eyeball is still increasing, causing the symptoms of acute glaucoma.
Usually only one eye is affected, but later the other eye is very exposed to attack.
In some cases, short previous seizures occur several months or weeks before the fully developed acute glaucoma appears. The attacks usually occur in the evening, when the light is dimmed and last as long as the iris blocks the fluid flow channel – usually for one to two hours. The vision becomes unclear, the patient sees the wreath around the lamp, the cornea swells (since the pressure in the eyeball of the apple pushes the aqueous humour in it), and the eye is often red and painful. However, there is no permanent visual impairment at this stage.
The actual seizure is characterized by the same symptoms, but this time they are permanent and gradually aggravated. Strong pain, which is the result of increased pressure in the eyeball, can be felt in the head and in the eye, and is often accompanied by vomiting. The cornea is all cloudy because of heavy fluid pressure, and sometimes it is gray and grainy. An eyeball can be very painful and hard to touch.
Acute glaucoma is very common, especially in older people. In the UK, between the ages of 45 and 65, one in every 100 people is suffering from some type of glaucoma, and over 65 years, one in every 20 people. Both men and women are equally prone to this disease. Half of these patients seek medical help because of symptoms that occur before a real seizure.
Acute glaucoma is about as common as chronic glaucoma simplex and is one of the most common eye disorders that require urgent treatment.
If the treatment of acute glaucoma starts early, the vision will return almost to normal. But as the seizures are already underway, the fibers of optic nerve in the back of the eye are often damaged, causing persistent loss of vision; if the seizures are completely neglected, a person can go completely blind.
What to do?
Acute glaucoma presents a danger to vision, therefore, a treatment is at the initial stage is essential; most people are still addressing the doctor because the symptoms are extremely unpleasant.
Do not ignore those symptoms. Contact your doctor immediately as soon as you notice the first sign of seizures.
The eye drops will be given to you in the hospital to keep the iris withdrawn from the flow of liquid. To reduce the creating of the aqueous humour, you will get a drug injection, and perhaps dehydration agent in a form of tablet or, in urgent cases, intravenous infusion.
By taking this measures, eye pressure will probably drop after several hours. A day or two after a simple operation called iridiectomy is performed, under local or general anesthesia, to prevent new seizures. Through the iris, a small artificial canal for the discharge of the aqueous humour is made and flows straight to the fluid flow angle. The canal extrudes through the outer edges of the iris, usually below the upper lobe so as not to be seen. Since glaucoma can easily affect the other eye, the specialist will definitely advise you to perform iridiectomy on a healthy eye while you are still at the hospital. The effectiveness of iridiectomy in preventing new glaucoma attacks is very high.
If you have delayed the treatment, the iris will no longer be able to be removed from the fluid flow angle and will be permanently blocked. In that case, a more complex glaucoma drainage operation will be required – allowing the aqueous humour to flow directly from the eye, beneath the conjunctivae. Local or general anesthesia is applied. This operation is also very successful.
If the surgical drainage of glaucoma succeeds only partially, the pressure of the fluid must, in most cases, be regulated by another similar operation or lifelong medication.