What Is Usually the First Sign of Glaucoma?

Early glaucoma usually has few symptoms, but the buildup of pressure in the eye over time leads to slow vision loss starting with peripheral vision.

Glaucoma refers to eye diseases that cause damage to a nerve in the back of the eye (the optic nerve). This damage is usually caused by pressure inside the eye and can result in vision loss and blindness. 

There are 2 types of glaucoma:

• Open-angle glaucoma 
  • The most common type
  • Occurs when eye pressure builds up slowly
• Angle-closure glaucoma (also called narrow-angle glaucoma) 
  • Less common 
  • Occurs when the fluid-draining system in the eye gets blocked
  • Eye pressure rises quickly

Glaucoma usually doesn’t have any symptoms at first and many people don’t know they have it. 

When symptoms of open-angle glaucoma occur, they usually include: 

• Slow vision loss
• Vision loss often starts with side (peripheral) vision, especially the part of vision that’s closest to the nose
• Center of vision appears clear (“tunnel vision”)
• It happens very slowly and many people can’t tell it’s happening at first

Symptoms of angle-closure glaucoma include vision loss and:

• Seeing halos around lights
• Headache
• Severe eye pain
• Nausea and vomiting
• Eye redness 
• Swelling and cloudiness in the colored part of the eye (iris)

Glaucoma is caused by high pressure inside the eye (intraocular pressure), but the reason for this increased pressure is often not known. 

Risk factors for developing glaucoma include:  

• Age over 60 years
• Being African Americans or Hispanic/Latino and over age 40 
• Family history of glaucoma 

Glaucoma is diagnosed by an eye doctor with a comprehensive dilated eye exam. 

A dilated eye exam includes:

• Dilation 
  • Checks for problems with the inner parts of the eye
  • The eye drops dilate (widen) the pupils so the doctor can see inside the eye
• Tonometry test 
  • Measures pressure in your eyes
  • A quick puff of air is blown onto the eye, or the eye is gently touched with a special tool (this is not painful)
• Visual field test 
  • Checks peripheral (side) vision
  • Tests how well you can see objects in your peripheral vision without moving your eyes
• Visual acuity test
  • Checks vision clarity
  • Patients read letters up close and far away
  • Eye muscle function test 
  • Check for problems with the muscles around the eyeballs
  • Patients follow a moving object with their eyes
• Pupil response test 
  • Checks how light enters the eyes
  • The doctor shines a small flashlight into the eyes to check how the pupils react to the light

Treatment for glaucoma should begin as soon as possible to prevent vision loss. Treatment may include: 

• Prescription eye drops 
  • The most common treatment
  • Eye drops to help fluid drain from the eye to lower eye pressure
  • Prostaglandins: latanoprost (Xalatan), travoprost (Travatan Z), tafluprost (Zioptan), and bimatoprost (Lumigan) 
  • Rho kinase inhibitor: netarsudil (Rhopressa)
  • Nitric oxides: latanoprostene bunod (Vyzulta)
  • Miotic or cholinergic agents: pilocarpine (Isopto Carpine) 
• Eye drops to help lower the amount of fluid produced by the eye
  • Alpha-adrenergic agonists: apraclonidine (Iopidine) and brimonidine (Alphagan P, Qoliana) 
  • Beta blockers: timolol (Betimol, Istalol, Timoptic) and betaxolol (Betoptic) 
  • Carbonic anhydrase inhibitors: dorzolamide (Trusopt) and brinzolamide (Azopt) 
• Laser trabeculoplasty 
  • Used to treat open-angle glaucoma
  • Uses lasers to help fluid drain from the eye
  • Can be done in a doctor’s office