MANSAROVAR EYE HOSPITAL,
LUCKNOW, INDIA.
Phones: 91-522-224292/228655/201717
Fax: 91-522-239259



WHAT IS 'GLAUCOMA'?

Glaucoma is a condition in which the pressure of fluid in
the eye-ball is abnormally high - higher than the eye can
tolerate over a long period of time. Glaucoma usually occurs
in both eyes , but it may start much sooner in one eye than in
the other. When the eye pressure is abnormally high over a
long period of time then it causes the slow death of nerve
fibrils inside the optic nerve leading to a gradual reduction
in vision. Eye-sight thus lost can never be regained.	

WHAT CAUSES GLAUCOMA ?

It is caused by the build-up of  the fluid - 'aqueous humor' 
which circulates within the eye. This occurs because either 
too much fluid is being formed  or the channel through which 
it normally drains - 'the canal of Schlemm' - is blocked.
Since new fluid continues to be formed the pressure continues
to rise.

CAN GLAUCOMA DAMAGE  SIGHT ?

If it goes untreated, YES. Raised pressure can constrict blood
vessels that nourish the sensitive visual cells in the back of 
the eye resulting in the slow death of these cells causing 
gradual,slowly progressive loss of vision. Blurring of side 
vision and reduced vision in low light conditions is usually 
noticed first. As the condition progresses, more nerve cells 
are damaged and the range of vision becomes narrower.
If left unchecked, this process will definitely lead to 
total blindness.

HOW CAN YOU TELL IF YOU HAVE GLAUCOMA ?

Usually you can't. Glaucoma is insidious : the vast majority 
of cases develop slowly over a period of months or years. 
In most cases there are no symptoms.damage can progress so 
slowly that the person is not aware of the gradual loss of 
sight.Some people do experience vague symptoms and these are
important warnings that a proper eye examination is needed.
Symptoms can include a need for frequent change of glasses,
difficulty in adjusting to dark rooms, loss of side vision, 
and generally blurred vision. Rarely, other symptoms, 
such as appearance of halos or rainbow colors around 
lights and severeheadache or pain associated with 
blurred vision and red eyes may occur.

WHO GETS GLAUCOMA ?

It most often appears in people in middle and later years 
of life.That is why it is important for everyone above 40 to 
have a proper eye examination at a well equipped eye clinic 
every two years. 
A very rare form of glaucoma can occur in infants. These infants
usually have one or both eyes that look abnormally big .They
have difficulty in opening their eyes in bright light  and 
a lot ofwatering from the affected eye. People at high risk 
include those with diabetes or those who
have relatives with glaucoma. Those who have a positive 
family history should be all the more vigilant and should 
be sure to have their eyes checked regularly.

ARE THERE DIFFERENT TYPES OF GLAUCOMA ?

Yes, there are several. The most common types are 
CHRONIC, ACUTE, CONGENITAL and SECONDARY. 
All of them require attention over a long period of time, 
often for the whole life.

Simple or chronic open-angle glaucoma : This accounts for 80% 
of the cases.It progresses slowly and often goes unnoticed 
for many months or years, causing a gradual deterioration 
of vision. Signs that suggest that a person has this type of 
glaucoma include : frequent change of glasses,none of which seem 
to help; aching or discomfort around the eyes; blurring of 
side vision and difficulty in adjusting to darkly lit
surroundings. This type of glaucoma usually responds well 
to medication, although resistant cases are always there. 
Therapy is usually continued for life so that the pressure is 
kept under control.Surgery is the onlytreatment for resistant
cases.

Acute or angle-closure glaucoma : It is much less common.In this
there is an acute and drastic rise in eye pressure causing 
severe pain and reduction in vision. If not treated at once 
it can permanently damage vision in a very short time. 
Unlike chronic open-angle glaucoma, acute glaucoma has very 
marked symptoms such as severe pain,blurred vision, 
appearance of halos around lights and nausea and vomiting.

Secondary glaucoma : this type is caused as a complication 
of certain pre-existing eye problem such as iritis, 
retinal detachment, over-ripe cataract or a tumor in the eye.

Congenital glaucoma : This is very rare and occurs in babies 
who are born with defective drainage canals. This makes the 
eye appear cloudy and causes the eye to become abnormally large.
The baby may shy away from light and keep its eyes closed to
avoid light. There may also be excessive watering from the 
baby's eyes. These symptoms indicate the need to get the baby's 
eyes examined by an eye specialist.

HOW IS GLAUCOMA DIAGNOSED ? WHAT ARE THE SPECIAL 
TESTS FOR GLAUCOMA ?

Only a qualified eye specialist will have the expertise and the
equipment to properly diagnose this condition. It is therefore
important for everyone to visit an ophthalmologist at around the 
age of 40 years to have a complete eye exam. The most 
important part of this eye exam is the measurement of eye pressure
using an instrument called the TONOMETER.  This is usually 
referred to as"taking the tension". This test takes only a 
few seconds and is absolutely painless. If the eye pressure 
is found to be raised , only then a set of confirmatory test 
are done to find out if the person really has the disease or not. 
These include the following:
GONIOSCOPY : with this test the doctor comes to know about the 
type of glaucoma that the patient is suffering from. A special
'contact lens' called the 'gonioscope' is placed on the eye 
and the inner structures are visualized using a special 
microscope called the 'slit-lamp bio-microscope'. This test is 
not painful and takes a few minutes only
FIELD TEST (PERIMETRY) : This test is done on a special,
computerized machine and provides information about the 
amount of damage that has been caused to the optic nerve 
by the disease. 
This is a very sensitive test and it can help diagnose the disease
in its earliest stages when a significant amount of damage has
not occurred. It needs to be repeated frequently every 3 to 6 
months in order to keep a close track of the disease and to see 
if it is in control or not. It helps tell how much treatment 
you need and how well it is working. 
REFRACTION :  this refers to the testing for glasses and
it is routinely done for all patients who have glaucoma 
wheneverthey come for their follow-up visits to the doctor. 
This helps to know if the vision is being maintained or not.

ARE REGULAR EYE CHECK-UPS IMPORTANT  ?

If the diagnosis of glaucoma is established then the 
tension test ,the field test and the refraction test have to 
be periodically repeated in order to know if the disease
is under control or not. That is why it isvery important 
for the patient not to miss his appointments with his
eye doctor. If home or work responsibilities, lack of money 
or difficulty in traveling interfere with your visits to
the hospital or in getting your medicine then you should 
talk with your doctor freely. 
He may be able to guide you to the right places for assistance.

CAN GLAUCOMA BE CURED ?

Although glaucoma cannot be cured it can usually be 
controlled with proper treatment. Glaucoma is a chronic
life-long condition requiring continual observation and
management of the patient to keep elevated intra-ocular
pressure under control and to help prevent loss of vision.
The earlier the condition is detected and
treated, the greater the success in preventing visual loss.

HOW IS GLAUCOMA TREATED ?
Eye drops and tablets :
It is usually controlled by using special eye drops.  
If one eye type of drop is not producing the desired effect 
then it may have to be supplemented or replaced by another one.
Sometimes tablets have to be taken also. It is very important
to use the medicine regularly and exactly as instructed by 
the doctor. As the effect of the medicine lasts for
only a few hours the drops must be instilled on schedule to keep
glaucoma under control. 
Side-effects of the drops :Sometimes the eye drops may sting or
cause pain when used . The eyes should not be rubbed or washed
to relieve this discomfort . Some drops may make the vision 
blurred or dim , but do not worry and inform the doctor about it. 
At times certain drops cause breathing difficulty, headache, 
palpitation etc. Be sure to inform the doctor about this so that 
he may advise alternatives.
How many drops to put : Only one drop of the medicine is enough
for the desired effect so do not put more. After putting the drop 
close your eye and wait for at least 5 minutes before putting 
the next medicine , if any. Do not use the drops if they are 
discolored. Keep all medicines out of reach of children as they 
are toxic if taken orally.
Side-effects of tablets : If pills have been prescribed they may 
causetingling sensation in  the fingers and toes. They can also 
cause drowsiness and stomach upset. These side effects are 
usually mild.

Although these side effects of the medicines may be a nuisance,
but they are worth the trouble to save the eye-sight. So they
should not be stopped without the doctor's advice or permanent 
damage to sight can occur !

SURGERY :  When glaucoma is not being adequately controlled 
with medicines , surgery is necessary.
It is usually possible with the help of surgery to bring the 
pressure down to normal levels and to halt permanently the 
reduction of vision. 
However, the amount of sight that has already been lost can 
never be recovered. Sometimes even after the operation one 
eye drop may be needed to keep the pressure under control. 
This will have to be continued life-long. As with any other 
surgical procedure there are risks involved in the operation 
of glaucoma also and the benefits of the surgery have to be 
weighed against the risks before a decision to operate is made. 
After operation when the eye has stabilized and the pressure 
is under control the patient will still be required to get 
his eye pressure tested periodically to make
sure that the operation is performing well.  Field test may also
be required once a year for the same reason.

LASER TREATMENT : 
Laser therapy is a very effective new form of treatment in 
selectedcases of glaucoma.It does not replace medical or 
surgical methods of treatment , but it has been found to be a valuable adjunct in the treatment.

SOME FINAL ADVICE :
If glaucoma is neglected or left untreated it will always result in
loss of vision and will ultimately cause total blindness therefore
a patient with glaucoma :
-  must come to the clinic regularly when called 
- use eye drops and/or tablets on time
- not stop treatment for even one day (unless directed by the 
  doctor for some   special test )
- be sure to notify the doctor if there is any change in 
  his condition.

THIS HOSPITAL IS FULLY EQUIPPED WITH ALL 
THE LATEST GADGETS  INCLUDING COMPUTERIZES 
PERIMETER AND LASER MACHINE FOR THE COMPLETE 
CARE OF GLAUCOMA PATIENTS.  
                                                          
This information brochure is published by 
Mansarovar Eye Hospital, Lucknow for the information 
of patients and it also forms a part of the informed 
consent for patients undergoing treatment of glaucoma. 


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