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Glaucoma - Medical Malpractice
Glaucoma is a condition of the major nerve responsible for vision, the optic nerve. The optic nerve becomes progressively damaged due to high pressure inside the eye so that it can lead to a loss of central vision and eventual blindness. Glaucoma is usually associated with high pressure in the eye but it doesn't have to be so. Normal pressure glaucoma is believed to be related to having poor regulation of the flow of blood to the optic nerve. Glaucoma is the most common cause of irreversible blindness in the world. As many as six million people are blind throughout the world because of glaucoma. Many, unfortunately, do not know they have the disease until it is too late.
Most glaucoma is the result of high pressure inside the eye leading to changes in the optic nerve. The optic nerve is the main nerve for vision of the eye, particularly central vision. Normally the eye pressure is between 8 and 22 mm Hg. The eye gets harder when the pressure goes up and this is how doctors measure glaucoma. In most people, the drainage angles for drainage of fluid from the eye are widely open but in some people they are narrow.
There is always fluid flowing into the eye and there is always fluid draining from it. When there is an imbalance of fluid within the inflow and outflow of the eye, you can get glaucoma. If there is too much inflow or too little outflow, the pressure rises within the eye. The increased pressure causes glaucoma.
Sight can be destroyed with very few symptoms. Everyone is at risk for glaucoma at any age but the highest risk factors include having an age greater than 45 years, a family history of glaucoma, being of black ancestry, having a history of increased intraocular pressure, and having diabetes. If you are near-sighted or have had an injury to the eye, you are at higher risk of getting glaucoma. If you have used cortisone substances in your eye or by any other means too much, you are at risk for getting glaucoma. Those who are far sighted can get glaucoma.
There are many different kinds of glaucoma but they can be defined as being open-angled or angle-closure glaucoma. They can be acute and happen over a short period of time or chronic. They usually affect both eyes but one eye can be worse than the other. If just one eye is involved, it is usually because of steroid use in one eye or because of trauma to that eye.
The types of glaucoma include open-angle glaucoma and primary chronic open-angle glaucoma or COAG is the most common type of glaucoma you can find. It is worse in the elderly and occurs due to a clogging of the drainage system of the eye. Normal pressure glaucoma or low tension glaucoma are related to COAG but are harder to diagnose because the pressure is measured as normal. The optic nerve gets damaged even with normal pressures. Congenital or infantile glaucoma is an open angle glaucoma that happens because the drainage area is not developed well in the womb. There is blindness in a young child.
In angle-closure glaucoma, the disease is more prevalent in Asia. It can be chronic or acute and is caused by the drainage angle becoming completely closed so that fluid in the eye cannot even reach the trabecular meshwork within the eye. This is a rare disease in the Western world. It is common in those with small eyes.
There are no signs and symptoms of the disease in its early stages. Vision loss is a late finding. Some people with angle closure glaucoma have severe eye pain, nausea, vomiting, headache and blurry vision. Eyes in open-angle glaucoma can be normal in appearance or can be red.
The real way to diagnose glaucoma is to check the pressure within the eye. This is done using tonometry, which measures the hardness or softness of the eyeball. Pachymetry is a test that measures the thickness of the cornea and requires numbness of the eyeball. Gonioscopy is done by numbing the eyeball and by and using a contact lens on the eye in order to examine the drainage angle and drainage area of the eyeball.
Treatment of glaucoma includes medications in the form of eyedrops that are beta antagonists that block beta receptors within the eye. Timolol and levobunolol are two of several types of eyedrops that are used to reduce the pressure within the eye. Prostaglandin analogs are taking the place of the beta antagonists for glaucoma. They increase the outflow of the fluid from the eyeball. Adrenergic agonists are also used as eyedrops for the eye. This can include epinephrine or Propine for the eye.
Laser surgery can be done to correct glaucoma. In laser iridotomy, there is a hole placed in the iris to drain fluid out of the eye. In a laser trabeculoplasty, you cannot cure glaucoma but improves the number of drops you need to take.
Glaucoma surgery can include a trabeculectomy, which creates a hole for drainage and other surgeries which increase the drainage of the eye fluid.LEGAL HELPLINE: ☎ 855 804 7125
The author of the substantive medical writing on this website is Dr. Christine Traxler MD whose biography can be read here