A glaucoma attack represents an abrupt and serious medical emergency affecting the eye. This condition involves a sudden and significant elevation of pressure inside the eye, which can occur without warning. If not addressed promptly, this rapid increase in intraocular pressure carries a substantial risk of permanent vision loss.
What is a Glaucoma Attack
A glaucoma attack is characterized by a rapid and significant increase in the pressure within the eye, known as intraocular pressure (IOP). The most frequently encountered type of glaucoma attack is acute angle-closure glaucoma. This occurs when the iris, the colored part of the eye, suddenly blocks the drainage angle, which is the area where fluid normally exits the eye.
When this drainage pathway is obstructed, the aqueous humor, a clear fluid produced inside the eye, accumulates rapidly. This buildup of fluid leads to a swift and dramatic rise in intraocular pressure. Such a sudden pressure surge can cause damage to the optic nerve, the bundle of nerve fibers that transmits visual information from the eye to the brain.
Identifying the Symptoms
During an acute glaucoma attack, individuals typically experience severe eye pain. Vision often becomes blurred, and in some cases, there can be a sudden and noticeable loss of vision. A distinctive symptom is the perception of halos or colored rings around lights, especially at night.
The elevated eye pressure can also trigger a headache, which may be localized around the eye or more generalized. Nausea and vomiting are also common symptoms, resulting from the stimulation of the vagal nerve due to the intense eye pain and pressure. These symptoms typically appear suddenly and are quite severe, distinguishing them from the more gradual onset of chronic forms of glaucoma.
Common Causes and Risk Factors
Certain anatomical features predispose individuals to a glaucoma attack, such as a narrow drainage angle or a shallow anterior chamber within the eye. These configurations make it easier for the iris to block the eye’s natural drainage system.
Various triggers can precipitate an acute angle-closure attack in susceptible individuals. Pupil dilation, often caused by certain medications like cold remedies or antihistamines, or occurring in dim lighting conditions, can push the iris forward, obstructing the drainage angle. Emotional upset or significant stress can also contribute to an attack.
Demographic factors also play a role in susceptibility. The risk increases with age, particularly for individuals over 60. Certain ethnicities, such as East Asian and Inuit populations, have a higher prevalence of narrow angles. A family history of angle-closure glaucoma also elevates an individual’s risk, as does hyperopia, or farsightedness, which can be associated with a smaller eye structure.
Emergency Steps and Treatment
A glaucoma attack is an ophthalmological emergency. If someone suspects they are experiencing a glaucoma attack, they should seek emergency medical care without delay. Prompt action is crucial to preserve vision and prevent irreversible damage to the optic nerve.
The primary goal of emergency treatment is to rapidly lower the high intraocular pressure. Initial medical treatments involve a combination of medications. Eye drops reduce fluid production and improve drainage. Oral medications, such as acetazolamide, decrease fluid production within the eye.
In severe cases, intravenous medications like mannitol quickly reduce eye pressure by drawing fluid out of the eye. Once the pressure is stabilized, the definitive treatment is a laser procedure called a laser peripheral iridotomy (LPI). This procedure creates a hole in the iris, restoring the normal flow of fluid within the eye and preventing future blockages.
Preventing Future Episodes
After experiencing an acute glaucoma attack, long-term management prevents future episodes. Regular, comprehensive eye examinations are important for at-risk individuals, especially those with narrow angles. These examinations allow eye care professionals to detect and address the condition before an attack occurs, often through preventative measures.
If one eye has experienced an acute angle-closure glaucoma attack, a laser peripheral iridotomy (LPI) is performed on the other eye as a preventative measure. This procedure addresses the anatomical predisposition in the unaffected eye, significantly reducing the likelihood of a future attack. Individuals are also advised to avoid known triggers, such as certain cold medications or decongestants that can cause pupil dilation, if their doctor recommends it. Adherence to any prescribed long-term eye drops and attending all follow-up appointments are important for managing the condition and preventing recurrence.