Counseling Sheet

Agatha M. Thrash, M.D.
Preventive Medicine

Pressure within the eye (intraocular pressure) which is higher than normal is called glaucoma. Approximately one million Americans have glaucoma and do not know it. It is the cause of one-tenth of all cases of blindness and occurs in 1 to 2.5% of all Americans over 35 years of age or older. Blindness due to glaucoma is more common in blacks than in whites. It tends to run in families. Relatives of glaucoma patients are five or six times more likely to suffer glaucoma than are persons without a history of glaucoma in the family.

Fluid is constantly being produced in the eye and constantly drains out. Pressure build-up occurs if the fluid called aqueous humor is prevented from flowing out. Normal eye pressure is 15 to 20 millimeters of mercury, but in glaucoma levels may reach 40 millimeters of mercury or more. Picture a balloon being filled with more and more water, with none of the liquid allowed to escape. The balloon wall is subjected to increasing amounts of pressure. This increased pressure in the eyeball may lead to damage of the optic nerve producing progressive loss of vision.

There are three types of glaucoma: angle closure, open-angle, and congenital. Angle closure glaucoma is often acute in nature and a medical emergency. The patient may experience episodes of decreased vision and colored halos around artificial lights. These episodes often occur when the person is under emotional stress or in a darkened environment which produces dilation of the pupil. There may be severe pain in or around the eye due to a rapid increase in intraocular pressure. Pain is most often present in only one eye. The pupil may become enlarged, and nausea and vomiting may be present.

Open angle glaucoma is slower in onset. The patient may experience mild discomfort or a feeling of tiredness in the eye, particularly after watching television or movies in a dark room, poor vision in dim light, and no improvement in vision with changes in prescription. He slowly loses his side vision - so slowly that he often does not recognize the loss. There may be halos around lights and loss of vision. This type of glaucoma is the most common. Open angle glaucoma generally begins at age 40 to 46. If untreated, it may lead to blindness by age 60 to 65.‍

TREATMENT:

• The person with glaucoma should be under the regular care of his physician. Early diagnosis and treatment are important in preventing blindness.
• Worry, anger, fear, and other emotional upsets should be avoided as they may increase intraocular pressure.
• Heavy pushing, lifting, etc. should be avoided, but moderate daily, out-of-door exercise will lower intraocular pressure.
• Any clothing which constricts the body (tight belts, collars, girdles) may raise intraocular pressure and should be avoided.
• Reading, sewing, etc., may be done in moderation.
• Avoid constipation as straining at the stool increases intraocular pressure.
• As blood pressure rises, so does the intraocular pressure. Treat high blood pressure promptly and faithfully.
• Obesity may hinder the outward flow of aqueous humor. If overweight, begin a weight-reduction program.
• A single cup of coffee is sufficient to bring on a violent glaucoma attack in susceptible persons. Avoid coffee and other caffeine-containing foods and beverages.
• A small adhesive patch containing medication to prevent motion sickness has recently been placed on the market. Several cases of glaucoma have been induced by these patches. Other drugs such as corticosteroids (cortisone-type drugs) may induce glaucoma.
• The new orthopedic devices that suspend a person upside-down have been shown to produce alarming elevations in both blood pressure and intraocular pressure.
• Lying in the prone (face down) position may produce a significant increase in intraocular pressure.
• Blood sugar abnormalities such as diabetes may hasten the onset of glaucoma.
• Tobacco use raises intraocular pressure.
• Do not take abnormally large amounts of fluid at one time. A glass or two at a time is probably safe. Spread fluid intake over the entire day.
• Some believe that some cases of glaucoma may be related to a food allergy.
• Hot compresses applied to the eyes for nine minutes, followed by a one minute cold compress, alternated for an hour daily, may be helpful.
• Use a sugar-free, visible-fat-free diet.