Glaucoma in the eye, what is it?

The term glaucoma is used to describe a group of diseases that have in common a chronic progressive optic neuropathy (a disease of the optic nerve) that causes characteristic changes in the shape of the nerve and in the layer of nerve fibers, responsible for transmitting the image from the retina to the brain.

These changes are associated with the progressive and irreversible death of retinal ganglion cells (one of the innermost layers of the retina) and loss of visual field. Intraocular pressure is a key modifiable factor, actually the only risk factor that ophthalmologists can control to reduce the probability of disease progression.

A common disease after 40

Glaucoma affects 2-3% of people over the age of 40, although it is likely that up to 50% of cases may remain undiagnosed. It is an important problem worldwide, since it is the second worldwide cause of blindness. Primary open-angle glaucoma is the most common form in whites, Hispanics/Latinos, and blacks, with the prevalence being especially high in the latter. Worldwide, primary angle closure (PAC) accounts for up to half of cases, and is particularly common in individuals of Asian descent.

Types of glaucoma

Glaucoma can be congenital, children are born with glaucoma, or acquired (develops later in life).

Among the types of acquired glaucoma, the most common type in people of European and African descent is primary open-angle glaucoma. It is a disease that affects men and women equally, in which elevated intraocular pressure causes thinning of the nerve fibers of the optic nerve, characteristic changes of the nerve (called “cupping”) and also typical lesions in the visual field..

Therefore, the most common types of glaucoma are: open angle, closed angle, normal tension and congenital glaucoma.

Open angle glaucoma

It is a chronic disease that affects the nerve that carries information from the eye to the brain. It results in a progressive loss of vision.

Angle closure glaucoma

Primary angle closure glaucoma may account for up to half of all glaucoma cases worldwide and is especially common in Asia.

Normal tension or low tension glaucoma

It is a type of glaucoma that occurs when the intraocular pressure is at normal levels (below 21 mmHg), but even so the fibers of the secondary optic nerve show damage, and loss of the visual field occurs.

Congenital and/or childhood glaucoma

The term congenital glaucoma encompasses a series of diseases, most of which are of hereditary origin. They are characterized by an ocular abnormality that exists from birth, and that causes an increase in intraocular pressure.

Secondary glaucoma

This type of glaucoma is said to have been caused by another disease, such as neovascular glaucoma due to the formation of new vessels in the iris, phacolytic glaucoma, produced by a long-standing cataract, or phantom cell glaucoma due to a vitreous hemorrhage.

Frequent questions

How often should I have my vision checked?

From the age of 60, an annual visit to the ophthalmologist is recommended to carry out a complete ophthalmological examination and rule out the possibility of suffering or not glaucoma.

If I have high eye pressure, does that mean I have glaucoma?

Glaucoma is not high intraocular pressure in the eye. The specialist must carry out a personalized diagnosis of each patient and examine the intraocular pressure that they have since glaucoma is a set of important symptoms and signs that must be taken into account, but not only intraocular pressure.

How does increased pressure damage the eye?

The eye needs to have a certain amount of pressure to maintain its shape and function properly. When there is a balance between the production and elimination of the aqueous humor, a transparent liquid that nourishes and oxygenates the lens and the cornea, the intraocular pressure (IOP) remains constant. But if the production of aqueous humor increases or if it is removed insufficiently, the pressure rises and the optic nerve can be put under pressure, increasing the risk of vision difficulties. Having elevated IOP is a risk factor for glaucoma.

What symptoms does glaucoma give?

Unfortunately, most types of glaucoma presentation do not usually cause any symptoms (except in the case of angle-closure glaucoma, whose pain is compared to “nail pain”) until very advanced stages where field loss of vision is already remarkable.

Is it true that you can’t heal and only be controlled?

Indeed, we cannot speak of eradicating the disease but of controlling and slowing down its evolution.

How is glaucoma treated?

First, blood pressure can be controlled with eye drops by combining up to three or four medications. There are four large groups of medicines and various combinations of medicines in the same eye drops. If this does not lower the tension, surgical intervention can be performed to control it with minimally invasive modern techniques and even tension regulating devices.

Is the treatment forever?

Glaucoma damage is permanent and therefore has no cure. However, its progression can be stopped with medication or surgery. The greater or lesser success of the results will also depend on the case that the patient makes to the indications of his ophthalmologist after the treatment received. A glaucoma patient must be very rigorous with these indications to be well controlled and achieve good visual quality despite having this disease.

With glaucoma, can you drive?

A glaucoma patient may have 100% visual acuity but a tiny visual field. If the terms of legal blindness are reached, that is, vision less than 10 degrees central, not only will you not be able to drive, since it could endanger your life and that of others, but you will also be unable to perform other types of tasks daily.

How does the loss of vision from glaucoma differ from that suffered, for example, in cataracts?

The fundamental difference is the lack of reversibility, what we lose, unlike a cataract, cannot be recovered. On the other hand, initially what is lost is the field of vision to finally lose frontal vision.

What happens if the drops make me intolerant?

If drop treatment is not possible or insufficient, the specialist will assess the possibility of laser treatment in cases where it is indicated, as well as surgical treatment.

How should the drops be used?

Eye drops should always be prescribed by your ophthalmologist. Those who use drops as a treatment for chronic glaucoma to control IOP at the desired levels for each patient. Strict and controlled compliance by the patient in the use of drops is a fundamental requirement to be able to continue adequately and effectively with medical treatment.

Oculoplasty or ocular plastic surgery is the unit specialized in ophthalmology in treating ocular pathologies related to the periocular area of ​​the face: eyelids, orbit and lacrimal ducts. A patient requires or needs medication or oculoplastic surgical treatment when the eye, which is protected by the eyelids and the lacrimal system, undergoes some alteration.

Eye plastic surgery or oculoplastic surgery resolves most pathologies of these organs that, in addition to affecting vision, can affect aesthetics. At Vijovis our oculoplastic surgeons have extensiveexperience in the diagnosis and treatment of these pathologies.

What treatments do we perform?

• Bags and excess skin on the eyelids
• Ectropion
• Entropion
• Eyelid ptosis
• Eyelid retraction
• Xanthelasmas
• Pterygium
• Evisceration / Enucleation
• Eyelid tumors
• Eyelid lesions
• Eyelid wounds
• Thyroid orbitopathy
• Eyebrow ptosis
• Aesthetic alterations
• Progressive aging

Oculoplasty Price

The oculoplastic surgeon must make a correct diagnosis of the trauma or alteration that involves the eyeball, the eyelids and the orbit to assess a surgical treatment or another in order to achieve the desired functional and aesthetic result. Therefore, the price will depend on each case , as well as the chosen procedure.

Frequent questions

After oculoplastic surgery, when can I put on makeup again?

It depends on the intervention, but the normal thing, for example, if it is after eyelid surgery (blepharoplasty), is after 15 days.

Should I avoid the sun after an oculoplasty procedure?

Yes, we recommend not exposing yourself to UVA rays from the sun as the scar that can remain after eye plastic surgery can cause it to darken. We recommend sunbathing for a month after surgery, as well as putting on a lot of sun protection. The only exception is transconjunctival blepharoplasty because, once the hematomas have been reabsorbed, there are no visible scars.

Can I go back to the gym soon?

After eye plastic surgery, we recommend waiting a week to 15 days to return to your usual sports activities.

If I have dry eye, can I undergo oculoplastic surgery?

It is not contraindicated, especially if it is a mild or moderate degree. However, in the case of ptosis, for example, a more conservative surgery may be required. There is also no contraindication for patients operated on for cataracts, retina, glaucoma, myopia, hyperopia and astigmatism.

Will I be able to shower after ptosis surgery?

Yes, the next day unless the specialist tells you otherwise.

Pediatric ophthalmology is the specialized part of children’s vision problems. For this reason, the prevention and early detection of ocular pathologies in childhood is very important. The visual acuity of a child’s eye improves from birth.

At 3 years his visual acuity reaches 50%, reaching 100% at 5 years. For this reason, the first years of life until the age of 7 or 8 are crucial for proper visual development. During this period of life, it is essential to detect anomalies that prevent normal visual evolution and anomalies that, if not detected in time, could cause irreversible sequelae for life.

Dr. Puneet Solanki insists that not only the role of the doctor is important, but also that of the parents, who play a transcendental role because they are the first to detect signs in their child that something is wrong. works well and they should assess in time that their son needs an ophthalmological check-up.

An early diagnosis, followed by an adequate and effective treatment is the necessary way to guarantee our children a good visual quality in the future.

When to go to the ophthalmologist?

It will be necessary to visit the pediatric ophthalmologist in these cases:

• Premature delivery.
• If either of the parents has a refractive defect or ocular pathology such as glaucoma.
• If the baby’s eyes water frequently.
• If the whitish pupil is observed.
• If there is any deviation in any of the newborn’s eyes or drooping eyelids.

Visual diseases in children

Lazy eye or amblyopia

Amblyopia or lazy eye is one of the main causes of irrecoverable vision loss in developed countries.

This may be due to a refractive error (myopia, hyperopia, astigmatism), a strabismus, a cataract, or any defect that does not allow the eye to receive a sufficiently clear image.

Child squint

Childhood strabismus is the abnormal deviation of one or both of the child’s eyes in one of the gaze positions.

The parallelism of the ocular axes is lost, which causes an alteration of binocular vision. This lack of alignment means that both eyes cannot focus on the same point simultaneously. When this occurs in childhood, there is an adaptation phenomenon by which the brain selects the best quality image and disconnects the vision of the other eye, thus avoiding double vision that would appear as a consequence of not being able to see exactly the same image with both eyes. same image.

Lacrimal obstruction

Lacrimal obstruction in childhood, what we call congenital dacryocystitis, occurs when the lacrimal duct, which is the route of tear removal from the eye to the nose, is not fully formed at birth, it is blocked. Consequently, the child has constant tearing from birth and, on occasions, rheum.

We know that in most cases, approximately 90%, these obstructions are resolved spontaneously during the first months of life. For this reason, in principle, we carry out a conservative treatment with massages in the lacrimal sac area and antibiotic eye drops when necessary. Only in very few cases in which the obstruction is not resolved with these measures, we must perform a lacrimal probing.

During its diagnosis it is important to rule out congenital glaucoma, it is a pediatric glaucoma that tends to be bilateral, more frequent in males and is caused by malformations during development (in the trabeculum and neighboring structures). Congenital glaucoma will cause buphthalmus (increase in corneal diameter due to increased intraocular pressure).

Pediatric inflammations

The most frequent pediatric inflammations are:

• Blepharitis is an inflammation of the eyelid margin that can be associated with conjunctival and/or corneal disorders.
• Conjunctivitis can arise for viral, bacterial or allergic reasons.
• Keratitis or corneal ulcer is corneal inflammation due to dry eyes or caused by various infections.
• Cellulite is a periorbital inflammation that requires a quick diagnosis. The main cause in childhood is ethmoid sinusitis.
• Uveitis is an intraocular inflammation related to juvenile rheumatoid arthritis or other infectious processes.

Refractive errors

Refractive errors that can appear from childhood are myopia, astigmatism, and hyperopia. They cause a blurred vision, without sharpness. Its early detection is very important because it can lead to poor school performance and it must be taken into account that children may not complain, despite noticing poor vision, for fear of needing glasses.

Symptoms of childhood eye disorders

Some symptoms that may be a warning sign for parents to consult with a pediatric ophthalmologist are:

• Continuous tearing in one or both eyes.
• Frequent rheum when getting up.
• The pupil must be black, if it is white (leukocoria) or is not round, you must go to the ophthalmologist.
• Drooping of the upper eyelids (palpebral ptosis).
• Involuntary back and forth movements (nystagmus).

In addition, parents should look to see if their child leans too close to the paper when reading, looks away frequently when reading, rubs his eyes more than usual, or has a lot of headaches.

How to detect visual problems in my child?

There are different symptoms that should make us suspect that there may be a visual problem. The following is a simple test that can help us assess whether we should take our child to a pediatric ophthalmology consultation.

1. Have you noticed if your child averts one eye, even slightly?
2. Have you noticed if the child often winks with the same eye when he is in the street?
3. Does he turn his head when he pays attention to something?
4. Cover one eye and then the other. Do you notice differences when it comes to recognizing an object?
5. Do you get very close to the television or the paper when you draw?
6. Do you narrow your eyes when you look at something far away?
7. Do you blink frequently?
8. Do you complain of a headache in the afternoon?
9. Do you have red eyes very often?
10. Do you have flaking skin between the eyelashes or do you get styes frequently?

Answer yes to questions 1, 2 and 3.

If this occurs after six months of age, it is very likely that your child has a problem with strabismus. Do not neglect this disorder, however small it may be, vitamins and time do not fix it.

Affirmative answer to question 4.

Your child has a vision defect in one of the two eyes (lazy eye). He should see an ophthalmologist as soon as possible.

Affirmative answer to question 5.

All children tend to be closer to television and drawing. This detail without other symptoms does not imply vision defects

Answer affirmative to questions 6, 7, 8, 9 and 10.

Normally the child usually complains of seeing poorly when there is a serious refraction problem. If this is not the case and after your observations you have answered YES to all or at least two questions in this block, you should consult an ophthalmologist. He will indicate the necessary treatment.

Frequent questions

When should I do my child’s first eye exam?

At 3-4 years is the ideal age, provided that before we have not noticed any signs that call our attention.

Can a child’s vision problem influence school failure?

Yes. We know that a high percentage of school failures may coincide with visual disturbances, and that 20% of school-age children have visual problems.

Does a newborn see well?

When babies are born they already see, what happens is that they do not see like an adult; that is, they do not yet have a mature vision. Mainly they see relatively well everything that is approximately 30cm from them. As they grow, their vision improves and they learn to focus on the same point with both eyes at the same time and their eyes stop being asymmetrical. This happens from the second or third month.