Compare conditions

Put any two — or three — conditions side by side, adult or pediatric, to spot the look-alike differences fast, row by row.

Open-Angle Glaucoma

—

In one line

·Slow, painless rise in eye pressure that quietly damages the optic nerve and side vision.

—

Normal physiology

·Your eye makes a clear fluid called aqueous humor every minute to keep the eyeball inflated and nourished. That fluid flows from behind the colored part of your eye (the iris), through the pupil into the front chamber, and then leaves through a spongy drain called the trabecular meshwork, which sits in the angle where the iris meets the cornea (the clear window at the front of your eye). From the drain, fluid flows into a tiny canal and then into the veins outside the eye. When fluid leaves at the same speed it is made, the pressure inside stays steady and safe.

—

What goes wrong

·The trabecular meshwork—the sponge-like drain at the angle of the eye—slowly gets clogged with microscopic debris and the drain cells stop working as well. Even though the angle itself stays wide open (which is why it is called open-angle glaucoma), fluid cannot leave fast enough. Pressure climbs, and that steady squeezing crushes the delicate nerve fibers in the optic nerve one by one.

—

Hallmark signs

—

Red flags · escalate now

·Sudden, severe eye pain (suggests acute angle-closure glaucoma instead, which is an emergency)
·Rapid vision loss over days or weeks (open-angle glaucoma is slow; fast loss means something else urgent is happening)
·Severe headache with nausea and vomiting along with blurry vision (points to sudden high pressure or another brain/eye emergency)
·Only one eye affected and vision dropping quickly (open-angle is usually both eyes; one-sided fast loss suggests stroke, detachment, or infection)

—

Workup

·Intraocular pressure (IOP) measurement by applanation tonometry
·Automated visual field test (standard automated perimetry, such as Humphrey field analyzer 24-2 or 30-2)
·Optic nerve head photography and cup-to-disc ratio assessment
·Optical coherence tomography (OCT) of the retinal nerve fiber layer (RNFL) and ganglion cell complex
·Gonioscopy
·Central corneal thickness (pachymetry)

—

Treatment

·Prostaglandin analog eye drops (latanoprost, travoprost, bimatoprost, tafluprost) once nightly
·Beta-blocker eye drops (timolol, betaxolol, levobunolol) once or twice daily
·Alpha-agonist eye drops (brimonidine, apraclonidine) two or three times daily
·Carbonic anhydrase inhibitor eye drops (dorzolamide, brinzolamide) two or three times daily
·Selective laser trabeculoplasty (SLT)
·Trabeculectomy (filtering surgery)
·Minimally invasive glaucoma surgery (MIGS, such as iStent, Xen gel stent, or goniotomy)

—

NCLEX trap

·Open-angle glaucoma sneaks up slowly without pain. The person usually does not notice anything wrong until they have already lost quite a bit of side vision (peripheral vision). It is the angle-closure type that causes sudden pain and blurry vision and needs emergency care. Open-angle glaucoma is caught during routine eye exams, not in the emergency room.
·Open-angle glaucoma damages the outer edges of vision first, so the person can read and see faces just fine even while losing their side vision. By the time they notice trouble, a lot of nerve damage has already happened. We measure success by checking eye pressure and doing special tests that map the entire field of vision, not just by asking if they can see the eye chart.
·The eye drops do not cure glaucoma; they control the pressure to protect the optic nerve from further damage. If the person stops the drops, the pressure climbs back up and the nerve damage continues. The drops need to be used every single day for the rest of the person's life, even when the pressure looks good, because that good pressure only stays that way because of the medicine.
·Damage to the optic nerve (the cable that carries pictures from the eye to the brain) is permanent. Lowering the pressure protects the nerve fibers that are still working, so vision does not get worse. But the vision that is already gone cannot be brought back. That is why catching glaucoma early, before much damage happens, is so important.

—

Install Maldek by Hill as an app — studies work even offline