Acute Glaucoma Symptoms, Warning Signs, and Treatment Options | Magruder Eye Institute

Acute Glaucoma Symptoms, Warning Signs, and Treatment Options

In 2010 around 60.5 million people had glaucoma. But by 2020, this figure could reach up to 80 million. 

This is because we are an aging population. And as we age the likelihood of experiencing glaucoma increases. But most types of glaucoma don’t just come on gradually with age. 

The signs of acute glaucoma are brutal and come on suddenly. And if left untreated the consequences can be severe. So how can you prepare yourself against acute glaucoma? 

Well, knowing what to expect and what to do is key. It could even save your sight one day.

Read on to find out more about acute glaucoma symptoms, causes and what to do if you experience them.

What Is Acute Glaucoma? 

Acute Glaucoma is also known as acute angle closure glaucoma. It is a sudden condition affecting one or both eyes.

Signs of glaucoma come on when the intraocular pressure (IOP) increases quickly. This is the pressure within the eye.

Your eye is always producing fluid, called the aqueous humor. Normally this drains away from your eye. But if it doesn’t, then the IOP begins to rise. 

This can happen suddenly if your iris touches the trabecular meshwork. Your iris might push back against or be pulled up against it. Either way, it blocks the fluid’s exit. 

This may occur if your pupils dilate very suddenly. For example, when going from a bright environment to a darkened one very suddenly. 

You might suffer from primary or secondary acute glaucoma. Primary glaucoma occurs when there isn’t an underlying eye disease. This is when acute glaucoma happens spontaneously. 

Secondary acute glaucoma is often linked to another factor. For example, an underlying eye disease might contribute to it. Trauma, chronic medical conditions or drugs can also bring on secondary acute glaucoma.

Because this change is very sudden, the symptoms are usually severe. And a doctor must treat them immediately to prevent damage to the optic nerve.

How Is It Different From Regular Glaucoma? 

There are several different types of glaucoma.

Open-angle glaucoma is the most common type and is also called chronic glaucoma. 90% of all glaucoma cases is open-angle glaucoma,  affecting roughly 3 million Americans.

Normal-tension glaucoma or NTG occurs when there is optic nerve damage. This can happen even though the IOP isn’t very high.

Congenital glaucoma occurs in babies when their drainage canals haven’t developed properly. This is a very rare and often inherited condition.

Other types of glaucoma include:

  • Traumatic glaucoma
  • Irido Corneal Endothelial Syndrome (ICE)
  • Uveitic Glaucoma
  • Pigmentary Glaucoma
  • Pseudoexfoliative Glaucoma
  • Neovascular Glaucoma

These vary in being open-angle or angle-closure glaucoma. But they all develop gradually over time.

This is the primary difference between the regular types of glaucoma and acute glaucoma. The speed at which the IOP increases determines how quickly glaucoma develops.

For example, with Primary Open-Angle Glaucoma, this pressure increases very slowly. This is because the iris closes the fluid drain off gradually. It takes a long time for the fluid to start building up. 

Often this means symptoms are harder to spot. But it’s easier to treat and doesn’t pose a great risk to the patient. 

What Causes Acute Glaucoma?

Glaucoma symptoms indicate what is happening inside the eye. But the events inside your eye don’t bring on acute glaucoma independently. There are several factors that can increase your risk of acute glaucoma. 

As a person ages, their eye’s lens gets bigger and this pushes the iris forward. This makes the gap for fluid drainage smaller. So older people are more likely to suffer acute glaucoma.

After the age of 40, the risk increases and is even higher once you reach 50. But age isn’t the only factor. 

As with many medical conditions, genetics predispose you to suffer from acute glaucoma. Finding out if your family has a history of the disease can help you preempt it.

Other underlying conditions that can cause it are hypertension and diabetes.

Any previous eye injury also increases your chances of having acute glaucoma. However, this depends somewhat on the nature of the injury. If this concerns you, you may want to make an appointment to discuss it with an eye expert.

Ethnicity influences your chances of suffering an attack too. African-American, Asian, and Hispanic people are more likely to get acute glaucoma.

This is because of the angle that fluid drains out of is narrower, so it closes up more easily. It is also the case in people who have farsightedness or hyperopia

But genetics and underlying conditions aren’t the only factors that induce acute glaucoma. External factors, such as environment, can influence your body just as much.

How Can Habits and Environment Affect Acute Glaucoma? 

Your eyes respond to any change in your environment. This response manages the sensory input that your brain receives. Without this assistance moving from one environment to another could be overwhelming.

For example, when you go from a brightly-lit room into a dark one your pupils dilate. This optimizes the amount of light that reaches your eye. But this transition can lead to an attack of acute glaucoma. 

As your pupil gets bigger, it increases the contact between your iris and your eye’s lens. In doing so it reduces the drainage gap in your eye. 

But this isn’t the only time that your pupils dilate. An emotional response, such as anxiety or excitement, can also cause this. This is one of the reasons why stressful situations can induce acute glaucoma.

Taking certain prescription drugs can also cause your pupils to dilate. The response varies depending on the drug, but these include: 

  • Steroids
  • Anti-depressants
  • Anti-emetics (or anti-nausea drugs) 
  • Cold medications
  • Anti-histamines

Other narcotics, such as cocaine, marijuana, and amphetamines also increase your pupil size. If you think this might be the cause of your acute glaucoma it is important to be honest and open with your doctor. Knowing the cause will help them to treat you safely and effectively.

What Are Acute Glaucoma Symptoms? 

Acute glaucoma signs come on rapidly and without warning. You should be aware fairly quickly that something is not right. 

These symptoms of glaucoma often get worse over a period of a couple of hours. They will usually only affect one of your eyes, but it is possible that you will experience an attack across both eyes. 

An attack of acute glaucoma will often feature severe eye pain. This is often accompanied by nausea or vomiting.

As your cornea becomes swollen it will cloud and impair your vision. Visual distortions with glaucoma include blurred sight and halos around spots of light.

From the outside, symptoms of glaucoma also include reddening of your eyes. If you someone is with you when it happens, they might be able to spot any changes to your eyes.

If you are suffering from any of these symptoms you need to seek immediate medical help. Go to the emergency room rather than your local doctor. A professional needs to assess and treat the condition as quickly as possible to avoid long-lasting damage.

How Can Attacks Vary?

Occasionally people suffer from minor attacks of acute glaucoma. 

During these, a person experiences the same symptoms of a regular attack, although often they won’t feel the usual severe pain or have any redness of their eyes. But the blurred vision and halos of light still occur. 

Usually, you can recover from these minor attacks by changing your environment. For example, going into a lit room or going to sleep may work. Doing either of these things will constrict your pupils.

This causes the iris to pull away, clearing the drain and stopping the build-up of IOP.

But if you aren’t sure what is happening it’s best to get medical attention. A professional will be able to tell the difference in the attacks. You shouldn’t risk waiting to find out.

What Happens if You Don’t Treat Acute Glaucoma?

Untreated acute glaucoma causes serious long-term damage. And because your eyes are small, it can progress very quickly.

In the worst cases, the built-up IOP in the eye causes optic nerve damage. This can permanently impair, or even destroy eyesight.

Scarring of the trabecular meshwork can lead to chronic glaucoma. This condition is more difficult to control and has to be carefully monitored. 

Acute Glaucoma can also lead to cataracts.

How Can You Treat Acute Glaucoma? 

Acute Glaucoma stops progressing if the IOP drops by 30 to 50 percent from the baseline. Consequently, this is your doctor’s first priority. 

Doctors use eye-drops, oral medications or intravenous (IV) medications  (including glycerol or carbonic anhydrase inhibitors like Diamox) to reduce pressure. But this is only a temporary measure. 

Anyone suffering from acute glaucoma will need more treatments. Often your doctor will perform laser surgery to address the internal issues. Anesthetic eyedrops will be used to numb your eye.

Laser Surgery for Acute Glaucoma

A laser iridotomy is a short surgery, that usually lasts about 30 minutes. The surgeon creates an opening in the iris with a laser. This relieves the blockage and allows the fluid behind the iris to flow out. 

This opening usually doesn’t cause any further issue but needs monitoring. Sometimes surgeons perform the same procedure on the other eye as well as a preventative measure. 

In rare cases, the cornea may be too cloudy to assess. In this case, a doctor makes a surgical incision in the iris. 

Some patients may require a laser gonioplasty as well. This helps to open the drainage angle so that the doctor can perform the iridotomy. 

In this procedure, the doctor creates a series of burns in the iris using a laser. The burns cause the iris to contract, opening up the drainage angle and helping to relieve pressure behind the eye.

Alternative Aqueous Drainage Surgery

If acute glaucoma symptoms aren’t treated quickly enough it could lead to scarring. This can also happen in you suffer from repeated attacks.

Scarring occurs between the iris and the peripheral cornea. It closes the angle permanently, causing chronic angle-closure glaucoma. An iridotomy cannot cure this condition. 

Instead, the ophthalmologist has to create a new drainage system for the eye. An aqueous shunt device or a trabeculectomy can do this. Both are more complicated procedures. 

The surgeon may also have to extract the lens in order to make room for the iris to move properly over the new drainage system.

Follow-up Treatments for Acute Glaucoma Surgery

Like any surgery, treatment for acute glaucoma needs follow-up appointments. They allow your doctor to check on the eye’s recovery. 

Part of the follow-up will include routine gonioscopies. These are examinations which help to predict the likelihood of having another attack.

During a gonioscopy, the doctor lightly places a mirror in front of the eye. This helps them examine the width of the drainage angle visually. Patients may have to have regular gonioscopy appointments for a period of time.

Patients can then be on the lookout for early warning signs of glaucoma. In some cases, doctors will even perform a laser iridotomy to prevent further attacks.

The Bottom Line

Acute Glaucoma is a serious medical condition. And if you start experiencing the symptoms you must seek medical attention immediately. 

There are lots of effective treatments for acute glaucoma symptoms and causes. But leaving it untreated for too long can result in serious long-term issues.

For more information on taking care of your eyes, check out our blog today!