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Glaucoma Treatment

Glaucoma Treatment Although Glaucoma causes irreversible damage to the optic nerve and eventual permanent loss of sight, once glaucoma is diagnosed, treatments and drugs can prevent further loss of vision. Treatments have been found to reduce intraocular pressure and improve the aqueous flow. Drugs can also be used to slow down and prevent any further vision loss in those diagnosed with this insidious disease.

Those diagnosed with glaucoma will usually be prescribed medicated eyedrops which must be taken permanently. There may be more than one type, so check how long you should wait before applying the second type. A chemical cocktail in the eye is not desirable! Use the drops exactly as the doctor prescribed, to avoid any further damage to the optic nerve. Be aware that some of these drops may be absorbed into the bloodstream, causing side effects to the rest of your body.

Best Practices for the Application of Eyedrops
The easiest and most effective way to ensure the eyedrops reach the eye is to pull down the lower eyelid with one finger and create a pouch. Apply the eyedrops into the pouch and blink to distribute. It is best to close the eye for 1-2 minutes. It seems an endless amount of time to be still and dark but it minimizes absorption into the blood stream and gets the drops to the correct place. Press lightly at the inner corner of the eye, near the nose, to close the tear duct during this wait and finally wipe any excessive eyedrops away from around the eye.

Beta Blockers are applied in the form of eye drops to reduce the production of the natural eye fluid, or aqueous humor, thereby preventing further build up and pressure in the eye. Side effects may include problems breathing, lower blood pressure, slower pulse rate, hair loss, impotence, fatigue, weakness, memory loss and depression. Beta blockers are not suitable for diabetics taking insulin or for those with asthma and other breathing problems. Other medications which also work to reduce the production of aqueous humor include Alpha-Agonists and Carbonic Anhydrase Inhibitors, although these are not suitable for patients who have sensitivity to sulfa drugs.

Drugs such as Xalatan and Lumigan are termed Prostaglandin-like compounds. These increase the outflow of the aqueous humor, which will also reduce the build up of pressure in the eye. Possible side effects of these drugs include reddening or stinging of the eyes, blurred vision, darkening of the iris or the eyelid skin. Epinephrine compounds also may be used for the same effect. Some patients may notice a headache, increased anxiety, increased blood pressure, heart palpitations and allergic reactions and should consult their doctor immediately. Miotic or Cholinergic Agents also increase the drainage of the aqueous humor. Rare side effects may include allergic reactions, sweating, salivation, pain, blurred vision or digestive problems.

For those who cannot tolerate eye drops, for one reason or another, oral medications may be prescribed. Carbonic Anhydrase Inhibitors may be taken in pill form, at mealtimes to minimize side effects. One health tip is to drink apple juice and eat bananas to minimize the potassium loss which is caused by these medications. Initial side effects may include a tingling sensation in the fingers and toes, and more frequent urination. These should pass in a few days. Rashes, depression, fatigue, stomach upsets, impotence and weight loss are more serious side effects which should be reported to your eye doctor.

All the above medications work by lowering the pressure in the eye caused by the build-up of aqueous humor. Drugs are currently in trials which may help protect the optic nerve from the damage caused by glaucoma.

Surgery to Treat Glaucoma
Surgery is the last resort, if simple medications are unsuitable. As with any surgery, there are some risks of complications developing and these should be discussed at the time with your doctor.

Trabeculoplasty (pronounced truh-BEK-u-lo-plas-tee) involves the use of a high-energy laser beam to open the clogged drainage channels, enabling the free drainage of the aqueous humor. Anesthetic eye drops are used and the procedure last 10-20 minutes. There is no discomfort after the procedure, and follow-up checks will be made in the following weeks. Laser surgery aims to reduce the pressure in the eye from a build-up of the aqueous humor to prevent glaucoma. Patients should be regularly checked to ensure that the intraocular pressure does not increase again in the future.

A Trabeculectomy (truh-bek-u-LEK-tuh-me) involves a surgeon operating on the eye to remove a tiny portion of the trabecular meshwork to allow drainage of the aqueous humor. This procedure, known as filtration surgery, is done in hospital or surgery and an anesthetic injection is used before the procedure. Antibiotics are prescribed along with anti-inflammatory drops to prevent infection and scarring and follow-up checks are scheduled. New procedures using an electro-cauterizing tool are providing successful, with few complications.

In rare cases drainage implant surgery may be necessary, when a silicone tube is inserted to aid with the drainage of the fluid. Children and those with secondary glaucoma are the most likely candidates for this surgery.

Emergency Surgery is only necessary for those with the sudden onset of acute angle-closure surgery (see Glaucoma Symptoms). In this case an iridotomy is performed to drain the aqueous humor as quickly as possible. Powerful Acetazolamide may be administered by injection or in pill form, if the eye is vulnerable to high pressure.

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