Acute congestive glaucoma - Symptoms and treatment

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Acute congestive glaucoma

Our eyes are wonderful, complex structures that reveal the world to us. They are of such importance part of our bodies that 60% of our brain is engaged in interpreting the signals received from the eyes and making sense of it. With increasing use of technology and social media in our lives, we have become more and more dependant on our eyes to communicate with the world. To function properly, our eyes need to maintain a pressure between 8 and 20 mm Hg. If the pressure goes higher than 21, in a condition also known as glaucoma, there is permanent damage of the nerves and loss of vision. Typically vision loss in glaucoma starts from the periphery and is so gradual that one does not notice it till it is too late. High pressures in glaucoma do not cause any pain except in one condition- Acute congestive glaucoma.

Our eyes maintain normal pressure by continuously producing fluid (aqueous humor) from an area behind the coloured part of the eye (iris) and draining it from channels in front of the iris (trabecular meshwork). For this, fluid should easily be able to pass through the hole in the center of the iris (pupil). In some patients, the edge of the iris sticks to the lens (as shown in the figure) and this leads to fluid pushing the iris forward to close the drainage area. The result of this is an attack of Acute congestive glaucoma. This is more common in people with plus power glasses in areas of dim lighting like movie halls or dimly lit rooms. One feels pain, redness, haziness in vision, vomiting sensation and watering in the affected eye. The pressure often shoots up to more than 50 mm Hg.

In case one experiences such symptoms, one should move to bright light and immediately show an eye specialist. Once the eye doctor examines and confirms the diagnosis, he will immediately start medicines to lower the eye pressure and perform a laser procedure called Yag Peripheral Iridotomy or PI. The laser creates a small hole in the corner of the iris which allows fluid to pass forward to the drainage channels even if the iris and lens get stuck. This small laser procedure takes a few minutes to perform, is done as an out-patient procedure, and there are no restrictions after the procedure (eg having bath, rubbing eyes), but gives life-long protection against acute congestive glaucoma. Often the other eye is seen to be predisposed to develop the same condition and is lasered before the attack affects it. Sometimes the attacks are mild and do not cause all the symptoms mentioned above. Even these attacks are stopped by the laser procedure. The earlier the treatment is done, the more likelihood that permanent damage and lifelong treatment can be avoided.

As mentioned above, people who wear plus powered glasses constantly are at a higher risk for Acute congestive glaucoma. All people above 40 years of age are at risk as well, which is why it is a good idea for everyone above 40 to have an annual eye check-up with a well-trained eye specialist. The idiom “prevention is better than cure” is especially true for glaucoma.

Dr. Prashaant Chaudhry
Senior Consultant & HOD

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