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Open-angle glaucoma: Epidemiology, clinical presentation, and diagnosis

Author
Deborah S Jacobs, MD
Section Editor
Jonathan Trobe, MD
Deputy Editor
Janet L Wilterdink, MD

INTRODUCTION

Glaucoma is a group of eye diseases traditionally characterized by elevated intraocular pressure (IOP). However, glaucoma is more accurately defined as an optic neuropathy than a disease of high pressure. In open-angle glaucoma, optic nerve damage results in a progressive loss of retinal ganglion cell axons, which is manifested initially as visual field loss and, ultimately, irreversible blindness if left untreated [1].

This topic will discuss the epidemiology, clinical presentation, and diagnosis of open-angle glaucoma in adults. Glaucoma in children, angle-closure glaucoma, and treatment and prevention of open-angle glaucoma are discussed elsewhere. (See "Overview of glaucoma in infants and children" and "Angle-closure glaucoma" and "Open-angle glaucoma: Treatment".)

CLASSIFICATION

There are different types of glaucoma, generally categorized by the anterior chamber (iridocorneal) angle (figure 1) and the underlying etiology, if known:

Open-angle glaucoma is an optic neuropathy characterized by progressive peripheral visual field loss followed by central field loss, in a characteristic pattern. This is usually but not always in the presence of elevated intraocular pressure (IOP), perhaps in part related to increased aqueous production and decreased outflow (figure 2). The optic nerve or "disc" takes on a hollowed-out appearance on ophthalmoscopic examination, which is described as "cupping." Cupping is associated with the loss of ganglion cell axons.

Angle-closure glaucoma is characterized by narrowing or closure of the anterior chamber angle. The normal anterior chamber angle provides drainage for the aqueous humor (the fluid that fills the eyeball). When this drainage pathway is narrowed or closed, inadequate drainage leads to elevated intraocular pressure and damage to the optic nerve (figure 3). Acute angle-closure glaucoma occurs in eyes with a certain anatomical predisposition. It presents as a painful red eye and must be treated within 24 hours to prevent permanent blindness. (See "Angle-closure glaucoma".)

                    

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Literature review current through: Nov 2016. | This topic last updated: Fri Jan 22 00:00:00 GMT+00:00 2016.
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