Acute congestive glaucoma: Keep an eye on your vision

Shillpi A Singh speaks to experts about acute congestive glaucoma an uncommon condition where the pressure in the eye suddenly rises, which might cause vision loss

PR professional Poornima Chauhan, 24, was almost caught unawares and one fine day, she woke up with a blurred vision, almost unable to see objects even at arm’s length. The young girl with 6/6 or normal vision had spent three nights organising a boxing league, and the blinding lights of the boxing ring, and the intermittent darkness in between around the area had done irreparable harm to her eyes. Chauhan came home, hit the sack with redness and pain in eyes, and next morning, she could not see properly. Hurried visits to her family physician followed, and he too concluded that the blurring of vision could to be a side effect of medication of epilepsy that Chauhan had been on for many years. Unconvinced at the diagnosis, she went to see an ophthalmologist who to her surprise informed her that she has acute congestive glaucoma. The normal intraocular pressure in her eyes that should ideally be between 10-20 mm of mercury was alarmingly high. She was quickly put on medication following which her vision improved, but the doctors advised surgery (laser iridotomy) to reduce the chances of reoccurrence, which may be irreversible this time around.

A rare form of glaucoma

Acute congestive glaucoma is an uncommon, but sudden, severe eye condition where the pressure in the eye suddenly rises many times the normal levels and creates a condition where vision is threatened. “Our eyes are wonderful, complex structures and 60% of our brain is engaged in interpreting the signals received from the eyes and making sense of it. But to function properly, our eyes need to maintain a pressure between eight and 20 mm of mercury. If the pressure goes higher than 21, in a condition also known as glaucoma, there is permanent damage to the nerves and loss of vision. High pressure in glaucoma does not cause any pain except in acute congestive glaucoma,” says Dr Prashaant Chaudhry, Senior Consultant Ophthalmology, Aakash Healthcare Super Speciality Hospital, New Delhi.

How to spot it?

Acute congestive glaucoma also is known as acute angle closure glaucoma. Explaining the mechanism, Dr Nikhil Sardar, Consultant Ophthalmologist, Nanavati Super Speciality Hospital, Mumbai, says, “It is a condition when the fluid inside our eyes called aqueous humour gets trapped inside due to mechanical or physical closure of its natural exit pathways via the trabecular meshwork in the angle of our eyes’ anterior chamber.” It happens when the pressure shoots up, in some cases, it touches more than 50 mm of mercury. It is more common in people with plus power glasses and when they are in areas of dim lighting like a movie hall or a dimly lit room.

 

The early symptoms are pain and redness in eyes every three-four month. “But slowly the frequency of these painful red eye episodes increases and finally patient lands up in acute congestive phase with severe pain, nausea, vomiting, and these symptoms are sometimes mistaken as heart problem in elderly,” adds Dr Sardar. Some patients may also experience coloured halos around eyes and water in the affected eye. “These symptoms sometimes resolve on their own, but often keep worsening till proper treatment is given,” says Dr Chaudhary.

Line of action

Angle-closure glaucoma is seen in about 1% of Indians above 40 years of age, accounting for half of the total patients with glaucoma. About one percent of patients with angle-closure glaucoma suffer an acute attack. But most of them do not have acute attacks, but more mild attacks and then continuous rise in pressure or primary angle closure glaucoma.

The diagnosis is confirmed by examination on a slit lamp, measurement of the pressure in the eye and if required, a test called gonioscopy. It can be treated by medicines and injections followed by eye drops, and in some advanced case, laser iridotomy is the way out.

“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,” says Dr Chaudhary.

The small laser procedure takes a few minutes to perform and is done as an out-patient procedure, and there are no restrictions after the procedure but gives life-long protection against acute congestive glaucoma. Often the second eye will also need this laser to prevent such an attack in it. Sometimes the attacks are mild and do not cause all the symptoms mentioned above. The laser procedure curbs these attacks too.

Prevention is better

 

Dr Chaudhary advises that if the disease has been present for long enough, life-long medication may be required to keep the eye pressures controlled. Vision loss occurs due to the high pressure in the eye during the acute congestive glaucoma attack, thus the earlier the pressure can be brought to normal levels, lesser the chances of vision loss.

One should get the treatment on an emergency basis without waiting for an appointment. “It’s best to prevent acute congestive stage by regular visits to an ophthalmologist,” adds Dr Sardar. People who wear plus powered glasses constantly are at a higher risk for acute congestive glaucoma. Even people above 40 years of age are at high risk, and to prevent falling prey to this attack, they should opt for an annual eye check-up with a well-trained eye specialist.