Glaucoma
Also called: open-angle glaucoma, angle-closure glaucoma, acute glaucoma, raised eye pressure, ocular hypertension, high eye pressure
Glaucoma is a group of eye conditions that damage the optic nerve, usually because pressure inside the eye is too high. The common type gives no warning signs, so regular eye tests matter. Sight that is lost cannot come back, but treatment can stop further loss.
General health information for Pakistan. It does not give doses or brand advice. If you are worried, or symptoms are severe, see a doctor. When to see a doctor
Overview
Glaucoma means damage to the optic nerve (the nerve that carries pictures from the eye to the brain). The eye makes a clear fluid all the time, and this fluid drains out through tiny channels at the front of the eye. If the fluid cannot drain well, pressure builds up inside the eye and slowly harms the nerve. It is one of the main causes of blindness in the world, and it is most common in older people.
The most common type is open-angle glaucoma. It develops very slowly, usually in both eyes, and first takes away side (peripheral) vision. Most people feel nothing, so it is often found only at a routine eye test. Angle-closure glaucoma is less common. In its sudden (acute) form the drainage is blocked quickly, the pressure shoots up, and the eye becomes very painful and red. This is an emergency. Glaucoma can also follow an eye injury, eye inflammation, or the use of steroid medicines, and a rare type is present from birth.
WHO says many people lose sight because they do not get care for conditions such as glaucoma. Treatment with eye drops, laser or an operation lowers eye pressure. It cannot bring back lost sight, but with regular treatment and check-ups most people keep useful vision for life.
In Pakistan
In the Pakistan national blindness and visual impairment survey, glaucoma was the fourth most common cause of blindness, behind cataract, corneal scarring and uncorrected sight after cataract surgery, causing 7.1% of blindness.
Symptoms
- Often no symptoms at all in the early stages of the common type
- Slow loss of side vision, which can later become tunnel vision
- Blurred vision
- Seeing rainbow-coloured rings (halos) around bright lights
- Sudden, severe eye pain with a red eye (acute angle-closure glaucoma)
- Headache, feeling sick or vomiting together with eye pain (acute type)
- Tenderness around the eye or a hazy, cloudy look to the eye (acute type)
- In babies: a cloudy front of the eye, large-looking eyes, watering and dislike of light
Causes and risk factors
Causes
- Fluid inside the eye not draining well, so eye pressure rises and damages the optic nerve; often the exact reason is not known
- Slow clogging of the drainage channels (open-angle glaucoma)
- Sudden blocking of the drainage angle by the coloured part of the eye (the iris), usually because of the shape of the eye (angle-closure glaucoma)
- Other eye problems, such as an eye injury or uveitis (inflammation inside the eye), or the use of steroid medicines (secondary glaucoma)
- Abnormal development of the eye before birth (congenital or childhood glaucoma)
What makes it more likely
- Older age; glaucoma is most common in people in their 70s and 80s
- A parent, brother or sister with glaucoma
- African, Caribbean or Asian family background; people of Asian origin have a higher risk of the angle-closure type
- Short sight or long sight; long sight is linked to the angle-closure type
- Diabetes
- Using steroid medicines, especially for a long time
- Women are more likely than men to have acute angle-closure attacks
- Some medicines, including eye drops that widen the pupil, can set off an attack in people with narrow drainage angles
Complications
The main complication is permanent loss of sight. Glaucoma first takes away side vision and later central vision, and without treatment it can lead to blindness. Lost sight cannot be restored. An acute angle-closure attack can damage the optic nerve within days, so it needs emergency treatment. The other eye has a high chance of a similar attack in later years, which is why doctors often treat both eyes. Loss of side vision can affect whether it is safe to drive. Eye drops can cause eye irritation, and laser or surgery carry their own small risks, which your eye doctor will explain.
When to see a doctor
- Sudden, severe pain in one eye with a red eye: go to an emergency department straight away
- Eye pain with headache, nausea or vomiting, and blurred vision or halos around lights
- Sudden loss of vision or sudden blurring that does not clear
- Eye pain or blurred vision soon after eye drops that widen the pupil, or after starting a new medicine
- A baby with cloudy, enlarged or watering eyes who dislikes light
- Noticing gaps or dark patches at the edges of your vision, or bumping into things on one side: see an eye doctor soon
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Diagnosis
Glaucoma is usually found during a routine eye test by an optometrist (eye test specialist) or eye doctor, because the common type has no symptoms. The tests are quick and painless. Tonometry measures the pressure inside the eye, either with a small probe after numbing drops or with a puff of air. The optic nerve at the back of the eye is checked with a special microscope (slit lamp), often after drops that widen the pupil, and a scan called OCT (optical coherence tomography) may be used. A visual field test checks for missing areas of side vision. Gonioscopy uses a special lens on the eye to see whether the drainage angle is open or closed, which shows the type of glaucoma. The thickness of the clear front window of the eye (the cornea) may also be measured.
If glaucoma or high eye pressure is suspected, you are referred to an ophthalmologist (eye specialist). Pressure readings and field tests are often repeated to confirm the result. Because eye pressure can change during the day, a normal reading does not always rule glaucoma out.
Treatment
- If you have sudden severe eye pain, a red eye and blurred vision, go to hospital at once: acute angle-closure glaucoma needs medicines to bring the pressure down quickly, followed by laser treatment
- For the common open-angle type, the eye specialist aims to lower eye pressure to protect the optic nerve; treatment cannot bring back sight already lost
- UK guidance offers laser treatment to the drainage channels (selective laser trabeculoplasty) as a first option for many people; prostaglandin eye drops are used if laser is not suitable, not wanted, or not enough
- If pressure stays high or the drops cause side effects, your specialist checks how you use the drops, then may switch to or add another type, such as a beta-blocker or carbonic anhydrase inhibitor drop, or a combination drop
- If drops and laser do not control the pressure, or the disease is advanced, an operation (most often a trabeculectomy) makes a new drainage channel
- For angle-closure glaucoma, a laser makes a tiny hole in the iris (laser iridotomy) so fluid can drain; the other eye is often treated too, to prevent an attack
- Keep every follow-up visit: pressure, optic nerve and side vision are checked regularly, from every few months to every year or two depending on your risk
Medicines in Pakistan
Medicines a doctor may use, by group. Read the role: some are only for special cases. Each link opens our page for that medicine, with every brand and its official DRAP price. Your doctor decides which medicine and dose are right for you.
| Group | Role | Medicines |
|---|---|---|
| Prostaglandin analogue eye drops | First choice of drop in UK guidance for open-angle glaucoma and high eye pressure when laser is not used or is not enough; they help fluid drain out of the eye | Latanoprost (21 brands) |
| Beta-blocker eye drops | Reduce the amount of fluid the eye makes; used if prostaglandin drops do not suit you or do not lower pressure enough, and in emergency treatment of acute attacks. Your doctor checks first whether they are safe with your other health conditions | Timolol (20 brands) |
| Carbonic anhydrase inhibitors | Reduce fluid production in the eye; drops are an add-on or alternative for long-term control, and tablets or an injection are used in hospital to lower pressure quickly in an acute attack | Acetazolamide (10 brands) |
| Combination eye drops | Two medicines from different groups in one bottle, used when one type of drop is not enough to control the pressure | Latanoprost + Timolol (4 brands), Dorzolamide + Timolol (1 brand) |
| Miotic eye drops | Make the pupil smaller and open the drainage angle; used in the emergency treatment of acute angle-closure glaucoma, and only sometimes for long-term control | Pilocarpine (11 brands) |
| Hyperosmotic medicines | Given into a vein in hospital to draw fluid out of the eye and lower very high pressure quickly during an acute attack | Mannitol (11 brands) |
Also used (not yet in our price list): Alpha-2 agonist (sympathomimetic) eye drops, such as apraclonidine, Preservative-free glaucoma eye drops, for people allergic to preservatives or with a sore, dry eye surface, Mitomycin C (used by the surgeon during glaucoma surgery to reduce scarring)
Self-care and prevention
Self-care
- Use your eye drops every day exactly as prescribed, even though you feel no difference; skipping drops lets the pressure rise
- Ask your eye doctor, nurse or pharmacist to show you how to put drops in, and ask about drop aids if you find it hard
- After each drop, close your eye and press gently on the inner corner for about a minute so less medicine reaches the rest of your body
- If you use more than one type of drop, wait at least 5 minutes between them
- Keep all follow-up appointments, and bring a list of all your medicines to every visit
- Tell every doctor and pharmacist that you have glaucoma before starting new medicines, especially steroids or anything that widens the pupil
- Do not drive after drops that widen the pupil, and ask your eye doctor whether your vision is safe for driving
Prevention
- Have regular eye tests, at least every two years for adults, and more often if your eye doctor advises
- Get your eyes checked early and more often if a parent, brother or sister has glaucoma, or if you have diabetes
- If you are told you have narrow drainage angles, ask about preventive laser treatment before an attack happens
- If you need steroid medicines, including steroid eye drops, for a long time, ask your doctor about checking your eye pressure
- Treat high eye pressure as advised and keep monitoring visits, so damage is found and slowed early
Common questions
Can glaucoma be cured, and can lost sight come back?
Glaucoma cannot be cured, and sight that has already been lost does not come back. But treatment with drops, laser or surgery can stop or slow further damage. With regular treatment and check-ups, most people keep useful sight for the rest of their lives.
Is high eye pressure the same as glaucoma?
Not always. Some people have high eye pressure (ocular hypertension) without any damage to the optic nerve yet. Others have glaucoma damage even with pressure in the normal range. Your eye specialist looks at the pressure, the optic nerve and your side vision together, and decides whether you need treatment or just regular checks.
Why do I need to use drops when my eyes feel fine?
Open-angle glaucoma causes no pain and no early symptoms, but it keeps damaging the optic nerve if the pressure stays high. The drops work by keeping the pressure down. If you stop them, sight can be lost slowly without you noticing until it is too late.
Can steroid medicines cause glaucoma?
Yes. Steroid medicines, including steroid eye drops, can raise eye pressure and cause a type of glaucoma in some people. Do not use steroid eye drops unless a doctor prescribes them, and ask for your eye pressure to be checked if you need steroids for a long time.
Should my family be checked if I have glaucoma?
Yes, it is a good idea. Glaucoma can run in families, and having a parent, brother or sister with it raises your risk. Close relatives should have regular eye tests, as early glaucoma has no symptoms.
Sources
- NICE. Glaucoma: diagnosis and management (NG81) (2017).
- WHO. WHO launches first World report on vision (2019).
- NHS 111 Wales. NHS 111 Wales - Health A-Z : Glaucoma (n.d.).
- Moorfields Eye Hospital NHS Foundation Trust. Glaucoma - Moorfields Eye Hospital (n.d.).
- MedlinePlus. Glaucoma: MedlinePlus Medical Encyclopedia (n.d.).
- StatPearls (NCBI Bookshelf). Acute Angle-Closure Glaucoma - StatPearls - NCBI Bookshelf (n.d.).
- British Journal of Ophthalmology (Dineen, Bourne, Jadoon et al.). Causes of blindness and visual impairment in Pakistan. The Pakistan national blindness and visual impairment survey (2007).
Prepared from the sources listed below by the MedInfoBase team. Last reviewed 16 October 2026. This page is general health information, not medical advice. It gives no doses and does not replace a doctor: talk to your doctor or pharmacist before starting, stopping or changing any medicine. How we write and check our pages.