Acute attack of glaucoma (glaucoma crisis): symptoms and first aid
An acute glaucoma attack usually begins suddenly. The eye suddenly feels heavy, and the pain may radiate to the temple, forehead, or half of the head. Vision becomes blurred. Light sources appear surrounded by colored halos. Nausea sometimes occurs.
These symptoms may lead a person to suspect a migraine, fatigue, or a pressure surge. However, the problem is internal and requires immediate attention.
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Why does a glaucoma crisis occur?
The attack is caused by a sudden disruption of the outflow of intraocular fluid. This is most often caused by the specific structure of the eye, and a specific situation is the trigger. Below, we will discuss the main cause and factors that increase the risk.
Angle-closure glaucoma as the main cause
The main cause of the crisis is angle-closure glaucoma. In this condition, the iris blocks the angle of the anterior chamber through which the fluid drains. The outflow stops, and pressure rises rapidly. This eye structure is often found in people with farsightedness and small eyes.
Risk factors and triggering factors
A crisis can be triggered by pupil dilation in the dark, severe stress, a sudden head tilt, or taking certain medications. Those at risk include:
- People over 40
- More often women
- Those who have already had a crisis in the other eye
Heredity also plays a role.
Knowing triggering situations helps you act proactively. If your doctor has previously diagnosed a narrow anterior chamber angle, you should be especially attentive to warning signs.
How does an acute attack of glaucoma manifest itself?
An attack usually causes a sudden combination of symptoms. The eye becomes painful, red, and tense, with vision seemingly obscured by a thick, cloudy film. Sometimes headache, nausea, and weakness are added. Because of this, a person may mistake the condition for a migraine or a pressure surge, although the source of the problem is related to a rapid increase in intraocular pressure.
The main signs of an attack
The first warning sign is often eye pain. It can be:
- Deep
- Bursting
- Can radiate to the temple, eyebrow, or half of the head
Redness appears, the cornea loses its transparency, the pupil dilates and becomes virtually unresponsive to light. Rainbow-like rings often appear before the eyes. Vision then worsens: the contours of surrounding objects become blurred, objects become less clear, and a feeling of fog develops.
General symptoms
The crisis often extends beyond the eye. Symptoms include:
- Migraine
- Nausea and vomiting
- Abdominal cramps
- General weakness
Therefore, the patient is referred to a general practitioner or neurologist, thereby wasting precious time.
The combination of ocular and general complaints is an important clue. If eye pain is accompanied by nausea and halos, the cause is almost certainly in the eye.
When you need urgent help
Some symptoms leave no time for reflection. They require immediate attention from an ophthalmologist, and you can't observe these symptoms at home. Below are the signs that require immediate medical attention:
- Severe pressure or aching in the orbital area
- Visual vision quickly becomes blurry, edges become blurred
- The whites of the eyes become red, and the eye appears strained
- Colored halos appear around lamps, headlights, or the screen
- Headache, nausea, and possible vomiting
If these symptoms occur together and worsen, emergency care is needed. The sooner the pressure is reduced, the better the chance of preserving vision.
What can an acute attack of glaucoma be confused with?
Comparison table: glaucoma, conjunctivitis, migraine, keratitis
Let's compare four conditions based on the nature of pain, vision changes, and patient intervention.
| Condition | Pain | Vision | Additional Symptoms | What to Do |
|---|---|---|---|---|
| Acute Glaucoma Attack | Sudden, deep pain in the eye and head | Sudden worsening, fog, rainbow-colored circles | Nausea, vomiting, redness, corneal swelling | See an ophthalmologist immediately |
| Conjunctivitis | Burning, itching, moderate | Normal, may lacrimation | Discharge, redness, photophobia | Doctor's examination, local treatment |
| Migraine | Throbbing, on half of the head | Temporary aura and glare | Nausea, vomiting, photophobia | Neurologist, rest |
| Keratitis | Severe, cutting | Blurred, tearing | Photophobia, redness, corneal defect | Urgent visit to an ophthalmologist |
First aid before an ophthalmologist examination
Correct actions in the first few hours influence the outcome. First aid for an acute glaucoma attack boils down to one thing: get to the doctor as quickly as possible without harming yourself along the way. Let's look at what you can and definitely shouldn't do.
What you can do yourself
Immediately call an ambulance or go to an ophthalmology center with emergency care. Tell the doctor about your complaints and that the attack began suddenly. If your ophthalmologist has previously prescribed drops for this type of attack, use them strictly according to their instructions.
What you shouldn't do
Don't wait until morning and hope it goes away on its own. Don't use random drops, especially those that dilate the pupil, and don't take medications without a prescription. Avoid warming your eye, don't cover it tightly with a bandage, and don't lie down in a dark room, as darkness dilates the pupil and worsens the attack.
How does a doctor confirm a diagnosis?
During the appointment, the ophthalmologist quickly assesses the eye and confirms the diagnosis with several tests. The goal is to confirm that this is indeed an eye crisis and to understand its cause. This determines further treatment.
Examination and measurement of intraocular pressure
The doctor examines the eye and measures the pressure using tonometry. During an eye attack, the readings are significantly higher than normal, confirming the diagnosis. The ophthalmologist also evaluates the cornea, pupil, and anterior segment of the eye.
Gonioscopy, evaluation of the optic nerve and visual field
To determine whether the outflow angle is blocked, gonioscopy is performed—an examination of the anterior chamber angle through a special lens. Additionally, the doctor evaluates the optic nerve and, if possible, the visual field. These data indicate the extent of damage to the eye structures.
In our practice, we see that in an acute attack of glaucoma, time is of the essence. The sooner a patient gets examined, the greater the chance of quickly lowering intraocular pressure, relieving pain, and preserving vision. Therefore, we always emphasize prompt diagnosis and a clear action plan. – ophthalmologist
General information
How we help patients with an acute glaucoma attack
The main goal during a glaucoma crisis is to quickly reduce pressure and protect the optic nerve. We have structured our appointments so that patients with acute symptoms receive help without a long wait. Below we'll explain what this process includes.
Urgent diagnosis and attack management
For acute complaints, we see patients without waiting and immediately measure their pressure. To relieve the attack, the doctor administers antiglaucoma drops and, if necessary, other pressure-lowering medications. At the same time, we monitor the eye's response to treatment.
Treatment selection and condition monitoring
Once the crisis is successfully managed, we develop a further treatment plan. Treatment for an acute glaucoma attack doesn't end with pain relief: it's important to maintain normal pressure and prevent a recurrence. To do this, we schedule follow-up examinations and adjust therapy dynamically.
When additional intervention is required
Sometimes eye drops alone are not enough to permanently open the outflow angle. In such cases, the doctor discusses with the patient laser or surgical interventions to restore fluid outflow. The decision is made individually, after a complete examination of both eyes.
Questions that help you avoid missing a dangerous condition
Why might an attack cause pain not only in the eye but also in the head?
Can an attack resolve on its own?
Why is it important for your doctor to know about lenses and their correction methods?
What should I do if my daytime vision deteriorates after an attack?
Why examine the other eye if the complaints are only on one side?
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How does a glaucoma crisis occur?
Intraocular fluid is constantly produced in the eye. Normally, it drains through special drainage areas and maintains stable pressure. If this pathway suddenly closes, fluid begins to accumulate. Pressure rises rapidly, tissues become compressed, and the optic nerve becomes dangerously strained.
This is how an acute attack of glaucoma, or a glaucoma crisis, develops. It is characterized by:
Increased intraocular pressure during such an attack can quickly damage the optic nerve fibers, so you can't wait for improvement at home. You should see an ophthalmologist or call an ambulance as soon as possible.