Secondary (Symptomatic) Glaucoma: Causes, Symptoms, and Treatment"
Secondary glaucoma is associated with a pre-existing problem: trauma, inflammation, surgery, vascular changes, or lens problems. Sometimes, it is caused by prolonged use of certain medications, especially without medical supervision. This causes increased intraocular pressure, placing strain on the optic nerve.
At "K+31," we examine the mechanism of the disease, assess vision risks, and recommend treatment after an in-person examination.
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What is secondary glaucoma?
This is a group of conditions that disrupt the outflow of intraocular fluid or alter the pressure within the eye. This causes increased intraocular pressure, and the nerve fibers gradually lose their resistance to stress.
How does it differ from the primary form?
The primary form often develops without an obvious cause. With the secondary form, the doctor looks for a factor: eye trauma, uveitis, surgery, cataracts, vascular pathology, or long-term steroid drops. Symptomatic glaucoma requires pressure reduction and control of the underlying problem.
This difference affects the examination route and treatment strategy.
| Symptom | Secondary form | Primary form |
|---|---|---|
| Cause | Trauma, inflammation, surgery, or vascular disorder are present. | There may be no obvious external cause. |
| Tactics | Reduce blood pressure and treat the source of the disorder. | Monitor blood pressure and nerve condition. |
| Dynamics | May begin after a specific event | Often develops gradually |
This table provides guidance but does not replace an in-person consultation. The decision on treatment and its tactics depends on the condition of the cornea, lens, anterior chamber angle, retina, and optic nerve. This decision is made by an ophthalmologist.
Why is this disease dangerous for vision?
The main danger is related to damage to the nerve fibers. The optic nerve transmits images from the retina to the brain. And with prolonged pressure, some of the fibers stop working. Once the visual field narrows, some of the changes are difficult to reverse.
Causes and forms of secondary glaucoma
Secondary glaucoma always requires an investigation of the underlying cause.
After eye trauma
Post-traumatic glaucoma can occur after:
- Blunt force
- Wounds
- Hemorrhage; with
displacement of the lens
Pressure sometimes increases immediately, but in some patients the problem develops months later.
Due to inflammatory diseases
Inflammation within the eye interferes with normal fluid circulation. Inflammatory cells, protein components, pigment, and adhesions can block the drainage zone. In this situation, the ophthalmologist considers the activity of the process and the risk of relapse.
After eye surgery
Postoperative complications can alter the outflow of intraocular fluid. Causes include:
- Inflammatory reaction
- Hemorrhage
- Scarring
- Displacement of the artificial lens
Neovascular, phacolytic, steroid, and other forms
Neovascular glaucoma is associated with abnormal vessels in the iris and anterior chamber angle. Phacolytic glaucoma occurs when the lens undergoes changes, causing protein deposits to promote inflammation and interfere with the normal outflow of aqueous humor. Regardless of the cause, symptomatic glaucoma requires a precise understanding of why intraocular pressure increases and which ocular structures are involved.
General information
Diagnosis of Secondary Glaucoma
The examination begins with complaints, anamnesis, and physical examination. The doctor will review any injuries, surgeries, inflammations, vascular diseases, medications, and any deterioration. Intraocular pressure is then measured and the ocular structures are assessed.
Ophthalmologist Examination and Intraocular Pressure Measurement
During the examination, the ophthalmologist will check visual acuity, the cornea, iris, lens, anterior chamber, and fundus. Tonometry measures the pressure at the time of the examination. If fluctuations are suspected, the doctor will order a repeat pressure check or a 24-hour assessment.
Perimetry, OCT, Gonioscopy, Ophthalmoscopy
Perimetry evaluates the field of view and helps determine if there are any losses in peripheral vision. Tomography reveals the nerve fiber layer and the parameters of the optic nerve head. Examination of the anterior chamber angle helps understand the drainage pathways. Ophthalmoscopy is necessary to evaluate the fundus, retina, and optic nerve head. Therefore, the doctor may include several tests in the diagnosis, each of which clarifies a specific aspect of the picture:
- Intraocular pressure measurement
- Fundus examination
- Visual field testing
- Optic nerve OCT
- Gonioscopy
- Determining the cause of the disease
After the examination, the doctor explains the outcome to the patient: whether there are any signs of damage, how active the process is, and what steps are needed next. This analysis helps understand not only the test and imaging results but also the overall monitoring or treatment plan.
What tests help find the cause?
Sometimes an ultrasound of the eye, an anterior segment examination, a retinal examination, keratopachymetry, and a consultation with a general practitioner, rheumatologist, endocrinologist, or vascular specialist are needed. If vascular changes are present, the retina and signs of ischemia are assessed. Regarding the dosage form, the doctor clarifies what eye drops, injections, and systemic medications the patient is currently taking or has used in the past. Hormonal agents are especially important because they can increase intraocular pressure.
Frequently Asked Questions
Can secondary glaucoma be completely cured?
Is secondary glaucoma always accompanied by pain?
Can vision be restored if it has already decreased?
Do I need to undergo regular follow-up after treatment?
References
- Russian Ministry of Health, clinical guidelines — https://cr.minzdrav.gov.ru/
- Russian Medical Journal (RMJ) — https://www.rmj.ru/
- CyberLeninka — https://cyberleninka.ru/
- EyePress / ophthalmology portal — https://eyepress.ru/
- Mediasphera - https://www.mediasphera.ru/
- Attending physician - https://www.lvrach.ru/
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Symptoms of secondary glaucoma
These depend on the cause and rate of pressure increase. Some patients experience eye pain and redness, while others experience only fog or a feeling of pressure.
Early signs that are often ignored
Signs of concern include fogging, rainbow-colored halos around incandescent lights, intermittent pain, one-sided headache, and decreased vision. If these symptoms recur, an ophthalmologist should be consulted. Self-administering eye drops can worsen the problem.
When to see an ophthalmologist urgently
An urgent examination is necessary if there is a sudden deterioration in vision, pain, redness, nausea, rainbow-colored halos, severe photophobia, or trauma. The combination of pain and a rapid decrease in vision is especially dangerous. In such a situation, intraocular pressure can rise rapidly. In this case, using hormonal medications without a doctor's supervision is dangerous.
How vision changes with progression
As vision progresses, peripheral vision suffers. The person:
Visual fields can help identify losses that are difficult to describe in words.