Is secondary glaucoma curable?
It’s important to know that there are a lot of reasons why secondary glaucoma can occur, from health conditions such as diabetes to problems with the way your eye normally functions. As such, the treatment plan for secondary glaucoma will usually depend on treating the underlying cause. However, your ophthalmologist may also recommend either medication such as glaucoma eye drops, laser treatment, conventional surgery or a combination of these to manage glaucoma itself.
With that in mind, let’s explore the different kinds of secondary glaucoma, which treatment options are available and which are the most effective with respect to each type.
If you need to learn more about these different glaucoma types first, you can find the required information in our glaucoma diagnosis guide.
Exfoliative glaucoma treatment
Exfoliative glaucoma will usually be picked up during a dilated eye examination, where the flaky material which peels off the outer layer of the lens is detected in the drainage network of the eye.
If you are over 401, or if you have a family history of exfoliative glaucoma, you may be more susceptible to developing the condition. The best way to keep this in check is to go for an eye test at least once a year.
This type of glaucoma is usually characterised by having greater than average variations in intraocular pressure (IOP) and having higher than average peak pressures during an episode of high IOP2.
Generally, medical therapy is not used to control this kind of glaucoma. Your ophthalmologist will usually recommend laser trabeculoplasty (a laser treatment, also referred to as SLT, designed to help drain fluid from the eye in order to lower eye pressure) or incisional surgery, as exfoliative glaucoma tends to respond better to this.
Neovascular glaucoma treatment
Neovascular glaucoma is a result of an underlying health condition, such as diabetes3 , or previous problems with the retina and its blood vessels, such as blockages in the retinal veins known as a retinal vein occlusion. These health conditions can cause new blood vessels to form on the iris and over the drainage system of the eye, known as the trabecular network. These vessels prevent the eye from draining the fluid within it naturally, causing IOP to rise.
With this type of secondary glaucoma, IOP is managed through medication that may include beta-blockers that reduce the production of aqueous humour (the fluid in your eye) and topical steroids that help manage the pain and inflammation. Surgical treatment usually involves cauterising the vessels through laser treatment, but it will be more important to keep the root cause of neovascular glaucoma in check. Managing the underlying health condition can help to prevent the further spread of the blood vessels which block the trabecular network.
Pigmentary glaucoma treatment
Pigmentary glaucoma occurs when the pigment granules from the iris disperse into the aqueous humour. These pigment granules gradually settle into the angle at which the iris meets the cornea, which can clog the drainage canals — leading to increased IOP.
Pigmentary glaucoma is usually identified during a gonioscopic examination where the highly magnified and mirrored gonioscopy lens reveals the presence of pigment which can be seen resting in the drainage angle.
A typical symptom of pigmentary glaucoma is a significant increase in eye pressure significantly during physical activity, however, it will usually return to normal post-exercise4. During these spikes, someone with pigmentary glaucoma may experience blurry vision and seeing rainbow-coloured halos around lights.
If you have pigmentary glaucoma, your ophthalmologist will focus on controlling your eye pressure. They will usually do this through a combination of eye drop medications that reduce the production of fluid within the eye. Alternatively, lasers or incisional surgery may be used to unblock the drainage system in your eye. In the presence of pigment dispersion (even when it has not developed into glaucoma), it is important to have your eye closely monitored at regular intervals.
Traumatic glaucoma treatment
Blunt or penetrating injuries can damage the ocular structures, leading to inefficient flow of intraocular fluid, and subsequently glaucoma. The effects may manifest immediately after the injury occurs, but can equally crop up years later.
A doctor will customarily recommend incisional surgery in order to restore the intraocular structures, and corticosteroids and antibiotics may be immediately prescribed to prevent tissue scarring and infection. In some cases, it’s possible the patient may also need medication in the form of beta-blockers, cycloplaegics (an eye drop that allows an eye doctor to measure vision issues through pupil dilation) and Diamox tablets (a carbonic anhydrase enzyme also found in eye drop form) post-surgery to maintain the intraocular pressure.
Uveitic glaucoma treatment
Uveitis is characterised by inflammation of the uvea, which is the pigmented layer of the eye consisting of the iris, choroid, and ciliary body. Uveitis may result from injury, infection or auto-immune disorders. The inflammatory debris and dead cells sink to the bottom of the angle between the cornea and iris, obstructing the trabecular meshwork. If the inflammation is not treated, it can lead to the formation of scar tissue, which will also limit the outflow of aqueous humour.
A multi-pronged approach is often needed to treat uveitic glaucoma. It’s possible that if you have this type of glaucoma, you will have consultations with several specialists. This is because, while corticosteroids (anti-inflammatory steroids) are used to treat the inflammation of the uvea, they have also been known to increase IOP5.
While the focus will be on managing the underlying cause, especially in the case of auto-immune disorders, IOP is usually controlled using drainage shunts, lasers and a combination of drugs including beta-blockers and carbonic anhydrase inhibitors. Treatment of uveitic glaucoma is usually complex, and your doctors will work closely with each other to devise a safe and effective treatment plan for you.
Congenital glaucoma treatment
Congenital glaucoma is a rare condition. This glaucoma occurs in babies when there has been an incorrect or incomplete development of the eye’s drainage canals during pregnancy.
The condition can be inherited and is usually diagnosed within the first year after birth. It’s recommended that if either parent has congenital glaucoma, they have their child checked when possible — doctors can usually spot it between the ages of three to six months6. Symptoms of congenital glaucoma include enlarged and/or watering eyes, corneal oedema (swelling) and increased sensitivity to light7.
Wherever possible, microsurgery is used to correct the structural deficiencies which originated during the developmental period of the baby. This type of surgery is incredibly advanced: using small tools to create a drainage canal for any excess fluid in the eye. If necessary, the doctor will also implant a small drainage valve or tube which will carry the fluid out of the eye. Any congenital condition is extremely stressful for the parent. If you’re concerned or worried at any point, speak to your specialist.
Secondary types of glaucoma can have many different causes, but they’re usually often treated similarly to primary open-angle glaucoma (with eye drops, laser treatment, surgery, or a combination). However, addressing the underlying cause of secondary glaucoma will often be the primary concern in shaping your treatment plan.
2. Holló G, Katsanos A, Konstas AG. Management of exfoliative glaucoma: challenges and solutions. Clin Ophthalmol. 2015;9:907–919. Published 2015 May 22. doi:10.2147/OPTH.S77570
3. Jeganathan VS, Wang JJ, Wong TY. Ocular associations of diabetes other than diabetic retinopathy. Diabetes Care. 2008;31(9):1905–1912. doi:10.2337/dc08-0342
5. Muñoz-Negrete FJ, Moreno-Montañés J, Hernández-Martínez P, Rebolleda G. Current Approach in the Diagnosis and Management of Uveitic Glaucoma. Biomed Res Int. 2015;2015:742792. doi:10.1155/2015/742792
6. Kozarsky, A. (2019). Primary Congenital Glaucoma: What Is It and How Did My Child Get It?. [online] WebMD. Available at: https://www.webmd.com/eye-health/primary-congenital-glaucoma#1