Absolute Glaucoma

Definition:

Absolute glaucoma is the final stage of glaucoma in which increased intraocular pressure results in permanent vision loss or blindness.

Characteristics absolute glaucoma

• Final or end stage of glaucoma
• Total loss of vision
• Treatment is focused on reducing pain and keeping the eye comfortable

Risk factors of Glaucoma progression to Absolute Glaucoma

Following factors have been proved to increase the risk of glaucoma progressing to absolute glaucoma:

• Elevated intraocular pressure (IOP)
• IOP fluctuation
• Male gender
• Pseudoexfoliation syndrome
• Worsening visual fields during follow up
• Optic disc haemorrhage
• Migraine
• Systemic diseases e.g. hypertension, diabetes, and myopia
• Low socioeconomic status

Causes of Absolute Glaucoma

Absolute glaucoma is the final stage of uncontrolled glaucoma and can occur due to any of the following reasons:

• Uncontrolled raised ocular pressure
• Non-compliance with glaucoma medication
• Trauma
• Intraocular surgery (especially cataract extraction)
• Associated with aniridia or Lowe syndrome or Sturge-Weber syndrome

Symptoms of Absolute Glaucoma

Glaucoma in its initial stage does not show any specific signs or symptoms and the condition goes unnoticed till the time vision loss occurs. In the final stage of glaucoma, patient complains of following symptoms denoting Absolute Glaucoma:

• Severe eye pain
• Stone-like appearance of the eye
• Tearing
• Photophobia
• Lost pupillary reflex
• No pupillary response

Diagnostic challenge for Absolute Glaucoma

Diagnosis of absolute glaucoma is a real challenge as visual field examination is either not possible to be performed or is unreliable in most of the cases. Optical coherence tomography (OCT) may be useful in the detection of glaucomatous progression to absolute glaucoma. Rest of the examinations depend upon the patient condition.

Treatments for Absolute Glaucoma

Majority of the damage is occurred till the time patient notices vision loss. So treatment is done in emergency setting with immediate hospitalization and following line of therapy:

• Loss of vision with absolute glaucoma is irreversible, and treatment is aimed at reducing pain and includes:
  • Topical steroids
  • Topical atropine
  • Cyclocryotherpay
  • Cyclodiathermy
  • Retrobulbar injection of alcohol
  • Enucleation
  • Radiotherapy
  • Laser/Cryotherapy
  • Cyclophotocoagulation