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Glaucoma - Symptoms and Signs
Last reviewed: 04.07.2025
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Acute attack of glaucoma
An acute attack of glaucoma can develop at any stage of the disease. An acute attack of glaucoma can develop without any externally visible causes. In other cases, the appearance of an acute attack of glaucoma is facilitated by severe emotional shock, an infectious disease, errors in eating or drinking, erroneous instillation of atropine or other means of dilating the pupil into the eye. Therefore, when treating elderly patients prone to increased intraocular pressure, it is necessary to refrain from prescribing these means.
An acute attack of glaucoma in a healthy eye often occurs without any apparent reason.
It begins suddenly, most often at night or in the morning. There is a sharp pain in the eye, orbit. The headache is accompanied by vomiting, general weakness of the body. Patients lose sleep and appetite. Such general symptoms of an acute attack of glaucoma can be the cause of diagnostic errors.
It is accompanied by pronounced symptoms in the eye: swelling of the eyelids and conjunctiva, and lacrimation often appears.
An acute attack of glaucoma can be provoked by stressful situations, staying in the dark, prolonged work in a bent position, instillation of mydriatics into the eye, and side effects of some commonly used medications.
Severe pain appears in the eye, radiating to the corresponding brow or half of the head. The eye is red, the vascular pattern on the conjunctiva and sclera is sharply intensified. The cornea looks rough, dull, cloudy compared to the transparent, shiny healthy cornea; a wide oval pupil is visible through the cloudy cornea, which does not react to light. The iris changes layer color (usually becomes greenish-rusty), its pattern is smoothed out, unclear. The anterior chamber is either very small or completely absent, which can be seen with focal (lateral) lighting. Palpation of such an eye is painful. In addition, a stony density of the eyeball is felt. Vision is sharply reduced, it seems to the patient that there is a thick fog in front of the eye, rainbow circles are visible around light sources. Intraocular pressure increases to 40-60 mm Hg. As a result of narrowing of some of the vessels, focal or sectoral necrosis of the iris stroma develops with subsequent aseptic inflammation. Formation of posterior synechiae at the edge of the pupil, goniosynechia, deformation and displacement of the pupil. Often, due to severe pain in the eye due to compression of sensitive nerve fibers, arterial pressure increases significantly, nausea and vomiting occur. For this reason, this clinical condition is mistakenly assessed as a hypertensive crisis, dynamic cerebrovascular accident or food poisoning. Such errors lead to the fact that the patient's intraocular pressure is reduced too late, when the disorders in the optic nerve become irreversible and lead to the development of chronic closed-angle glaucoma with constantly elevated intraocular pressure.
Open angle glaucoma
Open-angle glaucoma most often begins and progresses unnoticed by the patient, who does not experience any unpleasant sensations and consults a doctor only when severe visual impairments appear (advanced or advanced stages); at these stages, achieving stabilization of the process becomes very difficult, if not impossible.
Open-angle glaucoma can be confused with cataracts, leaving the patient untreated and allowing the development of incurable blindness.
With cataracts, intraocular pressure is normal, and when examined in transmitted light, the pink glow of the pupil is weakened and black streaks and spots of more intense opacities can be distinguished against its background.
Subacute attack of primary angle-closure glaucoma
A subacute attack of primary angle-closure glaucoma occurs in a milder form if the anterior chamber angle does not close completely or not tightly enough. Subacute attacks are characterized by no strangulation of the vessels and no necrotic or inflammatory processes in the iris. Patients usually complain of blurred vision and the appearance of rainbow circles when looking at light. Pain in the eyeball is mild. On examination, slight corneal edema, moderate pupil dilation, and hyperemia of the episcleral vessels are noted. After a subacute attack, there is no deformation of the pupil, segmental atrophy of the iris, or formation of posterior synechiae and goniosynechia.
Congestive glaucoma
The congestive form of glaucoma is characterized by the appearance of early subjective signs, which facilitates early diagnosis of the disease. In the initial stage, patients complain of blurred vision, the appearance of rainbow circles, discomfort, sometimes slight pain in the eye area, changes in refraction - the appearance of myopia. Often these symptoms appear after emotional stress, mental and physical overload. The cause of these complaints is a short-term increase in intraocular pressure, causing transient, unstable changes in the anterior segment of the eye.
In the initial stages of congestive glaucoma there are no organic changes in the organ of vision. Periods of increase in intraocular pressure are short-term, therefore, when examining patients, visual acuity and visual field are unchanged, and there are no changes in the optic nerve. The initial period lasts from several days to a year.
Over time, the increase in intraocular pressure reoccurs more frequently, periods of increased intraocular pressure become longer, and glaucoma progresses to the stage of pronounced congestive glaucoma. At this stage, persistent objective changes appear in the anterior segment of the eye, and visual impairment is detected.
Simple glaucoma
Simple glaucoma is much less common than congestive glaucoma: 4-5% of cases compared to congestive glaucoma. It occurs without objective changes in the anterior segment of the eye. The disease begins unnoticed, so that patients very often do not suspect that one of their eyes is affected, and discover this by accident.
The appearance of the eyes in simple glaucoma is normal: irritation is completely absent, occasionally one can notice slightly dilated veins and a slightly dilated pupil that weakly reacts to light. The main symptom of glaucoma - increased intraocular pressure - in simple glaucoma may be only weakly expressed.
Often, during the first examination, the intraocular pressure turns out to be normal, and only by repeated and systematic measurement at different hours over several days can some increase and instability of this pressure be established. At the same time, it turns out that in the evening the pressure is significantly lower than in the morning (a difference of 5 mm Hg will speak in favor of glaucoma).
With simple glaucoma, as with congestive glaucoma, the field of vision gradually decreases and visual acuity falls. Since the pupil glows grayish and therefore does not seem completely clear, an inexperienced doctor who does not have ophthalmoscopy techniques may mistake simple glaucoma for senile cataract. In essence, simple and congestive glaucoma are the same disease, and these forms can transform into each other: congestive glaucoma transforms into simple and vice versa.
Simple glaucoma, unlike congestive glaucoma, is characterized by a smooth, slow course, increases in intraocular pressure are low, sharp fluctuations in intraocular pressure are rare. But the disease progresses steadily.
The main symptoms of simple glaucoma are increased pressure, development of optic nerve atrophy with excavation of its disk, narrowing of the visual field and decreased visual acuity. The absence of early subjective sensations leads to the fact that patients seek medical attention only when visual functions are reduced, i.e., when irreversible changes have already occurred. Often, vision in one eye is completely lost or sharply reduced. Late visits to the doctor by the patient correspondingly worsen the prognosis of simple glaucoma. With late recognition and irregular treatment of glaucoma, blindness occurs.
Absolute glaucoma
Absolute glaucoma is the outcome of all clinical forms of glaucoma that proceed unfavorably and end in blindness. Under the influence of constantly acting increased ophthalmotonus, circulatory and metabolic disorders in the eye tissues, sharp atrophic changes occur, the function completely fades away, the eye is hard as a stone. Sometimes severe pain begins. Absolute glaucoma becomes absolute painful glaucoma. In the eye with absolute glaucoma, dystrophic processes are noted, the cornea is often affected in the form of dystrophic keratitis, corneal ulcers, etc. Dystrophic ulcers can become infected, a purulent corneal ulcer develops, often ending in a corneal perforation. When the cornea is punctured in an eye with high intraocular pressure, an expulsive hemorrhage may swell - a rupture of the long posterior ciliary arteries under the choroid. In this case, all or part of the membranes of the eyeball are pushed out of the eyeball under the pressure of blood.
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Secondary glaucoma
Secondary glaucoma has the same stages and degrees of compensation as primary glaucoma, but there are some special features:
- one-way process;
- can occur either as open-angle glaucoma or as closed-angle glaucoma (i.e. in attacks);
- inverted type of intraocular pressure increase curve (evening rise);
- visual functions deteriorate very quickly, within 1 year;
- With timely treatment, the decrease in visual functions is reversible.