Glaucoma management in adults: an update

Glaucoma is a group of progressive optic neuropathies that cause optic nerve damage and visual field defects. It is typically asymptomatic until irreversible vision loss has occurred. Early detection relies on regular comprehensive eye examinations, with targeted case finding particularly important for people at increased risk. Lowering intraocular pressure is the only proven strategy to slow disease progression, and treatment should be individualised. Topical prostaglandin analogues (eye drops) are commonly used as first-line medical therapy, with once-daily dosing associated with improved adherence. Topical beta blockers may be added if the target intraocular pressure is not achieved or disease progression occurs. Patient adherence, eye drop technique and adverse effects should be reviewed regularly. Selective laser trabeculoplasty (a laser treatment that helps fluid drain out of the eye, thereby lowering intraocular pressure) is an effective first-line alternative to eye drops. Urgent referral to an ophthalmologist or emergency department is required for a suspected acute angle-closure attack. Symptoms include severe eye pain, headache, blurred vision, halos around lights, nausea and vomiting.