Can glaucoma cause blurry vision and eye pain?

Glaucoma and Its Symptoms: Blurry Vision and Pain

Yes, glaucoma can cause blurry vision and eye pain, particularly in acute angle-closure glaucoma which is considered an ophthalmological emergency requiring immediate treatment to prevent permanent vision loss. 1

Types of Glaucoma and Associated Symptoms

Acute Angle-Closure Glaucoma

• When the anterior chamber angle is suddenly obstructed, intraocular pressure (IOP) rises rapidly, causing:
  • Blurred vision (due to pressure-induced corneal edema)
  • Halos around lights
  • Severe eye pain
  • Headache
  • Nausea and vomiting
  • Conjunctival and episcleral vascular congestion
  • Mid-dilated pupil
  • Lens opacities (glaucomflecken) 2

This condition is an acute angle-closure crisis (AACC) and requires urgent treatment as it can cause permanent vision loss or blindness if left untreated 2.

Primary Open-Angle Glaucoma

• Generally does not cause pain
• Visual changes are typically gradual and affect peripheral vision first
• Blurry vision may develop in advanced stages but is not a common early symptom 2

Pathophysiology of Symptoms

In angle-closure glaucoma, symptoms occur because:

• Blocked drainage of aqueous humor leads to rapid IOP elevation
• High IOP causes corneal edema (resulting in blurred vision)
• Pressure on ocular structures triggers pain signals
• Retinal nerve fiber layer damage occurs rapidly without prompt intervention 1

It's important to note that while most cases of acute angle-closure glaucoma present with pain, there are rare cases of painless acute angle-closure glaucoma that can mimic other conditions like amaurosis fugax 3.

Diagnostic Considerations

Symptoms of acute angle-closure glaucoma can sometimes be mistaken for:

• Migraine headaches
• Cluster headaches
• Transient ischemic attacks 1, 3

Risk factors for angle-closure glaucoma include:

• Asian ethnicity (particularly Chinese)
• Age over 50 years
• Female gender
• Family history
• Hyperopia
• Shallow anterior chamber
• Short axial length
• Thick crystalline lens
• Steep corneal curvature 1

Treatment Approach for Symptomatic Glaucoma

When a patient presents with blurry vision and eye pain suggestive of acute angle-closure glaucoma:

1. Immediate ophthalmological referral - same-day evaluation is essential 1

2. Medical therapy to rapidly lower IOP:

   • Acetazolamide
   • Topical beta-blockers
   • Alpha-2 agonists
   • Prostaglandin analogs
   • Systemic osmotic agents (e.g., mannitol) 1, 4

3. Definitive treatment:

   • Laser peripheral iridotomy
   • Surgical iridectomy if laser is not possible
   • Evaluation of the fellow eye (also at high risk) 2, 1

Important Clinical Considerations

• Without prompt intervention, approximately 18% of eyes can develop permanent vision loss following an acute attack 1
• The fellow eye is at high risk for developing angle-closure and should be prophylactically treated 2
• Patients with glaucoma often report difficulty with bright lights and light/dark adaptation, with about half expressing worry about potential blindness 1

Early recognition of symptoms and prompt treatment are critical to preserving vision in patients with angle-closure glaucoma.