Symptoms of Glaucoma
Primary Open-Angle Glaucoma (Most Common Form)
Primary open-angle glaucoma is typically asymptomatic in early stages, with minimal or no symptoms until significant vision loss has occurred. 1, 2
Early Disease Characteristics
- Most patients are completely asymptomatic and unaware they have the condition, which is why up to one-half of patients remain undiagnosed 1, 3
- No pain, redness, or visual complaints in the early stages 2
- The disease progresses insidiously over years before patients notice any visual changes 4, 3
Late-Stage Symptoms (When Present)
- Peripheral vision loss (tunnel vision) that develops gradually and may go unnoticed until advanced 5, 2
- Central visual field defects in more advanced disease 5
- Vision loss is irreversible once it occurs 1, 4
Important Clinical Pitfall
Many patients assume they would notice symptoms if they had glaucoma, but the lack of symptoms is precisely what makes this disease dangerous - by the time patients notice vision problems, significant irreversible damage has already occurred 1, 2. This is why screening high-risk patients is critical despite the USPSTF's insufficient evidence rating for general population screening 6.
Acute Angle-Closure Glaucoma (Ophthalmologic Emergency)
Acute angle-closure glaucoma presents with sudden, severe symptoms requiring immediate medical attention to prevent permanent vision loss. 7, 3
Cardinal Symptoms
- Severe eye pain and headache 7
- Blurred vision and halos around lights (from pressure-induced corneal edema) 7
- Eye redness 7
- Mid-dilated pupil that is non-reactive 7
- Nausea and vomiting (often mistaken for gastrointestinal illness) 7
- Decreased vision 7
Critical Warning
Delayed diagnosis can lead to permanent blindness - 18% of eyes become blind and 48% develop glaucomatous optic neuropathy within 4-10 years following untreated acute angle-closure crisis 7. This is a true ophthalmologic emergency requiring immediate referral.
Chronic Angle-Closure Glaucoma
- May be asymptomatic like open-angle glaucoma 6
- Can present with intermittent symptoms of blurred vision or halos that resolve spontaneously 7
- Eventually progresses to permanent visual field loss if untreated 6
Key Clinical Distinction
The fundamental difference is that primary open-angle glaucoma (90% of cases) has no symptoms until late-stage disease, while acute angle-closure glaucoma (rare but serious) presents with dramatic acute symptoms 6, 7, 2. Primary care physicians must understand this distinction to appropriately identify high-risk patients for screening and recognize acute emergencies requiring immediate ophthalmologic referral 3.