Causes & Risk Factors

Open angle glaucoma is 90% of adult glaucoma (making the remaining 10% the narrow angle type). While the causes of narrow angle glaucoma are mostly anatomic, the causes for most open angle glaucoma are not as obvious

The narrow angle is actually the risk factor for angle closure glaucoma (ACG), in that when the drainage angle formed by the clear cornea and the colored iris becomes narrow, the risk for actual angle closure is greatly increased. The narrow angle can set up a chain of events which results in actual closure of the angle. Then, the trabecular meshwork in the angle becomes blocked, preventing drainage of the fluid in the eye. A sudden rise in intraocular pressure occurs with this blockage along with significant pain and reduction in vision, the latter of which could become permanent if the attack lasts long enough.

In most cases of open angle glaucoma, the drainage channels in the trabecular meshwork simply do not function very well, the specific reason for which is not well understood. When the cause is not understood, the condition is referred to as primary open angle glaucoma (POAG), which, as described elsewhere, is slow to develop and fairly impossible for you to notice until it is very advanced.

Glaucoma Risk Factors:

  • ACG---Narrow Angle: See above.
  • ACG—Hyperopia: Many eyes with hyperopia, which with myopia (nearsightedness) and astigmatism are the three common refractive errors requiring glasses, are smaller eyes. The smaller the eye, the narrower the drainage angle.
  • ACG—Advanced Cataract: As the cataract progresses, some types, specifically nuclear sclerosis, become increasingly thick and crowd the anterior camber in front of the iris, narrowing the drainage angle.
  • ACG—Additional Risk Factors:
    • Age (cataract development typically happens as you age)
    • Asian ethnicity
    • Female gender (women have smaller eyes)
    • Family history of ACG
    • Iris function, how it behaves during dilation and constriction
    • Some drugs rarely can cause forward movement of the iris root
  • POAG—High Intraocular Pressure (IOP): While high IOP is not required for POAG, and neither does it guarantee POAG, it is the greatest risk factor for the development of POAG.
  • POAG—Age: The older you are, the greater the risk of developing POAG.
  • POAG—Corneal Thickness: People with normal or thinner than normal corneas, such as people of African descent, are at a greater risk for developing POAG.
  • POAG—Family History: If your parent, sibling, or offspring have had POAG, your risk for developing it are increased—less so if other relatives have had it.
  • SOAG—The S stands for Secondary: When open angle glaucoma occurs as a result of ocular trauma or tumor, pigment release from the iris, retinal detachment, inflammation, or a variety of cataract conditions, it is secondary open angle glaucoma.
  • POAG—Medical Conditions: Conflicting data suggest that diabetes, hypertension, heart disease and hypothyroidism may cause open angle glaucoma.

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