Chronic Glaucoma & Ocular Hypertension
Understand optic nerve damage, pressure assessment and lifelong monitoring.
Quick revision ↓ Medical Dictionary
01Damage rather than pressure alone
Glaucoma involves characteristic optic nerve damage; structural changes can precede detectable visual field loss. Raised intraocular pressure is an important modifiable risk factor but is not required in every case. Ocular hypertension means elevated pressure without established glaucomatous damage. Distinguishing these states requires structural and functional assessment rather than diagnosing from one pressure reading alone.
02Case finding and diagnosis
Assessment may include calibrated tonometry, optic disc examination or imaging, visual fields, corneal thickness and angle evaluation. Interpret results together and consider measurement quality. Family history and other risk factors influence concern. Early chronic open-angle glaucoma often causes no symptoms, so preserved central acuity does not establish an undamaged optic nerve.
03Setting a treatment plan
The aim is to reduce the risk of further visual loss, usually by lowering pressure to an individual target. Laser, drops and surgery have roles depending on disease stage, risk, suitability and local guidance. Explain the reason for treatment when the patient feels well. Existing optic nerve damage is generally irreversible; care focuses on preserving remaining function.
04Safe use of drops
Check the patient can administer drops and understands the schedule. Review contraindications and systemic adverse effects; topical beta-blockers can matter in asthma or conduction disease. Avoid touching the bottle tip to the eye. Adherence barriers such as cost, dexterity and confusion should be addressed directly rather than interpreting every missed dose as unwillingness.
05Follow progression
Repeat fields and structural assessments as clinically indicated, comparing trends rather than isolated results. A satisfactory pressure at one visit does not prove stability. Escalation depends on progression, target pressure and treatment burden. Give clear follow-up arrangements and urgent advice for a new painful red eye or sudden visual change, which is not the usual chronic presentation.
High-Yield Revision
- Normal-range pressure does not exclude glaucoma.
- Early disease may preserve central acuity and cause no symptoms.
- Monitoring includes structure and function.
Common Pitfalls
- Diagnosing glaucoma from one pressure value.
- Stopping treatment because vision feels unchanged.
References & Further Reading
Read the relevant guideline sections alongside these original clinical teaching cases. Local pathways, available services and individual patient factors determine care.
Reference review: 28 September 2026. Consult current local protocols for prescribing, procedures and escalation.