That Bad Headache Could be Sight Stealing Glaucoma

By Bob Aronson

If you have cataracts, even the beginnings of cataracts, you could experience the same sudden and painful glaucoma attack I did.  Recently on my Facebook group, Organ Transplant Initiative (OTI) I wrote about my experience with Acute Closed Angle Glaucoma.  It started with a little headache and by the time I got to the ER had foolishly endured 16 hours of searing hot, constant, ever increasing pain.  I knew I had early stage cataracts but never associated that condition with the pain I was experiencing.

Since that episode I have learned that transplant recipients or anyone taking corticosteroids (Cortisone, Hydrocortisone and Prednisone) may have a greater risk of contracting Glaucoma, more on that in coming paragraphs.

We rarely hear about Glaucoma  and when we do we get the impression that it develops slowly and only affects old people.  I have spent a good share of my lifetime working with the medical profession and have had the beginnings of cataracts for a while and still did not know that Glaucoma could attack suddenly, with intense pain and be caused by a cataract.

Before I go into any detail about what you can do should the same thing happen to you, let me first explain the two eye afflictions.  They are very different diseases and both can lead to blindness if not treated.  Here’s the simple answer.  A cataract is an opaque (you can’t see through) area on the lens. It’s kind of like one of those windows that lets light in but you can’t see through it.  Research indicates that about 90% of people have some cataract activity by age 65, but many get it earlier.  Regular eye exams will reveal it, even if it is just getting started.  The surgery for cataracts is pretty simple and very effective because the medical team will replace the lens.  There is a marked and significant improvement  in vision.

Glaucoma is totally different.  It is a complicated group of eye diseases which affect the optic nerve and can lead to progressive, irreversible vision loss.  It is the second leading cause of blindness caused by fluid accumulation that increases pressure inside the eyeball.

There are two main types of glaucoma, 1) open angle and 2) closed angle glaucoma. I won’t go into the medical details here., just some quick definitions.  If you would like more information just Google Glaucoma.

1) Closed Angle Glaucoma (acute angle-closure glaucoma). This is the condition that affected me.  It can come on suddenly (and it did) and the patient commonly experiences pain and rapid vision loss. Fortunately, the symptoms of pain and discomfort make the sufferer seek medical help, resulting in prompt treatment which usually prevents any permanent damage from occurring.  In my case I waited too long and was lucky they were able to save my left eye.

 

 

2) Primary Open Angle Glaucoma (chronic glaucoma) – progresses very slowly. The patient may not feel any symptoms; even slight loss of vision may go unnoticed. In this type of glaucoma, many people don’t get medical help until some permanent damage has already occurred.

 

 

Here are some of the signs and symptoms of closed angle glaucoma

• Eye pain, usually severe (It came on suddenly and kept getting worse.  Like a red hot poker in the eye.  It finally becomes unbearable pain).
•  Blurred vision(in started out blurred and by the time I got to the ER I had no vision in the eye)
• Eye pain is often accompanied by nausea, and sometimes vomiting (the symptoms were not unlike the worst hangover you’ve ever had.  Or…if you don’t drink, like the worst case of stomach flu you’ve ever had).
• Lights appear to have extra halo-like glows around them
• Red eyes
• Sudden, unexpected vision problems, especially when lighting is poor

Signs and symptoms of primary open-angle glaucoma

Peripheral vision is gradually lost. This nearly always affects both eyes.

• In advanced stages, the patient has tunnel vision

Rrisk factors are linked to glaucoma?

• Advanced age – people over 60 years have a higher risk of developing glaucoma. For African-Americans, the risk rises at a much younger age.
• Ethnic background is a risk factor as well.  For example,  East Asians, because of their shallower anterior chamber depth, have a higher risk of developing glaucoma compared to Caucasians. The risk for those of Inuit origin is considerably greater still. Studies show that African-Americans are three to four times more likely to develop glaucoma than whites.  Also…it appears as though Glaucoma favors women over men.  Studies indicate that women are three times as likely to develop glaucoma as men.  There are other risk factors as well and included among them is the use of corticosteroids.
• Patients who take Corticosteroids like cortisone, hydrocortisone and prednisone for long periods of time have a raised risk of developing several different conditions, including glaucoma. The risk is even greater with eyedrops containing corticosteroids.

Now that you have some background lets talk about the disease.  I get frequent headaches, I always have and aspirin has always worked for me.  When this attack hit me, I took some aspirin, it did nothing.  Then I remembered telling a physician about my headaches and he suggested that maybe they were mini-migraines but we did not pursue the topic even though his suggestion stuck with me.

As the headache worsened I thought about the mini migraines and my wife Robin went to the pharmacy to get some over the counter migraine medicine.  It had no effect and the headache kept getting worse.  Then we called my primary care doc, told him I was having a migraine and he called in a prescription.  I was to take it every four hours, which I did but the headache got worse.  Several times during this ordeal Robin asked me if I wanted to go to the ER to which I responded negatively.  Finally after 16 hours of worsening pain, loss of vision and vomiting I gave in.  It was 4 AM when I awakened Robin to tell her I could no longer tolerate the pain so she drove me to the Mayo Clinic Emergency Department in Jacksonville.

Upon entering the ER I was asked to describe my symptoms which I did but also said I was experiencing a migraine headache.  The Doctor listened but immediately looked at my eyes and expressed some doubt about my self-diagnosis.  She ordered morphine for pain a CT scan of my head and called for an ophthalmologist, who arrived within minutes and conducted a more thorough exam of my eyes which included testing for pressure on the eyeball.  He quickly arrived at the conclusions that I was suffering from  acute closed angle glaucoma.  Subsequent research tells me that medical people are concerned about eye pressures that are over 23-25.  Mine was 60.  I had waited far too long to come to the ER.  The eye specialist continually put drops in the eye until the pressure was down to a safer level at which time I was hurried into a laser surgery room where they zapped the eye to create a tiny hole that would release more pressure.  It took only a few minutes.  The headache was gone, my stomach was back to normal and I was high on morphine for two days.

I’m writing this so that others don’t make the same mistake. Headaches can be serious, and when you combine a bad headache with vision loss and vomiting the Emergency Room is where you should be headed.  I got lucky….my vision was not lost.  A few days after this incident I went back to Mayo and they did the laser surgery on the other eye.

In about six weeks I will return to the clinic and have the cataracts repaired and that, I hope, will be the end of this vision episode.

There are some steps you can take to prevent this condition.  Here’s what the Mayo Clinic Says.  http://www.mayoclinic.org/diseases-conditions/glaucoma/basics/definition/con-20024042

• Get regular eye care. Regular comprehensive eye exams can help detect glaucoma in its early stages before irreversible damage occurs. As a general rule, have comprehensive eye exams every three to five years after age 40 and every year after age 60. You may need more frequent screening if you have glaucoma risk factors. Ask your doctor to recommend the right screening schedule for you.
• Treat elevated eye pressure. Glaucoma eyedrops can significantly reduce the risk that elevated eye pressure will progress to glaucoma. To be effective, these drops must be taken regularly even if you have no symptoms.
• Eat a healthy diet. While eating a healthy diet won’t prevent glaucoma, it can improve your physical and mental health. It can also help you maintain a healthy weight and control your blood pressure.
• Wear eye protection. Serious eye injuries can lead to glaucoma. Wear eye protection when you use power tools or play high-speed racket sports on enclosed courts. Also wear hats and sunglasses if you spend time outside.

Don’t make the same mistake I did.  Don’t  self-diagnose, don’t delay.  When a condition has the potential to destroy your vision you must get immediate medical attention.

Bob Aronson of Bob’s Newheart is a 2007 heart transplant recipient, the founder of Facebook’s nearly 4,000 member OrganTransplant Initiative (OTI) and the author of most of these donation/transplantation blogs. You may comment in the space provided or email your thoughts to me at bob@baronson.org. And – please spread the word about the immediate need for more organ donors. There is nothing you can do that is of greater importance. If you convince one person to be an organ and tissue donor you may save or positively affect over 60 lives. Some of those lives may be people you know and love.