This guideline last updated 07/05/2022 9:31:19

Differential diagnosis

• Ocular hypertension
• Secondary glaucoma masquerading as primary open angle glaucoma
• Primary angle closure / Primary angle closure glaucoma

Possible management by Optometrist

• Refer, as per SIGN guidelines (http://www.sign.ac.uk/sign-144-glaucoma-referral-and-safe-discharge.html), if one or more of the following consistent with glaucoma in either eye:
  • Intraocular pressure (at least 2 measurement)- guidelines as for ocular hypertension
  • Optic disc cupping (DDLS grading)
  • Reproducible field defect

Management Category

• Usually non-urgent referral to ophthalmology
• If intraocular pressure >35mmHg and visual field loss, refer urgently (although these criteria may vary locally)

Possible management by Ophthalmologist

Reduce intraocular pressure pharmacologically considering:

• Estimated target intraocular pressure for the individual patient
• Likely degree of compliance (the simpler, the better)
• Side effects, contra-indications and drug interactions

Most primary open angle glaucoma is treated with eye drops

• Prostaglandin analogues are first choice
• Beta-blockers are second choice (relatively high incidence of unwanted effects)
• Other choices are carbonic anhydrase inhibitors and alpha agonist
• Selective Laser Trabeculoplasty is increasingly used as a first line treatment
• Systemic treatment for primary open angle glaucoma is rarely needed
  • Long-term therapy with oral carbonic anhydrase inhibitors may be necessary in a few refractory cases but drug intolerance is common
• Surgery (incisional or non-incisional) may be required