What Causes Glaucoma?

The cause of glaucoma is generally a failure of the eye to maintain an appropriate balance between the amount of internal (intraocular) fluids produced and the amount that drains away. Underlying reasons for this imbalance usually relate to the type of glaucoma you have.

Just as a basketball or football requires air pressure to maintain its shape, the eyeball needs internal fluid pressure to retain its globe-like shape and ability to see. But when glaucoma damages the ability of internal eye structures to regulate intraocular pressure (IOP), eye pressure can rise to dangerously high levels.

Unlike a ball or balloon, the eye can't relieve pressure by springing a leak and "deflating" when pressure is too high. Instead, high IOP just keeps building and pushing against the optic nerve until nerve fibers are permanently damaged and vision is lost.

To understand what causes glaucoma, you first must know something about the eye's anatomy and how fluids move through the eye:

1. Internal eye fluids are produced by the ciliary body, which is a small, circular structure found behind the iris or colored portion of the eye.
    
2. This fluid, known as the aqueous humor, flows behind the iris and through the pupil or central opening in the middle of the iris. Fluid then fills the anterior chamber, a space between the back of the clear cornea and the front of the iris.
    
3. The aqueous humor escapes from the eye through a structure known as the filtration angle, which is the angle formed inside the anterior chamber between the iris and the peripheral cornea.
    
4. The aqueous filters through this angle and through the sclera or white part of the eye and then joins with the network of veins outside the eye.
    
5. Any disruption of this outflow of aqueous can result in an increase in IOP.

Anatomically, the eye's filtration angle is referred to as being either "open" or "closed" (narrow). The narrower the angle, the more difficult it is for the aqueous to flow through it. An open angle also can hinder the outflow of aqueous, if structural damage exists within the ocular tissues of the angle itself.

[Read more about open angle glaucoma and narrow angle glaucoma.]

Most conventional methods of screening for glaucoma involve testing eyes for the presence of high IOP. But because glaucoma can occur even without high IOP, direct examination of the optic nerve with visual field testing or other means is essential in making (or ruling out) the diagnosis of glaucoma.

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In normal-tension glaucoma, some theories suggest that decreased blood flow to the optic nerve might be a factor. Inadequate blood flow also may help create high IOP contributing to optic nerve damage. Some studies also indicate that poor blood flow within the eye can be directly correlated with blind spots (scotomas) that develop within the visual field, as occurs with glaucoma.*

An intriguing study reported in August 2007 indicates a potential common cause of both glaucoma and Alzheimer's, which creates brain lesions and accompanying memory loss. London researchers who conducted the study found that buildup of a protein known as beta-amyloid in the eye's retina and brain tissue appears related to development of both glaucoma and Alzheimer's.

However, abnormal accumulation of beta-amyloid proteins does not mean that someone with Alzheimer's will have glaucoma or vice versa. Researchers said similarities between certain eye and brain tissue could explain why the buildup of beta-amyloid proteins can affect both the eye and the brain.

Increasingly, glaucoma treatments now are being investigated for their ability to protect nerve cells in the eye from damage.