Synopsis
Distinguish glaucomatous optic neuropathy from isolated pressure elevation, assess lifetime visual risk, and select an appropriate diagnostic and initial treatment pathway.
- Glaucoma is progressive optic nerve damage with corresponding structural or functional loss; ocular hypertension describes raised pressure without established glaucomatous damage.
- A pressure within the usual population range does not exclude glaucoma, and an isolated high reading does not establish optic neuropathy.
- Assess the optic discs, visual fields, angle and Goldmann applanation pressure; measure central corneal thickness during diagnostic assessment.
Key red flags
New severe ocular pain, corneal haze, nausea or abrupt visual loss is inconsistent with uncomplicated chronic disease and requires urgent same-day ophthalmic assessment.
Investigation priorities
Establish pressure with an appropriate method and assess reproducibility.
Management branches
A routine eye assessment identifies raised pressure or possible glaucomatous damage.
- Assess the disc, fields and angle and obtain Goldmann-type pressure measurements before deciding the routine referral pathway.
- Repeat uncertain measurements when clinically appropriate, while bypassing repeat-measure pathways if symptoms or severity require urgent assessment.
Key medicines
Latanoprost 50 micrograms/mL eye dropsInstil one drop into each affected eye once daily, preferably in the evening; continue long term until the glaucoma team changes or stops treatment.