Migraine and glaucoma can sometimes be associated. Typically, most people who have experienced migraine are at a low risk of developing glaucoma. However, patients with normal pressure glaucoma, for example, quite commonly have a history of migraine. It is believed that in those cases that it is not just the eye pressure that can be associated with some of the changes in visual fields, but also somehow the circulation in the optic nerve can affect the onset and progression of glaucoma.

Migraine has many trigger factors, but can particularly be triggered by red wine, and specific stronger rich cheeses.

Image of some visual symptoms experienced by someone experiencing a migraine.

CAUSE & SYMPTOMS

Primary angle closure glaucoma (‘’narrow or closed angle glaucoma’’) is the less common of the two major types of glaucoma where in the iris tends to be blocking the filtration channels (trabecular meshwork) of the eye resulting in obstruction of the drainage of fluid out of the eye. This can lead to a sudden sharp rise of eye pressure resulting in ‘an attack of angle closure’ which may give rise to the following symptoms :

• red eye
• severe eye pain (or headache)
• seeing haloes around lights
• cloudy vision
• sickness

Sometimes patients might experience intermittent ‘sub-acute attacks’ classically in the evening giving rise to misty vision, coloured rings around white lights  and some discomfort around eyes. The rise of pressure can also happen over a longer period of time when these acute symptoms are lacking (‘chronic angle closure’).

Field loss in patient with advanced glaucoma

RISK FACTORS

• Patients above 40 years of age
• Long-sightedness (high plus power in spectacles)
• Ethnic origin – commoner in Asians (rarer in Caucasians)
• Females

Many drugs can cause angle closure, including drugs with "anti-cholinergic" side effects. For such medications, there is usually a caution on the enclosed medication leaflet that advises "do not take this medication if you have glaucoma". Other drugs that can cause angle closure include sulpha based drugs (eg topiramate), dilating drops (eg cyclopentolate) and some anti-depressant medications (eg amitriptylline).

DIAGNOSIS

If patients experience any of the above symptoms they should contact their GP or optician immediately so that they can be referred to the hospital eye clinic for urgent treatment to avoid permanent loss of sight.

TREATMENT

Patients usually require admission for treatment of acute angle closure glaucoma. The treatment is with tablets or intravenous injections to reduce the eye pressure rapidly along with lots of eye drops. It may take from a couple up to few hours before the eye feels comfortable and the pressure is adequately lowered. Once the pressure in controlled, patients often require a further laser treatment (YAG laser iridotomy) in the affected eye to prevent a future recurrence and often a preventative laser treatment in the other good eye which carries the risk of a similar attack. Often many of these patients will go on to have a cataract extraction operation in near future which is best decided by the glaucoma specialist.

Narrow angles demonstrated on OCT

Mr Galloway is a Consultant Ophthalmic Surgeon at St James University Hospital, Leeds. His major interests are glaucoma management, and cataract surgery; Mr Galloway reviews over 2000 patients with glaucoma each year. He performs hundreds of specialist intraocular procedures per year, in addition to laser treatment for glaucoma. He trained in general ophthalmology at Bristol Eye Hospital undertaking a subspecialty training fellowship in glaucoma at Vancouver Eye Care Center, University of British Columbia, Canada. He is the author of 'MCQ Companion to the Eye: Basic Sciences in Practice' (published by W.B. Saunders, 2000) and is a member of the Royal College of Ophthalmologists, and the European Society of Cataract and Refractive Surgeons.

His areas of expertise are:

• Glaucoma surgery (such as trabeculectomy, combined cataract and glaucoma surgery, tube impant surgery, endoscopic laser for glaucoma)

• Small incision cataract surgery (routine and complex cases, especially patients with glaucoma)

• Medical management of glaucoma

• Glaucoma laser procedures (such as peripheral iridotomy, selective laser trabeculoplasty, ECP-endoscopic laser)

• Laser treatment/surgery(eg selective laser trabeculoplasty)

• Advanced/refractory glaucoma management
  
  

He is a member of the following professional organisations:

• Fellow of the Royal College of Ophthalmologists
• American Academy of Ophthalmology
• British Medical Association
• UK & Ireland Cataract and Refraction Surgeons
• European Society of Cataract and Refractive Surgeons
• International Glaucoma Association

Mr Galloway has 2 children, enjoys skiing from time to time, and in his spare time is a member of the Leeds and Bradford Triathlon club. In 2016, he is planning to raise money for St Gemma's Hospice and here is his JustGiving link for sponsorship:

Summary of selected papers on Selective Laser Trabeculoplasty

Selective laser trabeculoplasty study: eye drops versus laser - largest combined trials

BMC Ophthalmol. 2015 Aug 19;15:107.

Both SLT and topical medication demonstrate similar success rates and effectiveness in lowering intraocular pressure in patients with open-angle glaucoma.

Selective laser trabeculoplasty study: SLT and ALT and retreatment options

Russo V et al. Eur J Ophthalmol. 2009 May-Jun;19(3):429-34. Selective laser trabeculoplasty versus argon laser trabeculoplasty in patients with uncontrolled open-angle glaucoma.

SLT is effective as treatment for patients with OAG and appears to be equivalent to ALT in IOP lowering at 12 months only in patients without a prior treatment. In case of retreatment SLT appears to be better than ALT in IOP lowering.

Selective laser trabeculoplasty study: whether to have 180 degree or 360 degree treatments

Prasad N, Murthy S, Dagianis JJ, Latina MA. J Glaucoma. 2009 Feb;18(2):157-60. A comparison of the intervisit intraocular pressure fluctuation after 180 and 360 degrees of selective laser trabeculoplasty (SLT) as a primary therapy in primary open angle glaucoma and ocular hypertension.

This study suggests that 360-degree SLT is more efficacious in achieving smaller IOP fluctuations than treatment with 180-degree SLT.

Selective laser trabeculoplasty study: IOP fluctuation and SLT

Nagar M, Luhishi E, Shah N. J Glaucoma. Br J Ophthalmol. 2009 Apr;93(4):497-501. Intraocular pressure control and fluctuation: the effect of treatment with selective laser trabeculoplasty.

Both SLT and latanoprost had a significant impact on IOP control and fluctuation / ... / SLT has the benefit of being a one-time intervention not requiring ongoing patient compliance..

Images of the SLT laser machine