Differential diagnosis Two disorders are important in this context

Ocular hypertension. Patients with ocular hypertension have significantly increased intraocular pressure over a period of years without signs of glauco-matous optic nerve damage or visual field defects. Some patients in this group will continue to have elevated intraocular pressure but will not develop glaucomatous lesions; the others will develop primary open angle glaucoma. The probability that a patient will develop definitive glaucoma increases the higher the intraocular pressure, the younger the patient, and the more compelling the evidence of a history of glaucoma in the family.

Low-tension glaucoma. Patients with low-tension glaucoma exhibit typical progressive glaucomatous changes in the optic disk and visual field without elevated intraocular pressure. These patients are very difficult to treat because management cannot focus on the control of intraocular pressure. Often these patients will have a history of hemodynamic crises such as gastrointestinal or uterine bleeding with significant loss of blood, low blood pressure, and peripheral vascular spasms (cold hands and feet). Patients with glaucoma may also experience further worsening of the visual field due to a drop in blood pressure.

H Caution should be exercised when using cardiovascular and anti-hypertension medications in patients with glaucoma.

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