The psychology of the glaucoma patient

Under physiological conditions, intraocular pressure (IOP) is controlled by the autonomic and central nervous systems. Correspondingly, nerve fibers and neurotransmitters are present in ciliary body and trabecular meshwork. IOP responds to physical as well as psychological stimuli in healthy individuals. In patients with dysregulated IOP, eg, in those with primary openangle glaucoma, emotional instability without a specific personality pattern could be found. Whereas the statistical association between emotional changes and glaucoma is obvious, the causal relationship remains to be clarified. It is at least plausible that psychic stress may have an influence on IOP. However, the sequence of the events is unknown (emotional disturbance can be the result of the disease or it can be a primary sign of a nervous dysfunction). Therefore, it seems meaningful-in addition to standard glaucoma therapy-to try to improve the patient's emotional condition, both for treatment of the glaucoma and for the patient's general quality of life.