Some patients have heard of normal-pressure glaucoma—also called low-pressure glaucoma—and ask, “How can glaucoma develop when the intraocular pressure is normal?”
In fact, this form of glaucoma presents a particular challenge: the intraocular pressure is within the normal range when measured, yet damage to the optic nerve still occurs.
In this article, I explain, as an ophthalmologist, what you should pay particular attention to with normal-tension glaucoma, how it develops, how it is detected, and which preventive measures are useful for it.
Normal-tension glaucoma is a particular form of glaucoma in which characteristic optic nerve damage occurs despite the intraocular pressure being within the normal range.
In normal-tension glaucoma, the optic nerve damage typical of glaucoma is present, with thinning of the nerve fibers and visual field defects, even though the intraocular pressure is below 21 mmHg. This form of the disease accounts for about 30–40% of all glaucoma cases in Europe.
Because intraocular pressure is not elevated, it is often detected late. What’s particularly insidious is that many patients remain entirely symptom-free for a long time, even though the nerve fibres are already damaged. Therefore, normal-tension glaucoma is considered one of the “silent” forms of vision loss.
It’s important to understand that pressure measurements alone do not indicate the risk. Only when combined with imaging techniques and visual field testing can a reliable diagnosis be made.
The causes are multifactorial and primarily involve blood flow and the optic nerve’s individual sensitivity to pressure.
Vascular/circulatory disturbance
Disturbed blood flow to the optic nerve head is considered the main cause. Particularly notable is the so-called Flammer syndrome, with symptoms such as cold hands, migraines, or low blood pressure.
The blood supply to the optic nerve is complex and vulnerable — especially in people with low nighttime blood pressure, where reduced blood flow can occur and may cause long-term damage to the nerve tissue.
Other vascular conditions, such as diabetes or chronic hypotension, also increase the risk.
Pressure-sensitive optic nerve
Some optic nerves are more susceptible to damage, even at normal pressure levels. This can be genetic or age-related. Studies show that lean women with low blood pressure, in particular, are at increased risk.
A family history also plays a role: if you have close relatives with glaucoma, you should undergo regular check-ups even if your eye pressure is normal.
A reliable diagnosis depends on more than just measuring intraocular pressure. At Bányai Augenheilkunde, we use targeted examinations to detect normal-pressure glaucoma early.
Another diagnostic tool is optic disc photography, which documents progression over the years. A thorough medical history regarding migraines, sleep quality, and circulatory problems also helps to better assess an individual’s risk.
Even when pressure readings are normal, targeted therapy can help halt the progression of normal-tension glaucoma. The aim of treatment is to halt or at least slow existing damage.
Even if intraocular pressure is within the normal range, a further reduction may be advisable to relieve pressure on the optic nerve and improve its blood supply.
This is usually achieved through medication, laser therapy, or surgical procedures.
| Therapy module | Objective |
| Reduce intraocular pressure | Optic nerve relief |
| Optimize blood supply | Protection from circulatory disorders |
| Stabilize blood pressure | Preventing gaps in overnight care |
In certain cases, particularly when there is coexisting clouding of the eye’s lens, cataract surgery can be an effective method to permanently lower intraocular pressure.
The surgery removes the lens and replaces it with an artificial lens – this often not only improves vision but also leads to better regulation of eye pressure.
Laser treatments such as selective laser trabeculoplasty (SLT) are also available and can be used as an adjunct.
For people with normal-tension glaucoma, a healthy lifestyle and regular eye examinations are particularly important.
Even if intraocular pressure is within the normal range, this does not necessarily guarantee safety — the stability of the optic nerve and the individual’s sensitivity to pressure are crucial.
In practice, this means that check-ups should take place at least once a year and be more frequent for certain risk factors, such as low blood pressure, migraine, Flammer syndrome, or a family history.
It’s not just about measuring pressure; the visual field and the structure of the optic nerve must also be checked regularly to detect even the smallest changes early.
Overall health also plays an important role: stable blood pressure—especially at night—protects the nerve fibres from an inadequate blood supply.
Patients also benefit from a healthy lifestyle that includes a balanced diet, regular physical activity, effective stress management, and adequate sleep.
Extreme diets, nighttime drops in blood pressure, or excessive consumption of caffeine and nicotine can have negative effects — careful attention is required here.
In summary, the more consciously everyday life is structured, the better optic nerve health can be preserved over the long term.
Normal-tension glaucoma clearly demonstrates that an apparently normal intraocular pressure does not provide reliable protection against damage to the optic nerve.
Blood circulation, pressure tolerance, and nerve structure play a crucial role. If you are well-informed, you can act early and protect the optic nerve with the right preventive measures.
At Bányai Augenheilkunde, we place great emphasis on comprehensive diagnostics and personalized care to detect glaucoma symptoms early and treat them in a targeted manner.
Close collaboration between ophthalmologists and general practitioners is particularly important – only through their cooperation can pressure, vascular condition, and lifestyle be optimally managed.
If medications and laser treatments are insufficient to achieve the target pressure, or if the optic nerve continues to deteriorate.
Classical procedures such as trabeculectomy and, when a cataract is present, cataract surgery to reduce pressure.
It can measurably lower intraocular pressure and reduce the need for eye drops – an option particularly for normal-tension glaucoma.
Usually not. The procedure is performed under local anaesthesia and typically takes less than 30 minutes.
As with any procedure, yes. Possible complications include a drop in intraocular pressure, infection, or secondary cataracts — ophthalmology minimises these through modern technology.
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