Acta ophthalmologica
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Acta ophthalmologica · Sep 2011
ReviewRole of cerebrospinal fluid pressure in the pathogenesis of glaucoma.
The pathogenesis of normal (intraocular) pressure glaucoma has remained unclear so far. As hospital-based studies showed an association of normal-pressure glaucoma with low systemic blood pressure, particularly at night, and with vasospastic symptoms, it has been hypothesized that a vascular factor may play a primary role in the pathogenesis of normal-pressure glaucoma. That assumption may, however, be contradicted by the morphology of the optic nerve head. ⋯ One may, therefore, postulate that a low cerebrospinal fluid pressure may be associated with normal (intraocular) pressure glaucoma. A low systemic blood pressure, particularly at night, could physiologically be associated with a low cerebrospinal fluid pressure, which leads to an abnormally high trans-lamina cribrosa pressure difference and as such to a similar situation as if the cerebrospinal fluid pressure is normal and the intraocular pressure is elevated. This model could explain why patients with normal (intraocular) pressure glaucoma tend to have a low systemic blood pressure, and why eyes with normal (intraocular) pressure glaucoma and eyes with high-pressure glaucoma, in contrast to eyes with a direct vascular optic neuropathy, show profound similarities in the appearance of the optic nerve head.