Vidushi Gupta, B. Optom

Optometrist, Dr. shroff’s Charity Eye Hospital, New Delhi, India


Keywords:  Environmental factors, sunspot, glaucoma, stress, glaucoma in stress, glaucoma & temperature.

Glaucoma is a broad category of ocular disorders that all end in irreversible optic nerve damage and visual field defects.(1) It is a major public health problem with a burden that is mostly underestimated because of its asymptomatic form in many people. (2)

For clinical purposes, glaucoma is normally classified as Open Angle glaucoma and closed angle glaucoma. While the prevalence of primary open-angle glaucoma is greater than primary angle-closure glaucoma in the Western world, the primary angle closure accounts for 50% of global glaucoma blindness.

The risk factors for glaucoma include Age, Gender, Cataracts, Race, Family history, Refractive errors, Axial biometry, Plateau iris.

But apart from these there are some environmental and lifestyle factors that remains ignored such as (1)

  1. Light, season, and temperature
  2. Stress
  3. Sunspots

Light season and temperature:

In non-tropical countries there is often a wide variation in the number of day–light hour, depending on the season. In Finland using meteorological data and hospital discharge registers, the incidence of Acute angle closure (AAC) was found to be positively associated with the number of hours without sunshine, and was more common in winter and autumn than summer or spring.(3,4) In Croatia, a similar retrospective study also reported cases of AAC during winter, and on days with less sunshine.(5)  A similar seasonal incidence was seen in Birmingham and in Canterbury in the UK.(6,7) In Israel, a statistically significant preponderance of attacks were found in summer and winter, times of more extreme weather than in spring or autumn.(8)

In Singapore, a prospective island-wide incidence study, found AAC to be more frequent on hotter days. (9) In Switzerland, it was found that the majority of AAC cases presented during a particular pattern of adverse weather with advection of cold maritime air behind a low-pressure system. (10)

A common factor for all these environmental factors is thought to be that during adverse weather conditions people tend to stay indoors. The darker conditions are associated with pupil dilation and increased frequency of AAC.


Incidence of AAC, in the UK, appears to be inversely related to sunspot activity, both on the day of presentation and in the immediately preceding period. (6) In Singapore, there was a direct relationship between symptomatic angle closure and both the number of sunspots and mean solar radio flux. Increased sunspot activity is associated with a small increase in solar radiation, terrestrial geomagnetic storms, and heating of the Earth’s outer atmosphere. (9)  It remains unclear whether sunspot activity is truly associated with AAC.


Two 73-year-old sisters presented with simultaneous AAC after being involved in a fight. The release of adrenaline during the squabble, and associated mydriasis, was thought to be the causative factor. (11)

In another case study, A 78-year-old, personality type A, a lady with a history of pseudo-exfoliative glaucoma presented with an acute asymmetrical raise in intraocular pressure (IOP) immediately following a family breakdown. Her IOP had previously remained stable following a deep sclerectomy in the right eye and an Ex-PRESS shunt in the left eye. Her examination was entirely normal otherwise, with a patent filtration and diffuse bleb as confirmed with anterior segment OCT imaging. Near-normal IOP was observed within 24 h, concomitantly with the reduction of her stress levels. No other cause for the transient acute hypertensive episode were found. (12)

To conclude, it is well reported that environmental factors can cause glaucomatous optic nerve damage. Always patients do not have typical symptoms of angle closure. Clinicians should ensure the risk of angle closure and perform gonioscopy and educate patients routinely.



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