Background: We introduce a pathogenetic concept which explains the present known clinical and experimental facts.
Materials and methods: The known clinical risk factors for glaucomatous optic neuropathy as well as the outcomes of the experimental studies were systematically collected.
Results: IOP fluctuations are more damaging than a stable increased IOP, reduced circulation due to vascular dysregulation is more damaging than reduced circulation due to arteriosclerosis and the glaucomatous damage is clearly different from a pure ischemic lesion.
Conclusions: Although IOP can damage mechanically, IOP fluctuation and blood pressure drops may lead to short term ischemia, followed by a reperfusion damage. A vascular dysregulation interferes with the autoregulation of ocular perfusion and renders the eye more sensitive to IOP increase or blood pressure decrease.