In addition, there are symptoms not directly resulting from dysregulations of the blood supply, such as a prolonged time needed to fall asleep,[3] a reduced feeling of thirst, and high sensitivity not only to cold but also to odors, vibrations, psychological stress, or certain medications (e.g., calcium antagonists, beta blockers).
[4] In many people with glaucoma, the cause of the disease is perfusion issues of the optic nerve and retina, while intraocular pressure is normal.
[7] The diagnosis of Flammer syndrome is primarily based on the patient's history with its typical features as well as the findings of nail fold capillaroscopy.
This test shows an excessive constriction (narrowing) in the smallest blood vessels (capillaries) of the fingers in response to being exposed to cold.
Best known is the higher risk of normal tension glaucoma, a disease with an impaired regulation of blood flow in a large number of patients.
[10] Glaucoma patients with Flammer syndrome show some specific clinical signs like increased frequency of optic disc haemorrhages, activated retinal astrocytes, elevated retinal venous pressure, optic nerve compartmentalization, and fluctuating diffuse visual field defects.
[12] In a 2016 review on the risk factors for normal tension glaucoma by ophthalmologists from Asia (where this form of glaucoma is much more prevalent than in Europe or North America), Flammer syndrome has been attributed to increase the likelihood of ganglion cell damage in these patients, with disc hemorrhages as a characteristic clinical sign.
People with retinitis pigmentosa seem to have Flammer syndrome quite frequently, and possible associations with the vascular factor endothelin-1 are under investigation.
Nutrition should contain many antioxidants, such as those found in green tea, black filter coffee, red wine, blueberries, and fruits.
With lifestyle interventions, attacks—particularly pronounced symptoms such as massive cold extremities, tinnitus, or migraine-like episodes—can be avoided or reduced.
These nightly "dips" of blood pressure in normal tension glaucoma patients with Flammer syndrome can significantly damage the sensory cells of the retina.