1 The essence of the pathology of
Glaucoma is a disease that causes damage to the optic nerve and retina, which is accompanied by disturbances in the field of vision. The cause of this condition is too high blood pressure, which prevails in the eyeball. The main risk factors for this disease include:
- the presence of glaucoma in the immediate family;
- myopia( the more, the more predisposition to the occurrence of glaucoma);
- metabolic disorders in the body;
- low blood pressure;
- peripheral circulatory disorders;
- long-term treatment with steroids.
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Classification of the disease:
- Glaucoma primary:
- open-angle( glaucoma simple);
- is a closed-end.
- Secondary glaucoma:
- is a closed-end.
- Children's glaucoma.
2 Changes in the field of view of
Glaucoma is a disease that consists in a characteristic progressive change in the appearance of the optic nerve. This is manifested, mainly, by disturbances in the field of view, which leads to irreversible blindness.
Stage I - increase in the blind spot of Mariott, then scotoma( holes in the field of view) in the upper or lower part of the field of view - Bjorrum scotoma, which increase with time, and then merge with each other and with a blind spot.
Stage II - there is an increase in the field of vision from the nose - in the upper or lower quarter.
Stage III - the scotoma takes up gradually both quarters of the nose and approaches the field of central vision. There is an island of central vision( as seen through a telescope) and a second island in the temporal field of view.
Stage IV - the central vision disappears, the residual fragment of the field of view from the side of the temples remains temporarily.
Of all types of glaucoma, the most common form of glaucoma is the primary open-angle form, known as "glaucoma simple," which appears in 75% of all cases.
3 Primary open type
In most cases open-angle glaucoma does not cause any symptoms, the disease develops in a person gradually, occupying more and more fields of vision. The main risk factor for its development is too high intraocular pressure. The disease develops in both eyes, although, as a rule, this development is not a simultaneous process.
Sometimes its first symptoms are:
- periodic vision disorders in the form of fog or the perception of a rainbow strip in the form of wheels, especially around light sources;
- short-term eye pains and their areas;
- burning sensation and lacrimation;
- difficulties in the selection of glasses due to changes in refraction of the eyes.
4 Closed-end form
This type of glaucoma appears most often in humans after age 60, and the frequency increases with age. It occurs much more often in women than in men, in a ratio of 4: 1.In the European population, 6% of all cases of glaucoma are observed. The cause of its occurrence is the anatomical predisposition in the structure of the eye, which hinders the outflow of the intraocular fluid, as a result of which an increase in intraocular pressure appears. The primary closed-angle type of glaucoma is known under 3 clinical options: acute closed-angle, glaucoma with a periodically occluded angle and chronic angle-closure glaucoma, the symptoms of which manifest different intensity.
Symptoms of acute closed-angle glaucoma:
- severe head and eye pain( sometimes pain is minor or not observed);
- hyperemia of the eye;
- in severe cases, nausea and vomiting;
- the eyeball is hard as a stone;
- rapidly progressive deterioration of vision;
- very high intraocular pressure( 50-100 mm Hg);
- corneal edema with the presence of fluid bubbles within the epithelium;
- reduction of the anterior chamber with the iris adhering to the cornea;
- pupil is vertical-oval, medium-wide, immovable and does not react to light;
- the vessels of the iris enlarged.
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A periodically exacerbated disease can be caused by pupil dilating when watching TV in a dark room, movie theater or theater and during an excessive emotional reaction( stress).Unsustainable illness includes symptoms:
- transient pain in the eye area;
- foggy vision;
- the emerging rainbow circles around the light sources;
- is a round pupil with a preserved response to light;
- feeling bad overall.
In chronic occlusive glaucoma, the following symptoms are observed:
- intraocular pressure above 21 mm Hg.p.
- characteristic of glaucoma, damage to the optic nerve;
- defects in the field of view;
- as a rule, there is no pain and malaise.
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5 Secondary glaucoma
Secondary open angle glaucoma affects people over 60 years of age, the onset of the disease is asymptomatic, up to a large damage to the visual field and changes in the appearance of the optic nerve disc.
Clinically, it is divided into acute and chronic forms, the symptoms are the same as in primary glaucoma of the closed type.
6 Congenital ailment
Appears from birth to 2 years. Her symptoms are:
- spasm of the eyelids;
- large eyeball;
- pale disc of the optic nerve;
- deep front camera;
- open angle of glaucoma.
Congenital malady passes into children's glaucoma. The disease is observed from 3 to 10 years. Symptoms are diverse, and include:
- transient headaches;
- complaints of a child for poor vision;
- changes in the structure of the cornea;
- other symptoms characteristic of primary open-type glaucoma.
7 Therapeutic tactics
Is glaucoma treated? The chances of a favorable prognosis of the treatment increase the rapid definition of the disease and early conducted appropriate therapy. But this is quite difficult, given the almost imperceptible subjective symptoms, especially at the onset of the disease. Therefore, it is worthwhile to visit the ophthalmologist on a regular basis and undergo control studies. It is necessary to do this, especially to the short-sighted person, because myopia often leads to glaucoma.
How to treat glaucoma? At the initial stage of treatment of glaucoma, drugs administered topically are used. These are basically simple and complex solutions in the form of eye drops, available only on prescription. A more advanced form of the disease or a disease that does not respond to pharmacotherapy requires surgery or laser therapy. Pharmacological treatment of glaucoma without surgery uses certain drugs from the group of β-blockers, sympathomimetics and inhibitors of carbonic anhydrase, parasympathomimetics and derivatives of prostaglandins. In emergency situations( acute attacks of glaucoma), some osmotic diuretics are used, for example, a 20% solution of mannitol that causes the outflow of fluid from the inside of the eye, which leads to a rapid decrease in intraocular pressure.
The action of all drugs is aimed at an effective and persistent reduction of intraocular pressure to the correct values, mainly due to the reduction of fluid production and facilitating its outflow and transport.
Is it possible to cure glaucoma in a short time? Glaucoma of the eye is a chronic disease, therefore its pharmacological treatment, as a rule, takes many years and often lasts even up to the end of the patient's life. It is worth noting the fact that these drugs only limit or inhibit the development of the disease, but they can not abolish the already existing damage to the cells of the retina and optic nerve.
Prolonged medicines may cause the development of allergic symptoms in the eye after a while.
Treatment of glaucoma in elderly people with medicines for a long time causes a weak response to therapy. These drugs can aggravate some of the symptoms of glaucoma, mainly such as: ptosis, diplopia, general weakness. In addition, the use of eye drops, which are in reusable containers, creates the danger of bacterial inflammation of the cornea, so it is preferable to use them as a single dose. When applying glaucoma drugs, remember that you can not drip them into the eyes when contact lenses are in them( they need to be removed in order to avoid their discoloration, and then to put on the lenses again only after at least 15 minutes after applying the drops).
8 Laser iridotomy
How to treat glaucoma with a laser? After lowering the intraocular pressure and achieving transparency of the cornea, a laser procedure called iridotomy is performed. Laser iridotomy is aimed at restoring the flow of intraocular fluid from the back of the eye to the anterior segment. It consists in the laser making holes in the peripheral part of the iris.
In some cases, such an operation is not possible due to lack of transparency of the cornea, a significant reduction in the anterior chamber. It is very important during the operation to cooperate with the attending physician. Laser iridotomy is a relatively safe procedure, but complications may occur after it. During operation, bleeding from the vessels of the iris may occur. Most often it stops spontaneously or under the influence of a little pressure. Very rarely, the lens or endothelium of the cornea is damaged. After the procedure, there may be an increase in intraocular pressure or a weak inflammation reaction in the anterior chamber. Other rare complications include macula burn and adhesions.
9 Surgical intervention
Surgical treatment is the last resort for glaucoma. Sometimes pharmacotherapy is ineffective or can not be used. Then the operation is performed.
Cases where the operating procedure is the treatment of the first choice, is:
- congenital glaucoma;
- primary glaucoma with inability to control pressure;
- need to reduce high intraocular pressure, when this can not be achieved by other methods.
In the case of congenital glaucoma, first of all, a goniotomy is performed, which consists in dissection of the fusion in the region of the iris-corneal angle of the eye.
The second surgical method, which is used for glaucoma( it is used if the treatment of the first choice proved ineffective or to which there are contraindications), is trabeculectomy. The procedure consists in creating a new channel for the outflow of fluid between the front chamber and the space under the Tenon handbag.
Damage after glaucoma is irreversible, and in this case even surgery will not help. The goal of surgical treatment is only a slowdown in the development of the disease. It should be taken into account that even after surgical treatment, glaucoma can return.