Glaucoma - Causes, Symptoms and Treatment .MF .
Glaucoma - a group of diseases characterized by often an increase in intraocular pressure (IOP), but not always, changes in the visual field, and pathology of the optic nerve (excavation until atrophy).
So seeing people with glaucoma:
Risk factors for the disease:
- increased intraocular pressure (ocular hypertension)
- age over 50 years
- ethnicity (among blacks glaucoma is more common)
- chronicdiseases of the eye (iridocyclitis, chorioretinitis, cataracts)
- eye injury
history - general disorders (atherosclerosis, hypertension, obesity, diabetes)
- long-term use of certain medications (antidepressants, psychotropic drugs, antihistamines, etc.).
- heredity (in families where someone from the family is ill with glaucoma, there is a risk of developing the disease)
glaucoma can be congenital and acquired.The first type is associated with impaired eye development in the embryonic stage of development.Often this intrauterine infection - rubella, influenza, toxopla
The main types of glaucoma acquired - is the primary (open-zakratougolnaya, mixed) and secondary (inflammatory, fakogennaya, vascular, traumatic, post-operative).
Symptoms of glaucoma
Signs of open-angle glaucoma include ocular (intermittent or constant pressure), loss of sight (the person does not see a part of the surroundings).Open-angle glaucoma
Open-angle glaucoma is divided into stages (according to the degree of development of clinical signs) and the level of intraocular pressure.
Stages of primary open-angle glaucoma:
I stage (initial) - changes in peripheral vision are absent, but there is little in the central (paracentral scotoma in the Bjerrum area, the expansion of the blind spot), excavation of the optic nerve papilla, not reaching to the edges.
II stage (advanced) - narrowing of the peripheral field of view of more than 10 degrees from the nasal side or concentric narrowing, less than 15 degrees from the point of fixation, excavation of the optic disc (edge)
III stage (advanced stage) - is characterized by a concentric contraction of the visual field, and in oneor more segments of more than 15 degrees from the point of fixation, excavation of the optic disc
IV stage (terminal) - a complete lack of vision or with a wrong projection svetovospriyatie possibly residual vision in the temporal area.If eye protection is transparent and visible fundus, then there is atrophy of the optic nerve.
Stages of glaucoma
In terms of intraocular pressure are 3 degrees:
A normal IOP (up to 27 mm Hg..)
In-moderate IOP (28-32 mmHg)
C-High IOP (more than 33 mm Hg)
Separately isolated glaucoma with normal intraocular pressure.In this case there are characteristic visual field loss develops excavation with subsequent atrophy of the optic nerve papilla, but IOP is normal.
Angle-closure glaucoma occurs in cases of full or partial block iridokornealnogougla through which the aqueous humor outflow.Precipitating factors: small eyes (often develops farsightedness), shallow anterior chamber, excessive production of intraocular fluid, a large lens, a narrow iridocorneal angle (CCP).Manifested periodic increase in IOP, the extreme manifestation of which - an acute attack of glaucoma, which can result in long stay in a dark room or at dusk, a large amount of fluid you drink, the emotional strain.There are severe pain in the eye, extending to the corresponding half of the head, redness, iridescent circles when looking at the light source.
acute attack of glaucoma
This condition requires immediate treatment.
also distinguish depending on the degree of progression of a stabilized and non-stabilized glaucoma (for sharpness and the field of view).
Depending on the degree of compensation can be compensated glaucoma (no negative dynamics) subcompensated (there is negative dynamics) and asthma (acute glaucoma attack with a sharp deterioration in visual function).
Glaucoma long time may be asymptomatic and patients seek help when some visual function already irretrievably lost.
symptoms for which is to see a doctor to stop the progression of the disease:
- loss of sight (can not see certain objects)
- iridescent circles when viewed from the source
light - blurred vision
- frequent changes in glasses
- pain in the brow area
1. Ophthalmologic examination:
- visometry (even with tubular vision acuity can be 100%)
- perimetry, includingcomputer.Identify the slightest changes in the field of view.
- campimetry - study of the blind spot (area of the field of view, which in normal people can not see) - at a rate of 10 × 12 cm
- biomicroscopy (visible vasodilation of the conjunctiva, the emissaries of the symptom (the deposition of pigment along the anterior ciliary vessels), Cobra symptom (expansion of episcleral veins in the form of a funnel in front of perforation of the sclera), and degeneration of the iris pigmented precipitates)
- Gonioscopy-examination iridocorneal angle using goniolinzy (determined by the size of the anterior chamber angle)
- tonometry on Maklakov (norm 16-26 mm Hg)., non-contact tonometry (not the exact method used to study mass)
- tonography - tonometry for 4 minutes with an electronic tonography.Normal figures:
P0 = 10-19 mm Hg(True intraocular pressure)
F = 1,1-4,0 mm 3 / min (minute volume of intraocular fluid)
C = 0,14-0,56 mm 3 / min / mm Hg(Outflow lightness ratio)
CB = 30-100 (Becker coefficient = P0 / P)
- ophthalmoscopy (determine the excavation of the optic nerve), and inspection with Goldman lens
Excavation of the optic nerve
- optical coherence tomographyretina (determined by the slightest changes in the optic nerve head)
- Heidelberg retinotomografiya
- rheoophthalmography (determine the degree of ischemia or hypovolemia each eye)
- stress tests (to help in the diagnosis of angle-closure glaucoma, The dark, ortoklinostaticheskie with mydriatics).This expands the pupil, the angle of the anterior chamber is closed, and there are symptoms of an acute attack.
2. General examination - clinical tests and blood sugar, blood chemistry, counseling therapist, cardiologist, neurologist, endocrinologist to identify comorbidities that could trigger the beginning or the development of complications in patients with glaucoma.
from glaucoma can not be cured, you can only suspend the progression of the disease.Treatment appoint a doctor.
Treatments used in glaucoma:
1. Local drug treatment:
- prostaglandin derivatives (increase the outflow of intraocular fluid) - Travatan, Xalatan - buried 1 drop in each eye before going to bed
- β-blockers - reduce the production of aqueousmoisture - (nonselective (no side effects on the heart and the bronchi, are contraindicated for people with bronchospasm) and selective) - timolol (Arutimol, Kuzimolol 0.25% or 0.5%), and Betoptik Betoptik S. Buried every 12 hours.
- miotics - 1% pilocarpine - used in angle-closure glaucoma (constrict the pupil, the iris moves away from the root of the anterior chamber angle, thereby opening it) - 1 drop of up to 3 times a day.
- carbonic anhydrase inhibitors reduce the production of intraocular fluid (Azopt, Trusopt) - 1 drop of 2 times a day.
first prescribed the drug 1 (most are derivatives of prostaglandin).If there is no effect, added to other drops, such as β-blockers.Treatment selects only a doctor becausesome drugs are toxic and have many contraindications.
Antihypertensive drops are used constantly to slow the development of glaucoma.
2. neuroprotective nebhodimo becauseGlaucoma affects the nervous tissue.There are direct and indirect (improves microcirculation and indirectly act on neurons).It is directly related vitamins C, A, B complex, emoksipin, mexidol histochrome, neuropeptides (retinalamin, cortexin), indirect-theophylline, vinpocetine, pentoxifylline, nootropics, cholesterol-lowering drugs.The patient 1-2 times a year is undergoing medical treatment in a hospital.
3. Physiotherapy treatment includes the use of techniques such as electrical stimulation of the optic nerve, magnetic therapy, laser therapy.
4. If drug therapy is ineffective, surgical treatment (laser or traditional).
acute attack of glaucoma requires immediate treatment.There are arching pain in the eye, radiating to the surrounding area, nausea and vomiting, can be okulokardialny syndrome.On examination revealed a mixed injection, swelling of the cornea, shallow anterior chamber, dilated pupil, bombazh (bulging) of the iris, the ocular fundus can be seen clearly, the optic nerve with hemorrhage.The eye gets rock density.
First ask the patient when the last time was a chair and urination, measured blood pressure (BP).These conditions contribute to high blood pressure.When emptying the bowel removed spasm of blood vessels, and there is a strong likelihood that the IOP decreases rapidly.
Required often instilled 1% pilocarpine and timolol, 2 times a day.Intramuscular anesthetic (Promedolum, analgin).Apply diversionary therapy (eg, mustard plasters on his head).Take diakarb with asparkamom, Lasix intramuscular blood pressure under control.After cupping of an attack recommended surgery.
Surgical treatment of glaucoma
The main types of laser treatment: laser iridectomy (form a hole in the iris), trabeculoplasty (improve the permeability of the trabeculae).
Ways microsurgical treatment lot.The most widely used method - it sinustrabekulektomiya , in which form the new path of the outflow of aqueous humor under the conjunctiva, and then the liquid is absorbed into the surrounding tissue.Also available in other operations - iridotsikloretraktsiya (widen the angle of the anterior chamber), sinusotomy (improvement in churn), tsiklokoagulyatsiya (reduced production of aqueous humor).
Folk remedies are ineffective.Patients only spend valuable time on the treatment of them, while the disease progresses.
Complications Complications of untimely or irrational treatment: blindness, terminal aching glaucoma leads to the removal of the eye.
prevention is early detection of the disease.In the presence of risk factors should be regularly visit an ophthalmologist for examination and measurement of intraocular pressure.
Patients with glaucoma should observe the regime of work and rest, exercise stress is not contraindicated, eliminated bad habits, not to drink plenty of fluids, wear clothes that may hinder blood flow to the head (tight neckties, collars).
Ophthalmologist Letyuk TZ