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  • Glaucoma - Causes, symptoms and treatment. MF.

    Glaucoma is a group of diseases, often characterized by increased intraocular pressure( IOP), but not always, changes in the visual field and pathology of the optic nerve disk( excavation up to atrophy).

    So sees a person with glaucoma:

    Causes of glaucoma

    Risk factors for the development of the disease:

    - increased IOP( ophthalmic hypertension)
    - age over 50
    - ethnicity( in the Negroid race glaucoma is more common)
    - chronic eye diseases( iridocyclitis, chorioretinitis, cataracts)
    - eye traumas in anamnesis
    - common diseases( atherosclerosis, essential hypertension, obesity, diabetes)
    - stress
    - prolonged use of certain drugs( antidepressants, psychoropnye agents, antihistamines, etc.)
    -. heredity( in families where someone from the family is ill glaucoma, there is a risk of developing the disease)

    Glaucoma is congenital and acquired. The first type is associated with impaired development of the eye in the embryonic period of development. Often these are intrauterine infections - rubella, influenza, toxoplasmosis, parotitis, or mother's diseases and the influence of damaging factors( severe endocrine pathologies, the action of high temperatures and radiation).

    The main types of acquired glaucoma are primary( open-angle, closed-angle, mixed) and secondary( inflammatory, phacogenic, vascular, traumatic, postoperative).

    Symptoms of glaucoma

    Signs of open-angle glaucoma include ophthalmic hypertension( periodic or continuous increase in pressure), loss of the visual field( the person does not see a part of the surrounding objects).

    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:

    Stage I( initial) - there are no changes in peripheral vision, but there are small changes in the central( paracentral scotoma, in the Bjerrum zone, the expansion of the blind spot), excision of the nipple of the optic nerve that does not reach its edge.
    II stage( developed) - narrowing of the peripheral field of vision more than 10 degrees from the nasal side or concentric constriction, not reaching 15 degrees from the fixation point, excavation of the
    III stage( far gone) is characterized by concentric narrowing of the field of view and in oneor several segments more than 15 degrees from the fixation point, excavating the
    IV stage( terminal) - complete absence of vision or light perception with an incorrect projection, possibly residual vision in the temporal region. If the medium of the eye is transparent and the fundus is visible, then atrophy of the optic nerve is present.

    The stages of glaucoma

    The level of intraocular pressure distinguishes 3 degrees:

    A-normal IOP( up to 27 mmHg)
    B-moderate IOP( 28-32 mmHg)
    C-high IOP( > 33 mmHg)

    Separately, glaucoma is isolated with normal intraocular pressure. In this case, typical fallout of the field of vision is present, excavation with subsequent atrophy of the nipple of the optic nerve develops, but IOP is normal.

    Closed-angle glaucoma

    Closed-angle glaucoma occurs in cases of a complete or partial block of the iridocorneal angle through which outflow of aqueous humor occurs. Provoking factors: small eyes( often develops hyperopia), small anterior chamber, excessive production of intraocular fluid, large lens, narrow iridocorneal angle( CCP).There is a periodic increase in IOP, the extreme manifestation of which is an acute attack of glaucoma, which can lead to a prolonged exposure in a dark room or in the twilight, a large amount of drunk fluids, emotional stress. There are severe pain in the eye, giving 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.

    Stabilized and unstabilized glaucoma( in terms of acuity and field of vision) is also distinguished depending on the degree of progression.

    Depending on the degree of compensation, glaucoma can be compensated( there is no negative dynamics), subcompensated( there is a negative dynamics) and decompensated( acute attack of glaucoma with a sharp deterioration of visual functions).

    Glaucoma for a long time may have an asymptomatic course and patients seek help when some visual functions are already irretrievably lost.

    Symptoms in which it is worth to see a doctor to stop the progression of the disease:

    - loss of field of view( not visible to some objects)
    - iridescent eyes when viewed light source
    - blurred vision
    - frequent glasses change
    - pain in the brow region

    Diagnosisglaucoma

    1. Ophthalmological examination:

    - visometry( even with tubular vision, visual acuity can be 100%)
    - perimetry, incl.computer. Identify the slightest changes in the field of view.
    - campiometry - examination of a blind spot( an area in the field of view that a person normally does not see) - at a norm of 10 × 12 cm
    - biomicroscopy( the enlargement of the conjunctival vessels, emissary symptom( pigment deposition along the anterior ciliary vessels), cobra symptomexpansion of the episcleral veins in the form of a funnel before their perforation of the sclera), iris degeneration and pigmented precipitates)
    - gonioscopy-examination of the iridocorneal angle with goniolinase( determine the angle of the anterior chamber)
    - tonometry according to Maklakov( . The shape of 16-26 mm Hg), non-contact tonometry( not precise method used for mass Research)
    - tonography - tonometry for 4 minutes using an electron tonography. Normal parameters:
    P0 = 10-19 mmHg.(true intraocular pressure)
    F = 1.1-4.0 mm3 / min( minute volume of intraocular fluid)
    C = 0.14-0.56 mm3 / min / mmHg(coefficient of ease of outflow)
    KB = 30-100( Becker coefficient = P0 / C)
    - ophthalmoscopy( determine optic nerve drive excavation) and examination with Goldman lens

    Optic disc optic scan

    - optical coherent tomography of the retinaoptic disc
    - Heidelberg retinotomography
    - rheophthalmography( determine the degree of ischemia or hypervolemia of each eye)
    - stress tests( help in the diagnosis of closed-angle glaucoma-dark, ortoclinicstatic, with the migratory).This dilates the pupil, the angle of the anterior chamber closes, and symptoms of an acute attack appear.

    2. General examination - clinical blood and sugar analyzes, biochemical blood analysis, consultations of a therapist, cardiologist, neurologist, endocrinologist for the detection of concomitant pathology, which can trigger the onset or development of complications in patients with glaucoma.

    Treatment of glaucoma

    Glaucoma can not be cured, you can only stop the progression of the disease. Treatment is prescribed only by a doctor.

    The types of treatment used for glaucoma:

    1. Local drug treatment:
    - prostaglandin derivatives( increase the outflow of intraocular fluid) - Travatan, Xalatan - 1 drop drop in each eye before beding
    - β-adrenoblockers - reduce the production of watery moisture -(non-selective( do not have side effects on the heart and bronchi, are contraindicated to people with bronchospasm) and selective) - Timolol( Arutimol, 0.25% or 0.5% Kuzimolol), Betoptik and Betoptik S. Bury every 12 hours.
    - myotics - pilocarpine 1% - used in closed-angle glaucoma( narrowing the pupil, the root of the iris departs from the angle of the anterior chamber, thereby opening it) - 1 drop to 3 times a day.
    - inhibitors of carbonic anhydrase reduce the production of intraocular fluid( Azopt, Trusopt) - 1 drop 2 times a day.

    First prescribe 1 drug( more often it is derivatives of prostaglandins).If there is no effect, add other drops, for example β-adrenoblockers. Treatment is selected only by the doctor, tk.some drugs are toxic and have many contraindications.

    Hypotensive drops are used constantly to slow the development of glaucoma.

    2. Neuroprotectants are necessary, becauseGlaucoma affects the nervous tissue. There are direct and indirect( improve microcirculation and indirectly affect neurons).To the direct include vitamins C, A, B, emoxipin, mexidol, histochrome, neuropeptides( retinalamine, cortexin), indirect-theophylline, vinpocetine, pentoxifylline, nootropics, hypocholesterolemic drugs. The patient 1-2 times a year undergoes a course of drug therapy in the hospital.

    3. Physiotherapy includes the use of methods such as electrical stimulation of the optic nerve, magnetotherapy, laser therapy.

    4. If drug therapy is ineffective, surgical treatment( laser or traditional) is indicated.

    Glaucoma attack

    Acute attack of glaucoma requires immediate treatment. There are bursting pains in the eye, irradiating to nearby areas, nausea and vomiting, may be oculocardial syndrome. Upon examination, a mixed injection, a swollen cornea, a small anterior chamber, an enlarged pupil, a bombardment( bulging) of the iris, a fundus of the eyes are not clearly visible, an optic nerve with hemorrhages. The eye acquires a stone density.

    First of all, ask the patient when the last time there was a stool and urination, measure blood pressure( BP).These conditions help increase blood pressure. When emptying the intestine, a spasm of the vessels is removed, and there is a high probability that IOP will rapidly drop.

    Pilocarpine 1% and timolol 2 times a day are often instilled. Intramuscularly anesthetics( promedol, analgin).Apply distracting therapy( for example, mustard plasters on the back of the head).Take diacarb with aspartame, intramuscular lasix under the control of blood pressure. After a seizure, surgical treatment is recommended.

    Surgical treatment of glaucoma

    The main types of laser treatment: laser iridectomy ( form a hole in the iris), trabeculoplasty ( improve the permeability of trabeculae).

    Iridectomy

    There are many ways of microsurgical treatment. The most widely used method is the sinostrabekulelectomy , in which a new path of outflow of aqueous humor under the conjunctiva is formed, and from there the liquid is absorbed into the surrounding tissues. Other operations are also possible - iridocyclotretic ( widen the angle of the anterior chamber), sinusotomy ( improvement in outflow), cycloagulation ( watery moisture production decreases).

    Folk remedies are ineffective. Patients only spend precious time treating them while the disease progresses.

    Complications of glaucoma

    Complications of untimely or unreasonable treatment: blindness, terminal painful glaucoma leads to the removal of the eye.

    Prevention of glaucoma

    Prophylaxis is the early detection of the disease. In the presence of risk factors, it is necessary to visit the ophthalmologist on a regular basis to examine and measure intraocular pressure.

    Patients with glaucoma should observe the regime of work and rest, the dose-related physical activities are not contraindicated, harmful habits are excluded, large amounts of liquid can not be drunk, clothes that can obstruct blood flow in the head( tight ties, collars).

    Doctor ophthalmologist Letyuk T.Z.