How is closed-angle glaucoma diagnosed and treated?

Glaucoma in translation from ancient Greek means "blue", since the eye acquires a light blue color due to a chronic increase in intraocular pressure and atrophy of the optic nerve.

A dangerous complication of glaucoma is blindness, which can occur without treatment of the disease. One form is closed-angle glaucoma, which is rare and occurs due to overlapping of outflow of watery moisture through the angle of the anterior chamber of the eye.

Causes of open-angle glaucoma

In contrast to open-angle glaucoma, when the angle of the anterior chamber is open, with the closed-angle form of glaucoma, this angle overlaps, whereby the disease proceeds acutely with an instant increase in intraocular pressure. The incidence of this form of glaucoma is only 5-10% among all forms of the disease.

Very often this condition develops with the existing farsightedness in people whose age is over 30 years. In these patients, an eye cavity of small size creates all the conditions for the appearance of a disturbance of the outflow of the intraocular fluid. These include a shallow anterior chamber of the eye, as well as some shift in the anatomical structures of the eye forward. With age, these signs of the structure are exacerbated by an increase in the lens and a decrease in the anterior chamber due to the increasing farsightedness.

By the nature of the course of closed-angle glaucoma is acute, subacute and with a chronic course. Especially dangerous are acute and subacute conditions, which, without emergency medical care, lead to immediate loss of vision.

The causes and predisposing factors that can lead to angle-closure glaucoma include:

• Features of the structure of the eyes and the size of the eye cavity.
• Farsightedness.
• Mechanical damage and eye injury.
• Frequent stressful situations and nervous overexertion.
• Eye fatigue and overwork when working with dim light.
• Acceptance of certain groups of drugs( tranquilizers).
• Hereditary factor.

Diagnosis is not difficult, because the disease begins acutely, with sudden headaches, pain in the eye and other symptoms. For differential diagnosis, the following survey methods are used:

• Ophthalmotonometry - the pressure in the eyes is measured. Can be carried out with and without load.
• Ophthalmoscopy - this method determines the degree of damage to the optic nerve.
• Gonioscopy - which determines the degree of overlap in the angle of the anterior chamber of the eye.

Other test methods( optical coherence tomography) can be used for indications and general condition.

Symptoms of closed-angle glaucoma

During an attack, the clinical picture is bright, and the signs of the disease are pronounced. Symptoms of closed-angle glaucoma are as follows:

• Sharp vision impairment and narrowing of margins( peripheral).
• Headaches( in the eyebrows and temples) and dizziness.
• Pain in the eyes of varying intensity, up to a sharp and pulsating.
• Nausea and possible vomiting.
• Redness of the eye and increasing swelling of the eyelid.
• Lachrymation.
• The dilatation of the pupil, which does not narrow even in bright light.
• Intolerance and hypersensitivity to bright light.
• Fuzzy vision and motion blur.
• The appearance of rainbow circles around the available light sources.

In some cases, signs of glaucoma can be mistaken for poisoning symptoms, so it is very important to conduct differential diagnosis of the disease. When there are severe symptoms, the patient should immediately be hospitalized in a hospital and provide emergency medical care. Failure to provide assistance for several hours during an attack can result in loss of vision.

Methods of treatment and therapy

First aid for glaucoma is in hospital and has the purpose of reducing intraocular pressure and recovery of outflow of intraocular fluid. For this, inside and as a local therapy, the following medicines are used:

• Solution pilocarpine, which is instilled in the eye every quarter of an hour for 1 -2 drops for an hour. When the condition of the drop improves with closed-angle glaucoma, drip every 30 minutes( for 4-5 hours), then every hour, and then switch to 6-7 times a day every 3 hours.
• Inside take diacarb in a dose of 0.25-0.5 2 times a day, which is a diuretic and reduces swelling in the eye. To increase the reduction in the outflow of intraocular fluid intramuscularly or intravenously, furosemide is administered, which is also a diuretic.
• Eye drops with beta-adrenoblockers in them( for monitoring of intraocular pressure).

If conservative therapy does not exert its effect and the pressure does not decrease, resort to surgical methods of treatment. In the period between attacks, treatment of angle-closure glaucoma shows the local application of drops that reduce intraocular pressure( timolol, pilocarpine, dorzolamide and others).

Operation in closed-angle glaucoma can be performed by laser surgery or conventional eye microsurgery. The method of correction of pressure by the operation is chosen depending on the patient's condition, the presence of concomitant diseases and the severity of the disease.

Treatment of an angle-closure glaucoma with a laser can be:

• Laser iridectomy - in which an artificial drainage through holes in the root of the iris is created using a laser. The presence of holes helps keep the pressure within normal limits and improves the outflow of fluid.
• Gonioplasty - in which the angle between the iris and the cornea is widened. In the region of the root of the iris, laser cauterization is done, which leads to some reduction( wrinkling) of the tissue and allows to widen the angle of the anterior chamber of the eye.

Microsurgical methods of treatment are as follows:

• Surgical iridectomy - at which part of the iris is excised, and thus the outflow of intraocular fluid is provided.
• Operations with the creation of fistulas - which act as additional ways of outflow of fluid from the anterior chamber into the subconjunctival space.
• Operations on the ciliary body( destruction of the ciliary body) - in which the ciliary body cilia is burned, which significantly reduces the production of intraocular fluid.