Glaucoma - an eye disease for whichcharacterized by recurrent or persistent elevation of intraocular pressure (IOP). The reason for increase in IOP is a violation of the circulation of intraocular fluid (decrease its churn). Optic nerve atrophy is due to elevated IOP, which over time leads to complete loss of vision.
Glaucoma primarily threatens whoserelatives had been exposed to the disease (a disease often transmitted through generations: if sick grandfather, then grandson will almost certainly develop glaucoma). Also in the risk group includes people suffering from myopia, diabetes, endocrine diseases. Glaucoma can be congenital, and is set to age: acquired glaucoma often occurs after 60-65 years, and in some cases even after 40 years.
How does glaucoma
The eye constantly produces waterymoisture which then moves into the posterior chamber - a small space between the iris and the lens. Then through the pupil moisture gets into the anterior chamber - between the cornea and iris. In front of the camera corner, where converge the cornea and the iris, is the drainage system of the eye. After drainage of moisture exits the eye and into the bloodstream. If the outflow is broken - increased IOP. The longer the IOP remained elevated, the more compressed the optic nerve. Over time, the fibers of the optic nerve begin to die and the person gradually fades. To IOP was normal, it should be a balance between the production of water and its outflow.
In a normal eye pressure does not exceed 16-27 mm Hg. Art. Although glaucoma IOP can be either a normal (or not much to go beyond the norm) and increased. But if the pressure exceeds 35 mm Hg. Art. and it remains so for a long time, necessarily require treatment.
If the intraocular pressure increases, peopleexperienced a number of unpleasant symptoms: vision becomes blurred, it gives the impression that you look "over the net". When looking at a lamp or other light source in front of the eyes appear iridescent circles deliquescent. Deteriorating eyesight at dusk, there is pain in the eyes, tearing, a feeling of heaviness and tension, pain around the eyes.
It happens so that the person does not noticeincreased intraocular pressure (glaucoma is asymptomatic in the early stages) and go to the doctor only when begins to narrow the field of view. our website drew attention to the fact that in this case, you can only stop the loss of sight, return the normal field of view is no longer possible.
An acute attack of glaucoma develops suddenly. There is severe pain in the eye and the corresponding side of the head, pain in the back of the head, nausea, vomiting, general weakness. attack symptoms are very similar to symptoms of a hypertensive crisis or poisoning - due to the time that the patient does not get help, and may lose vision.
Here are the symptoms, which can determine the attackglaucoma: there is swelling of the eyelids, the eyes become red, cloudy cornea, pupil expanded and has an irregular shape. The vision is sharply reduced. If you touch the eye with your fingers (closed), it will be very hard - because of increased IOP. To help the patient, you should immediately begin to drip 2% pilocarpine solution, take 0.25 g diakarba (diuretic required to remove fluid from the body) and how to seek medical advice as soon as possible.
For the diagnosis of an ophthalmologistit is necessary to conduct a series of simple (for the patient) examinations: determining visual acuity (visometry), measuring intraocular pressure (tonometry), examining the visual field (perimetry), determining the state of the optic nerve during examination of the fundus (ophthalmoscopy). All necessary devices are in any office of the ophthalmologist. An experienced doctor can diagnose glaucoma even after palpation of the eyeballs and ophthalmoscopy.
Classification of glaucoma
As already mentioned, glaucoma can be either congenital or acquired during life.
Congenital can appear as a child (up to 10 years, most of the cases) and at a later age.
Acquired glaucoma depending on the causeits development is divided into primary and secondary. Primary glaucoma develops due to violations of the outflow of aqueous humor from the eye, and, as a consequence, increase in IOP. The secondary glaucoma include all those that appeared as a complication of other diseases (diabetes, cataracts, thrombosis), injuries and inflammation of the eyes and other organs.
On the mechanism of increase in IOP - acquired glaucoma divided into open-and-closure.
In open-angle glaucoma drainage systemeyes gradually changed, why the pressure rises periodically and suffer from optic nerve. In angle-closure glaucoma intraocular fluid outflow overlaps the root of the iris, which closes the angle of the anterior chamber.
Depending on how amazedglaucoma, the optic nerve is divided into 4 stages. At the 1st stage (primary) field of vision has not narrowed, but fundus examination visible changes. For the 2nd stage (glaucoma) is already characterized by narrowing of the field of view, and changes in the fundus are more pronounced. On the 3rd stage (advanced stage glaucoma) field of view is narrowed concentrically and on the 4th (terminal glaucoma) the patient loses vision or only light perception remains.
In the treatment of glaucoma, there are three main areas: therapeutic, surgical and laser.
In therapeutic treatment of a patient appointeddrugs that lower the intraocular pressure, and in addition thereto - medications that improve blood flow to the eyes and normalizing metabolism in the eye tissues.
Medications that reduce intraocular pressure should be regularly reduce the pressureBut it happens and so that the patient hasresistance to the action of drops - and then have to choose another drug. In the first weeks of the appointment drops glaucoma patient should regularly visit an ophthalmologist to maintain control of the state of the intraocular pressure. If the drops have a positive effect, the patient will need to see a doctor only once in 2-3 months. In some cases, the drops are so successfully that with their help it is possible to control the IOP for a few years - you need only once a year to change the drug, reducing the pressure to avoid any addiction.
To reduce eye pressure, use twotypes of drops: drops, improving the outflow of intraocular fluid (pilocarpine, Izokarpin et al.) and drops that reduce the production of intraocular fluid (clonidine, Betoptik, Okumed). our website is strongly recommended: never mix drops. This wild "cocktail" of various drugs of no benefit to the eyes, on the contrary, a drop will lose its medicinal properties.
If the drops are not effective, it is necessary to do the operation. Most often performed first laser operation. The most effective is laser iridotomy (iridectomy) and laser trabeculoplasty.
The essence of laser iridectomy is thatdoctor using a laser beam makes a small hole in the iris. Through this opening intraocular fluid starts to leave the eye without obstacles, normal IOP. By this operation, resorting to form-closure glaucoma treatment.
Laser trabeculoplasty is performed atopen-angle glaucoma. It also contributes to the normalization of IOP, but the principle of its operation is different: the laser beam causes the iris to a few microscopically small burns, which increases the permeability of the liquid iris.
The advantages of laser eye surgery:
- intraocular fluid outflow occurs in the natural pathways;
- for surgery sufficiently to drip into the eye pain reliever;
- operation can be performed on an outpatient basis;
- rehabilitation period is minimal.
Disadvantages of laser eye surgery:
- fragility effect operation (1-2 years);
- during operation can cause damage to the corneal epithelium, lens capsule and blood vessels of the iris;
- reaction to the laser operation can be increased IOP in the first hours after the operation;
- postoperative tissue adhesions can form in areas of laser exposure.
A decision on the need for surgeryoperations shall be made in each case based on the type of glaucoma, intraocular pressure readings and fluid outflow from the eye level, field of vision, as well as an overall assessment of the patient's health. The most common types of surgeries for glaucoma are trabeculectomy and penetrating deep scleroticectomy (NDSE).
When trabeculectomy creates new outflow tractintraocular fluid. During surgery, the doctor removes the tissue site and creates a direct communication between the anterior chamber and subconjunctival space. This operation is in essence a relatively easy, and brings quite good results. But not infrequently results trabeculectomy is not only stored for a long time, but, on the contrary, there is a number of negative consequences. At the site of surgery scars occur, ie, again blocking the outflow of fluid. And that is typical, a second operation will not have the same effect due. In some cases, on the contrary, outflow of intraocular fluid starts to go much faster than it is reproduced - it is also a negative impact on the state of the eye.
NDSE essence lies in surgical thinningperipheral areas of the cornea. Through these thinned place moisture circulate freely and easily leaves the eye. After NDSE patient can return to normal activities within 2-3 days. But that eye pressure remained stable, require periodic (2 times a year) maintenance therapy: drugs that improve blood flow to the eyeball and the optic nerve (cavinton, pikamilon, mildronat), physiotherapy.
As you can see, glaucoma - a rather seriousdisease. Therefore, if you feel that the vision is dimmed or even just a slight pain in the eyes, not too lazy to go to the doctor. As a precaution, after 40 years, it is desirable to periodically go and see an eye doctor and for no apparent reason. Those visual disturbances that come along with the development of glaucoma, has not reversed - it and you have to remember to take care about the state of your eyes.