Glaucoma

Glaucoma is a chronic eye disease with a constant or periodic increase in intraocular pressure, optic nerve atrophy (glaucomatous excavation) and changes in the visual field. Glaucoma distinguishes primary, secondary and congenital.

Etiology, pathogenesis. The development of primary glaucoma is preceded by trophic disorders in the tissues of the anterior part of the eye, especially in its drainage system, caused by changes in the vascular system and hemodynamics of the eye, and general pathological changes. This causes a violation of the circulation of aqueous humor and leads to an increase in the ophthalmotonus. Its high level causes secondary trophic changes in the tissues of the eye. Reduction of vision is associated with death of functional elements of the retina and optic nerve. The disease usually develops in people older than 40 years. With secondary glaucoma, changes in the pathways of outflow of the intraocular fluid leading to an increase in the ophthalmotonus are caused by various eye diseases (inflammatory and degenerative diseases of the eye membranes, lens pathology, consequences of eye trauma, etc.). With congenital glaucoma, the increase in intraocular pressure arises mainly due to a violation of the outflow of the intraocular fluid due to the closure of the anterior chamber angle by the mesodermal tissue.

Symptoms, course. There are two main forms of primary glaucoma - open-angle and zakratougolnuyu.

Open angle glaucoma is associated with progressive degenerative changes in the drainage system of the eye. The disease usually develops imperceptibly for the patient. Subjective sensations in most patients are absent. Sometimes there are complaints of a feeling of fullness in the eyes, headache, blurred vision, the appearance of rainbow circles when looking at the light. Very sparse and visible changes in the eye There may be an expansion of the anterior ciliary arteries (a symptom of cobra), with biomicroscopy, iris dystrophy and violation of the integrity of the pigment fringe along the edge of the pupil. With gonioscopy, the angle is open. The increase in intraocular pressure in the initial stage of the disease is not constant and is often detected only with daily tonometry, compression-tonometric and tonographic studies. Excavation of the optic nerve and changes in the field of vision occur several years later. Vision gradually deteriorates until blindness.

Closed-angle glaucoma is due to blockade of the anterior chamber angle by the root of the iris. It is characterized by complaints of the patient for pain in the eye and headache, blurred vision, the appearance of iridescent circles around the light source and stagnant phenomena in the anterior segment of the eye. Often, the disease begins with an acute or subacute attack, which is accompanied by acute pain in the eye and head, general malaise, often nausea and vomiting. There is a marked injection of the anterior ciliary arteries. The cornea is swollen, the chamber is shallow, the pupil is dilated. Possible edema of the iris, the formation of the rear synechia and goniosinia. The eyeground is visible in the fog, the optic nerve disk is edematous, with indistinct contours. At gonioscopy the angle of the chamber is completely closed. Intraocular pressure rises to 60-80 mm Hg. Art. Vision sharply decreases.

With secondary glaucoma, increased intraocular pressure and associated changes are combined with a diverse clinical picture of the underlying disease. In congenital glaucoma, photophobia, lachrymation, dullness of the cornea, and then stretching of the shells of the eyeball and associated changes (increase in the diameter of the cornea, banded opacification on its posterior surface, deepening of the anterior chamber, atrophy of the iris, dilatation of the pupil) are noted first. In the advanced stage of the disease, the optic nerve excavation and its atrophy occur.

In the initial stage, the diagnosis of glaucoma is based on the data of daily tonometry, elastotonometry, loading and unloading samples. Acute seizure is differentiated from iritium. The main difference: with iris pupil narrowness, normal cornea and depth of anterior chamber, significant ciliary injection, normal, low, rarely slightly elevated intraocular pressure.

Treatment. At zakratougolnoy glaucoma, the main task is to lower the intraocular pressure. In case of an acute attack, a lytic mixture consisting of aminazine (control of arterial pressure!), Dimedrol and promedol injected in / m in one syringe is used (in a hospital setting). At the same time give 0.25 grams of fonurit or diamoksa (if there is no kidney disease), 50% glycerin solution (the latter at the rate of 1.5 g / kg of patient's body weight). Leeches on the temple area, saline laxative, hot foot baths. In the eye-frequent installation of 2% pilocarpine solution, 0.02% phosphacol solution, 0.005% and 0.01% solution of armin. For the night 2% pilocarpine ointment for eyelids. Further treatment is surgical. In the chronic course of closed-angle glaucoma, surgical treatment is indicated.

Treatment of open-angle glaucoma begins with the use of local antihypertensive agents (instillation of 1-2% solution of pilocarpine, adrenopylocarpine, 0.125%, 0.25% or 0.5% clonidine solution, 0.25%, 0.5% solution of Optolol (timolol maleate) The frequency of instillation is determined by the level of IOP.If there is no normalization, laser or surgical division is indicated.In parallel with local antihypertensive treatment it is recommended to use general treatment:

Vasodilators (no-spa, cavinton, nikoshpan), antisclerotic drugs and metabolic therapy (aminalon, riboflavin, riboxin). In secondary glaucoma, the main disease and its complications are also treated.

A major role is played by observance of the general sparing regimen, a diet with a restriction of liquid (5-6 glasses per day), table salt and extractives, exclusion from the diet of strong tea, coffee, spirits; to give up smoking. Resort treatment in the conditions of the cardiological sanatorium is shown. General balneological procedures are prescribed only with the initial compensated glaucoma. Treatment of congenital glaucoma is surgical. Drug treatment has an auxiliary significance.

The prognosis for primary glaucoma in case of timely and correct treatment is favorable, with secondary glaucoma depends on the timely elimination of the cause of increased ophthalmotonus and the success of treatment of the underlying disease. An early and correctly performed operation allows you to keep your eyesight for a long time with congenital glaucoma.

Prevention. Careful preventive eye examinations in persons aged 40 years and older. Individual prevention: avoid unnecessary disturbance. To prevent secondary glaucoma, timely and correct treatment of eye diseases, which can lead to an increase in the ophthalmotonus.