GLAUCOMA - an eye disease, the main sign of which is an increase in intraocular pressure.
Primary and secondary glaucoma are distinguished. Primary glaucoma is associated with impaired regulation of intraocular pressure and outflow of intraocular fluid. Secondary glaucoma develops as a complication of a number of eye diseases (iridocyclitis, intraocular tumor, etc.).
There are two clinical forms of primary glaucoma: closed-angle and open-angle. In the case of the angle-angle form of glaucoma, periodically occurring pain in the eye area, blurred vision, vision of rainbow circles around the light source are noted; an ophthalmological examination reveals changes in the anterior part of the eye - an injection of the anterior ciliary vessels, swelling of the cornea, small anterior chamber, and dilated pupil. The open-angle form of glaucoma is asymptomatic for a long time and is manifested by a decrease in visual acuity, a narrowing of the field of vision revealed during examination.
The initial, developed, far-reaching and terminal stages of the development of glaucoma are distinguished. In the initial stage, visual acuity and field of view are not changed. The developed stage is characterized by a narrowing of the field of view; at a far advanced stage, the narrowing of the visual field is more significant (usually from the nasal side). In the terminal stage, complete loss of vision or the presence of light perception with an incorrect projection of light is noted while maintaining sufficient transparency of the optical media of the eye. Deterioration of visual function in glaucoma is associated with atrophic changes in the optic nerve.
The course of primary open-angle glaucoma is chronically progressive. An acute attack (decompensation) of glaucoma is observed with a closed-angle form, accompanied by acute pain in the eye, in the temporal region, in the forehead, and a deterioration in the general condition. Often there are nausea and vomiting . The palpation of the eyeball is dense, like a stone, hyperemic, the pupil is wide, visual acuity is sharply reduced.
The state of intraocular pressure is assessed as normal (at a pressure not exceeding 27 mm Hg), moderately elevated (pressure within 28-32 mm Hg), high (more than 32 mm Hg). A state of acute attack is also distinguished, in which intraocular pressure can increase to 50 mm Hg. Art. With intraocular pressure equal to 27 28 mm RT. Art., a complete ophthalmic examination is necessary.
Since glaucoma for the most part begins and often proceeds without pronounced manifestations, patients, especially the elderly, complaining of decreased vision, pain in the eye area, should be referred to an ophthalmologist at the same time.
Treatment. Conservative treatment can be carried out on an outpatient basis with the help of mystical (pilocarpine, carbacholine, aceclidine, physostigmine , army, etc.) and adrenomimetic (adrenaline, ephedrine) agents that are used as eye drops.
In an acute attack of glaucoma, frequent instillation (every hour) of 1 - 2% pilocarpine hydrochloride solution, 0.013% phosphacolum solution and other pupil-constricting drugs, instillation of urea in the lower eyelid film, 30% urea (30 - 50%) 0.75 - 1.5 g solution in sugar syrup per 1 kg of body weight) or 50% glycerol solution (a mixture of equal amounts of glycerin and fruit juice or syrup at the rate of 1.5 g of glycerin per 1 kg of patient’s body weight), application leeches on the temporal region (2-3 on the sides e lesions), hot foot baths, saline laxative. For severe pain, analgesics are prescribed.
The indication for surgery is persistently increased intraocular pressure with a progressive deterioration in visual function, especially a narrowing of the visual field, despite drug therapy. Microsurgical antiglaucomatous operations are carried out, as a result of which an artificial pathway is created for the outflow of intraocular fluid from the anterior chamber of the eye; laser treatments are used.