GLAUCOMA

GLAUCOMA is an eye disease, the main symptom of which is an increase in intraocular pressure.

Allocate primary and secondary glaucoma. 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 a closed-angle glaucoma, periodic pain occurs in the eye area, blurring of vision, a vision of iridescent circles around the light source; In ophthalmological examination, changes in the anterior part of the eye are detected - injection of the anterior ciliary vessels, edema of the cornea, small anterior chamber, dilatation of the pupil. Open-angle form of glaucoma for a long time is asymptomatic and manifests itself by a decrease in visual acuity, narrowing of the field of vision detected during examination.

Isolate the initial, developed, far-reaching and terminal stages of glaucoma development. In the initial stage, visual acuity and field of vision are not changed. The advanced stage is characterized by narrowing of the field of vision; At far gone stage the narrowing of the field of vision is more significant (usually from the nose). In the terminal stage, complete loss of vision or the presence of a light sensation with an incorrect projection of light is noted while maintaining sufficient transparency of the optical media of the eye. Deterioration of visual functions in glaucoma is associated with atrophic changes in the optic nerve.

The course of primary open-angle glaucoma is chronically progressing. 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, deterioration of the general condition. Often there are nausea and vomiting . The eyeball is dense at the palpation, like a stone, is hyperemic, the pupil is wide, the visual acuity is sharply lowered.

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). There is also a state of acute attack, in which intraocular pressure can rise to 50 mm Hg. Art. With intraocular pressure, equal to 27 28 mm Hg. A full ophthalmological examination is necessary.

Since glaucoma mostly begins and often occurs without severe manifestations, the patients, especially the elderly, complaining of low vision, pain in the eye area, should be sent to the ophthalmologist.

Treatment. Conservative treatment can be performed on an outpatient basis with the help of ophthalmologist-appointed (pilocarpine, carbachol, acetylidine, physostigmine , army, etc.) and adrenomimetic (epinephrine, ephedrine) agents, which are used as eye drops.

In case of an acute attack of glaucoma, frequent instillations (every hour) are required in the eye of 1 to 2% solution of pilocarpine hydrochloride, 0.013% solution of phosphacol and other pupil-narrowing agents, lining of the ocular drug film with pilocarpine, inward administration of urea (30-50% Solution in sugar syrup of 0.75 - 1.5 g per 1 kg of body weight) or 50% solution of glycerol (a mixture of equal amounts of glycerin and fruit juice or syrup at the rate of 1.5 g of glycerol per 1 kg of body weight of the patient), application Leeches on the temporal region (2-3 on the side of the lesion), hot foot baths, salt laxative. With severe pain, analgesics are prescribed.

Indication for surgery is persistently increased intraocular pressure with progressive deterioration of visual functions, especially narrowing of the field of vision, despite drug therapy. Microsurgical antiglaucomatous operations are performed, as a result of which an artificial path is created for the outflow of intraocular fluid from the anterior chamber of the eye; Methods of treatment using lasers are applied.