Glaucoma is a severe eye disease associated with increased intraocular pressure. Glaucoma as a formidable disease, because of the high risk of loss of vision, is equally common among the population of different countries: the inhabitants of the south, the north, urban and rural residents, physical and mental workers.
This pathology of the eye occurs in women more often than in men. It can appear on the healthy eye without any apparent cause, usually the illness precedes the experience of negative emotions, but the hereditary factor must also be taken into account.
Here we will talk about the causes, symptoms and signs of glaucoma, about its treatment, prevention and operation with increased pressure in the eyes.
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Causes and signs of glaucoma
The name "laukoma »- the Greek origin. It was formed because sometimes the pupil area of the glaucomatous eye has a yellowish-greenish color( the Greek word glaukos translates as light green).This happens during an acute attack of glaucoma.
The main sign of glaucoma is violation of regulation of intraocular pressure. The increase in intraocular pressure as a cause already leads to the development of all the other symptoms characteristic of the glaucomatous process.
Now, glaucoma is the main cause of incurable blindness and deep disability.25% of all blind people from various diseases are patients who have lost their eyesight from glaucoma.
Ophthalmic pressure: norm
The boundaries of normal intraocular pressure range from 18 to 27 mmHg. The highest ophthalmotonus( ie, the level of maximum pressure in the eyes) in most people is in the early morning, and then during the day, intraocular pressure decreases by 2-5 mm Hg.
The palpation test is an approximate method. The pressure of the eye is measured by the AI Maklyakov in the supine position, the difference in the intraocular pressure in the right and left eye usually does not exceed 5 mmHg.
Elastotonometry is a method for determining the ophthalmotonus in the measurement of intraocular pressure by tonometers of different weights( 5.0 g, 7.5 g, 10.0 g, 15.0 g).Tonographic studies are carried out using electronic tonographs. Normally the coefficient of ease of outflow( C) in people 40 years and older varies from 0.16 to 0.48 mmz( min / mmHg).The minute volume of watery moisture( D) is from 1.1 to 3.58 mm / min. The true( non-tonometric) intraocular pressure( Po) is from 10.48 to 20 mm Hg. Art.
Measurement of ocular pressure: suspected glaucoma
Early diagnosis of primary glaucoma is extremely important( determine the level and regulation of intraocular pressure with the help of tonometry and tonography).The need for periodic and repeated measurements of intraocular pressure in patients with glaucoma leads to the fact that some of them develop an allergic eye reaction to dicaine. Before the measurement of intraocular pressure for anesthesia of the cornea, a 3-5% solution of trimenoin or a 2% solution of lidocaine should be used instead of a solution of dicaine or novocaine.
Intraocular pressure is usually measured at 6-8 am and at 6-8 pm. Daily changes are determined in a hospital or glaucoma dispensary: the morning measurement of intraocular pressure is performed in a patient still in bed. The optimal duration of the study is 7-10 days, the minimum duration is 3-4 days.
Suspicion of glaucoma occurs in the following cases:
1) intraocular pressure is 27 mm Hg.p.
2) there are complaints characteristic of glaucoma;
3) small front camera;
4) blanching of the optic disc;
5) asymmetry in the state of two eyes( level of intraocular pressure, depth of anterior chamber, condition of optic nerve discs);
6) the presence of small paracentral relative and absolute livestock.
Primary glaucoma is a two-sided process, however painful manifestations can be expressed in varying degrees in both eyes.
Symptoms of glaucoma
Glaucoma changes the field of vision. The worst supply of retinal blood from the temporal side, rather than from the nasal side, leads to the fact that the narrowing of the visual field begins first in the upper part in the form of a sector, then the entire nasal side falls out and gradually the defect approaches the fixation point.
In the study of the blind spot( projection of the optic nerve disk) by the method of campimetry, a significant increase in its frequency is often found already at the earliest stage. The blind spot has the appearance of an arcuate scotoma surrounding the fixation point in the form of a semicircle.
Atrophy of the optic nerve develops, as a rule, gradually. First, the color of the disc changes, a shift of the vascular bundle appears, and then an edge inflection of the vessels arises.
Acute attack of glaucoma
An acute attack begins suddenly, more often at night or in the early morning hours. There are sharp pains in the eye, orbit, head. Headache is often accompanied by vomiting, general weakness, slowing of the pulse.
Phenomena from the side of the eye are pronounced. Eyelids are edematic, there is watery eyes. The stagnant injection of the vessels of the eyeball and the vessels of the conjunctiva of the eyelids is sharply expressed. There may be chemosis of the conjunctiva. The cornea becomes dull, rough. The sensitivity of the cornea is sharply reduced, sometimes completely absent. The anterior chamber is small, the pupil sharply widens, there is no reaction to pupil light, the shape may be wrong, the vitreous body swells. The pupil area acquires a greenish color. The disc of the optic nerve is hyperemic, its borders are dimmed.
Intraocular pressure in acute attack is sharply increased - up to 60-70 and even 90 mm of mercury. Palpatory, to the touch, the eye is "hard as a stone."Vision can be reduced to light. Sometimes after the first attack of glaucoma comes blindness - this is a lightning-fast glaucoma.
Separately isolated pre-glaucoma as a transitional state between the norm and pathology. In the pre-glaucoma stage, intraocular pressure may be normal - and there are no glaucoma-specific changes in the visual field and the optic nerve. However, as a result of any unfavorable influences or specially conducted stress tests, for some time, the main signs of glaucoma are observed: increased intraocular pressure, a decrease in the outflow of aqueous humor, and the emergence of cattle in the paracentral field of view.
With the so-called hypersecretory glaucoma, increased production of aqueous humor is noted at its normal outflow, in connection with which it can be attributed to one of the types of ophthalmic hypertension.
The main goal of treating an acute attack of glaucoma is to reduce the intraocular pressure and thus restore the circulatory disturbance in the eye. Begin treatment with instillation of a 2% solution of pilocarpine every 15 minutes for 1 hour, and then every 30 minutes for the next 2 hours - and then every hour. At the same time give 0.5 g( 2 tablets) of diacarb or preparations of this group, you can give 1 tbsp.l.glycerol( 50% glycerol solution).Intraocular pressure after taking glycerin begins to decrease after 30 minutes.
After conducting emergency medical activities, the patient is referred for inpatient treatment. In a hospital with an insufficient effect of previous treatment after 2-3 hours in the absence of arterial hypotension, administration of aminazine is shown, it reduces arterial and intraocular pressure.
If drug treatment does not stop an acute attack of glaucoma within 8-10 hours, an antiglaukomatous operation is performed.
In any form of glaucoma, it is necessary to be at the dispensary observation at the oculist in the eye cabinet, to monitor the intraocular pressure at least once every 3 months, to select with the help of the doctor adequate treatment.
Treatment of glaucoma with medical preparations
The use of vasodilator drugs and agents affecting tissue metabolism processes( nicotinic acid at 0.05 g 3 times a day for 3 weeks, no-spu to 0.04 g 3 times a day, Cavinton 0,005 g 3Riboxin 0.2 g 3 times, vitamins B1, B2, B6, B12, FBS 1.0 mg IM at a rate of 20 daily injections, ATP 1.0 mg ip / muscle at a rate of 30 injections per daycourse).
The level of blood pressure should be taken into account when performing treatment. Patients with glaucoma at low arterial pressure should not be prescribed vasodilators. Assign ascorbic acid( inside 0.1 g 3 times a day for a month).
Four stages of glaucoma
There are 4 stages of glaucoma: initial, advanced, far-reaching and terminal. The stages of glaucoma are determined by the state of the visual field and the optic disc.
In the initial stage there is no edge excavation of the disc and changes in the peripheral boundaries of the field of view. The advanced and far-reaching stages of glaucoma are characterized by the presence of marginal excavation, narrowing of the peripheral boundaries of the field of vision and the appearance of cattle. With the advanced stage of the disease, the visual fields are narrowed by no less than 5% from the inside, at a far-reaching stage the field of vision is narrowed at least in one meridian, does not exceed 15% of the fixation point.
Forms and types of glaucoma
Primary glaucoma: open and rectangular
Glaucoma can be primary( open angle and zakratougolnoy), secondary( with violations of blood circulation in the vessels of the eye, orbit and with intraocular hemorrhage), glaucoma of the aphanyous eye, with wounds( inflammation of the eye)and congenital( hydrophthalmic).An acute attack of glaucoma can occur in any of its forms.
The primary glaucoma is an open-ended and a closed-angle form.
Open-angle glaucoma
The open-angle form of glaucoma usually occurs after 40 years. The onset of the disease is often asymptomatic. Complaints about the appearance of rainbow circles around the light source, for periodic blurring of vision are noted only in 20% of patients. Often observed early, not age-appropriate easing accommodation. Changes in the anterior part of the eye are usually minor. The depth of the anterior chamber with open angle glaucoma is usually not changed. A special feature of the clinical picture of open-angle glaucoma is the development of glaucomatous atrophy of the optic nerve in the form of marginal excavation.
With the further development of the glaucomatous process, defects in the peripheral field of vision are detected. Visual acuity usually changes and decreases only in the late stages of the disease.
A number of factors adversely affect the course and prognosis of open-angle glaucoma: lowering of arterial pressure( arterial hypotension), the presence of cervical osteochondrosis, sclerotic changes in blood vessels.
Closed-angle glaucoma
The closed-angle form of glaucoma accounts for about 20% of cases of primary glaucoma and usually develops over the age of 40 years. It is much more common in the form of hypermetropic refraction( a small anterior chamber and a large lens).Closed-angle glaucoma occurs with periods of exacerbations and remissions.
The immediate causes of an acute attack of angle-closure glaucoma are emotional stimulation, dilatation of the pupil( in particular, during prolonged exposure in a darkened room), copious fluid intake, overeating, cooling, prolonged head incidence, neck compression, alcohol intake.
Treatment of closed-angle glaucoma
For medical treatment of angle-closure glaucoma, the most important are myotic preparations, mainly cholinomimetic( pilocarpine, carbacholin, acetylidine).It is also possible to administer a 0.25-0.5% solution of timolol( Optimum).Other preparations: phosphacol, adrenaline, clonidine, etc. - with this form of glaucoma are contraindicated because of their midrian properties and the possibility of causing a pupillary block.
Of generic agents for the reduction of intraocular pressure, diacarb and glycerol are used. Given the pathomechanisms of increased intraocular pressure in closed-angle glaucoma( the occasional partial blockade of the anterior chamber angle), as well as the insufficient effect of locally applied drug therapy, laser or surgical treatment is usually used. Laser treatment consists of laser iridectomy and iridoplasty.
Treatment of primary glaucoma
Basic principles of drug treatment for primary glaucoma
Currently, medical treatment of glaucoma is carried out in three main directions:
- normalization of intraocular pressure( local and general therapy);
- treatment, which improves the blood supply to the inner membranes of the eye and optic nerve;
- treatment aimed at the normalization of metabolism in the tissues of the eye in order to influence the dystrophic processes characteristic of glaucoma.
Intraocular pressure usually decreases after a single instillation of the drug. This is the basis for conducting a drug test before the systematic administration of the drug. At subsequent instillations the hypotensive effect is regularly repeated. However, the antihypertensive effect of the drug is not immediately apparent, at first it may be mild and worsens on subsequent days of treatment. The hypotensive effect with prolonged use may decrease until complete resistance to this drug. In this regard, long-term treatment is appropriate replacement of one drug to another.
Often there is resistance to the drug from the outset( this drug does not reduce eye pressure), therefore, its purpose is impractical. Sometimes, after instillation of the drug, intraocular pressure rises( paradoxical effect).In such cases, the appointment of this drug is contraindicated.
Given the different mechanism of action of antihypertensive agents( miotiki cholikomimeticheskogo and anticholinesterase action, sympathicotropic drugs, B-adrenoblockers, etc.), one can not judge finally their effectiveness on the basis of a single instillation.
When developing a regime of drug treatment for a patient with glaucoma, a follow-up period( not less than 2-3 weeks) is established, during which the drug is applied. Further monitoring of the effectiveness of treatment is carried out 1 time in 1-3 months.
Treatment of patients with primary glaucoma usually begins with the appointment of instillation of 1% solution of pilocarpine hydrochloride 2-3 times a day. Pilocarpine improves the outflow of watery moisture from the eye, which leads to a decrease in intraocular pressure. In the future, the frequency of instillation of pilocarpine is altered taking into account the level of intraocular pressure, its fluctuations and the values of the coefficient of ease of outflow and the minute volume of aqueous humor. If treatment with a 1% solution of pilocarpine hydrochloride does not result in normalization of intraocular pressure, instillations of a 2% solution of pilocarpine 3 times a day are prescribed.
In case of insufficiency of 3 fold instillations a day pilocarpine solutions of prolonged action( 1% solution of pilocarpine hydrochloride with methylcellulose, 1-2% solutions of pilocarpine hydrochloride with carboxymethylcellulose or polyvinyl alcohol) are used. These drugs are used 3 times a day. It is also used pilocorpine hydrochloride in the ophthalmic drug film 1-2 times a day and 2% pilocarpine ointment at night. An increase in the concentration of pilocarpine solution( 3-6%) and the frequency of its instillation( 6 times or more per day) is impractical, since this usually does not lead to a significant increase in the hypotensive effect, but often causes a general negative reaction of the body.
Other cholinomimetic agents( 1-3% solutions of corbacholin or 2-5% solutions of acetylidine) are used less frequently. With insufficient efficacy of cholinomimetic drugs, one of the myotics of anticholinesterase action is additionally prescribed( prozerin 0.5%, phosphacol 0.013%, armin 0.005%, tosmylen 0.25%).The frequency of instillation of these drugs is no more than 2 times a day.
Their action is also aimed at improving the outflow of aqueous humor from the eye. Fosfakol, armin, tosmilen with angle-closure glaucoma appoint carefully, under the control of intraocular pressure.
Patients with open-angle glaucoma with low or normal blood pressure( without hypertensive disease) with insufficient efficiency of pilocarpine hydrochloride are added instillation of 1-2% solution of adrenaline hydrotartrate or prescribed adrenopilocarpine( 0.1% solution of epinephrine hydrochloride with 1% solutionpilocarpine hydrochloride) 2-3 times a day.
The hypotensive effect of epinephrine is due to a decrease in the production of aqueous humor and partly to an improvement in its outflow. Combination pilokarpina with adrenaline is very advisable, since adrenaline potentiates the hypotensive action of pilocarpine, and pilocarpine interferes with the development of mydriasis, which usually occurs after instillation of adrenaline.
The use of epinephrine in the form of eye drops in some patients can cause an increase in blood pressure, extrasystole, an attack of tachycardia, headache, tremor of the extremities, nausea. Therefore, adrenaline and adrenopilokarpin are contraindicated in patients with severe cardiovascular and endocrine pathology( hypertension, angina pectoris, a previous myocardial infarction, severe atherosclerosis, thyrotoxicosis, diabetes mellitus, etc.).The use of epinephrine and adrenopilokarpin is contraindicated in closed-angle glaucoma.
Patients with open-angle glaucoma with elevated or normal arterial pressure are prescribed instillations of 0.125-0.25-0.5% solutions of clonidine. The hypotensive effect of clonidine is explained by oppression of the secretion of watery moisture, and also by an improvement in its outflow. Clopheline has almost no effect on the width of the pupil and therefore can be used alone or in combination with pilocarpine. After instillation of clonidine in the conjunctival sac, in most patients not only intraocular pressure but also arterial pressure decreases. At low arterial pressure, clonidine eye drops are contraindicated. In cases of side effects( dry mouth, weakness, drowsiness), you should reduce the concentration of the drug or the frequency of instillations, and sometimes cancel.
In both open-angle and closed-angle glaucoma, B-adrenoblocking agents are used in the form of eye drops( ocupress 0.25-0.5%, timolol 0.25-0.5%, optolol 0.25-0.5%).
The hypotensive effect of these drugs is due to a decrease in the secretion of aqueous humor. They do not change the width of the pupil and do not affect blood pressure. These drugs are used alone or in combination with pilocarpine hydrochloride, and with open-angle glaucoma - adrenopilocarpine. Usually they are applied 2 times a day for 1 drop.
With insufficient effectiveness of local antihypertensive therapy of open-angle primary glaucoma, it is supplemented by short-term administration of antihypertensive agents of general action: carbonic anhydrase inhibitors( diamox, diacarb), osmotic( glycerol) and neuroleptic agents( aminazine).Inhibitors of carbonic anhydrase reduce the production of intraocular fluid, this leads to a decrease in intraocular pressure. These drugs are especially effective in hypersecretory glaucoma. Diacarb is administered orally 0.125-0.25 g from 1 to 3 times a day. Intraocular pressure decreases usually after 40-60 minutes, the maximum decrease occurs 3 hours after taking diacarb. After 6-12 hours the intraocular pressure returns to the initial level.
Diacarb and its group preparations in some patients cause paresthesia of the limbs, weakness, nausea, sometimes renal colic. With prolonged use, it is advisable to simultaneously prescribe sodium hydrogencarbonate, potassium orotate, panangin, alkaline mineral waters in order to maintain a normal acid-base state in the body. After 3 days of taking diacarb it is recommended to take a break for 1-2 days. Side effects quickly pass. Glycerol and aminazine are prescribed once for acute increases in intraocular pressure. For the systematic treatment of glaucoma, they are not used.
Secondary glaucoma
Glaucoma of the afnich eye can develop at different times after removal of the cataract. Sometimes glaucoma in the aphanic eye may be a manifestation of primary open-angle glaucoma not identified before cataract extraction. Treatment is carried out with 1-2% pilocarpine solution;0.25-0.5% solution of clonidine, optimol;inside the diacarb by 0,125-0,25 g 2-3 times per day, 50% solution of glycerin or glycerin with ascorbic acid and fruit syrup. If the medication is ineffective, surgical intervention is indicated.
Causes of
The cause of secondary glaucoma in iridocyclitis and uveitis is increased exudation in the anterior chamber, changes in the vessels of the uveal tract associated with the inflammatory process.
Secondary glaucoma for circulatory disorders in the vessels of the eye, orbit and intraocular hemorrhages occurs more often with thrombosis of the central vein of the retina, less often in cases of venous circulation in the orbit( inflammatory processes, tumors, pulsating enzophthalms, edematous exophthalmos), with obliteration of venous vessels after scleral diathermocoagulation andher resection, with intraocular hemorrhages.
Treatment of secondary glaucoma
Treat, above all, the underlying disease. Miotic means( 1- and 2% solution of pilocarpine) is prescribed in the absence of newly formed vessels in the iris. If they are available, instillations of solutions of adrenaline, clonidine, and also corticosteroids are recommended.
Apply the means that promote resorption of hemorrhages: topically - instillation of a 3% solution of potassium iodide;0.1% solution of lidase or ronidase;intramuscularly use lidazum, vitreous.
Congenital glaucoma: five stages of development of
Congenital glaucoma is hereditary( about 15%) and intrauterine( 85% of cases).Intrauterine glaucoma occurs as a result of the influence of various pathological factors on the eye of the fetus, which leads to developmental defects in the anterior part of the eye. Increase in intraocular pressure occurs due to a violation of the outflow of intraocular fluid.
In most cases, congenital glaucoma occurs in newborns or in the first 6 months of a child's life, as well as in the first year of his life. Congenital glaucoma is characterized by a progressive course. There are five stages of the disease: initial, developed, far-reaching, almost absolute and absolute.
In the initial stage of the disease, photophobia, lacrimation, dullness of the cornea are noted;the length of the sagittal axis of the eye and the diameter of the cornea are normal or slightly enlarged. In the advanced stage, the diameter of the cornea increases - and the corneal edema increases, and its opacity increases. The pupil is enlarged. The visual acuity is reduced, the field of view is narrowed from the nose to 45-35 °.
A far-reaching stage of the disease is characterized by a sharp increase in the eyeball, the limb is stretched, the sclera is thinned, through it the vascular membrane shines through the bluish-bluish color. Visual acuity is sharply reduced.
In the stage of almost absolute and absolute glaucoma complications develop: subluxation and dislocation of the lens, intraocular hemorrhage, complicated cataract, retinal detachment, etc., vision is reduced to light perception with an incorrect projection, in the absolute stage - complete blindness.
Treatment of congenital glaucoma
Treatment of congenital glaucoma is surgical. Drug treatment( before and after the operation): 1-2% solution of pilocarpine, 2-3% solution of aceuklidia or 0.25% solution of Optimum.
Juvenile( youthful) glaucoma develops at a young age. There is a hereditary transmission. People usually are ill not older than 30 years. The clinical picture is diverse. In some patients, changes in the iris are noted, in others the symptoms progress slowly, the cornea is normal, the anterior chamber is deep.
Treatment: topical application of pilocarpine, optimol, clodiline;in the absence of compensation for glaucomatous process and impairment of visual functions - surgery.
Operation for glaucoma
The question of surgical treatment of open-angle glaucoma is solved individually taking into account the shape of glaucoma, the level of intraocular pressure, the coefficient of ease of outflow, the condition of the anterior chamber angle, the visual field and the general condition of the patient. The main indicators for the operation are:
1) persistent and significant increase in intraocular pressure, despite the use of various antihypertensive agents of local action;
2) progressive deterioration of the visual field;
3) negative dynamics of clinical data( condition of iris, angle of anterior chamber, optic nerve), i.e. unstabilized nature of the course of glaucomatous process.
In recent years, laser methods have been used to treat primary glaucoma. With open-angle glaucoma, laser goniopuncture and trabeculospasia( stretching of the trabeculae) using argon or ruby lasers are used.
Prevention of glaucoma
In addition, you can find information on the treatment of glaucoma folk remedies and methods, as well as with a list of eye drops that reduce intraocular pressure in order to prevent acute attacks of glaucoma.
To prevent the occurrence of glaucoma and just to maintain a good or sufficient vision, it is necessary to observe the physical activity of a person, good lighting, the correct mode of work and rest.
With the aging of a person, the ability of his body to regulate blood circulation during a change in body position is reduced. This leads to the fact that when the torso is tilted, the blood flow in the vessels of the eye and brain worsens, a person may develop a fainting condition. Necessary in this case are exercises that promote the training of blood circulation reactions, i.e., turns and torso of the trunk.
"Dose" of such exercises - as much as a person can perform without stress;rotations, rotations of the trunk and head are advisable. Together with the slopes, they increase the blood circulation in the vessels of the spine and its ligament apparatus.
Even at the age of more than 75 years, under the influence of special coordination exercises, accuracy and coordination of movements are improved.
In accordance with the change of day and night, the daily biorhythm of a human being was formed in the course of evolution. The life activity of the organism fluctuates during the day: the greatest activity in the morning, then the recession in the middle of the day, again some rise in the evening hours and a sharp decrease in activity at night.
Our distant ancestors lived in strict accordance with the requirements of the daily biorhythm not only because they were guided in life by the sun, but also because they knew from experience: the most controversial work - in the morning. And early packed to have a good night's sleep. After dinner, went to bed, because you can not earn a full stomach, and the strength to the end of the work day may not be enough. So dictated by nature, the needs of the organism and the need for a great labor return from sunrise to sunset.
With the development of society, the way of life and the character of people's labor change rapidly. We were surrounded by social rhythms: the time of the beginning and the end of the working day, the working week, the onset of vacation. The organism adapts in the surrounding environment, bringing its physiological processes in line with it.
Therefore, in order to avoid desynchrosis diseases, that is, mismatching rhythms, those who work in shifts need to take more care of their health, more strictly follow the order of work and rest, lead a healthy lifestyle.
Of course, if a person works on a night shift, he is busy all day with household chores, talking to family and friends in the evening, it will not lead to anything good. Fatigue, the disturbed rhythm of life will have a harmful effect on well-being and working capacity. Vision sharply decreases, the mucous eye turns red, chronic conjunctivitis appears, and intraocular pressure rises.
During the night shift many have drowsiness, lethargy, increased nervousness in the event of interference. The minimum of working capacity and the greatest number of failures are noted at 2-4 o'clock in the morning.
Gradually within 1-3 months there is a complete adaptation of the body. Those who work at night, need to sleep 7-8 hours. You can sleep in the day if the room is dark and quiet. You can sleep 6 hours before the shift and at least 2 hours after it.
After night shifts, a two-day active rest is provided to restore the body to its original level.
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Source: source material for article writing is taken from the site: http: //bibliotekar.ru/med/ med7-1.htm
