Closed-angle glaucoma: causes and methods of treatment

Glaucoma in the translation from the language of Hippocrates and Aristotle means "light blue" or "blue".Today this term is called a group of eye diseases characterized by increased intraocular pressure. As a result, the patient develops dangerous disorders: a significant decrease in vision and loss of the optic nerve.

The most common is open-angle glaucoma, it affects more than 90% of all patients with an increase in IOP. The difference of this form is that the corneal angle of the iris remains open.Closed-angle variant of glaucoma is rare in humans. About the peculiarities of this variety of glaucoma and will be discussed in our material.

Definition of disease

Closed-angle glaucoma is an acute or chronic eye disease, which is characterized by a paroxysmal increase in intraocular pressure

; it increases due to the closing of the angle of the anterior chamber by the iris of the eye and the inhibition of the outflow of the intraocular fluid.

This disease occurs when the flow of watery moisture is blocked and IOP very quickly becomes extremely high.

An acute attack of an angle-closure glaucoma is a dangerous situation. If you do not immediately take up the treatment, the disease leads to an absolute loss of vision.

Types and Classifications

The nature of development of closed-angle glaucoma is:

• Stable(the symptoms of the disease are rapidly progressing);
• Unstable(it develops relatively slowly).

By the mechanism of development this pathology is classified as follows:

• Glaucoma with a flat iris;
• Creeping;
• With pupillary block (80% of all cases of closed-angle glaucoma);
• Malignant glaucoma with vitreochrustalic block.

Isolate the closed-angle glaucoma of the primary type (no exact cause is identified) and secondary glaucoma caused by other conditions.

By the mechanism of disturbed outflow glaucoma is divided into:

• Sharp;
• Subacute(intermittent);
• Chronic.

Several stages of the disease under consideration are known:

1. Initial;
2. Developed;
3. Far behind;
4. Terminal glaucoma.

Causes

Physicians still can not establish the exact causes of the development of closed-angle glaucoma.From observations it became clear that in patients with glaucoma, the site within the angle of the anterior chamber of the eye, in which the process of removing the liquid occurs, is narrower than it is normally expected.

Glaucoma - a multifactorial disease and develops, most likely, from a combination of several causes, which ultimately lead to eye damage.

The risk factors for the development of the closed-angle variant of glaucoma are as follows:

• Heredity.Some features of the structure of the eye, inherited, contribute to a difficult outflow of intraocular fluid (for example, large lens, high attachment of the root of the iris, the location of the scleral sinus, the size of the eye, the lumen of the episcleral vessels, the composition of the scleral collagen and etc.).
• Myopia(enlarged sizes of the eyeball predispose the scleral plate of the optic disc to fracture when the IOP increases).

• Low blood pressure(hypotension often leads to the fact that with an increase in IOP blood flow over them significantly slows down).
• Bronchial asthma.
• Diabetes.
• Allergic pathology.

• Rheumatic diseases(chronic diseases lead to a disruption of the metabolism in the optic nerve and a slowdown in the outflow of the intraocular fluid).
• Farsightedness.
• Injuries and bruises of the eye.
• Frequent nervous tension.
• Overwork.

Be attentive to taking some medications. There are many drugs that increase the risk of occlusive glaucoma. For example, the development of this disease is facilitated by tranquilizers, which are used in the treatment of depression and other mental disorders. Do not forget to read the instructions to the drug: if side effects of the drug indicate an increase intraocular pressure, then ask the doctor if possible to replace this medicine with an analogue that does not contain similar effect.

Symptoms

In the early stages of the symptoms of glaucoma is little pronounced.To notice them, it is necessary to attach importance to every unpleasant manifestation. What is typical for the clinical picture of patients with angle-closure glaucoma?

• Pain in the eye;
• Blurred vision;
• Reduction of visual acuity in the dark;
• Redness of the eyeball;
• Visible blood vessels in the eye;
• The appearance of rainbow circles before the eyes;
• Pupil dilated;
• Headache;
• General fatigue;
• Nausea, vomiting;
• Pain giving to the heart and stomach.

At later stages, noticeable defects of the visual fields appear in the form of dark spots, arc-shaped figures.As a result, only the so-called "tube" vision is retained in patients and peripheral vision is lost.

With a strong attack of angle-closure glaucoma, the pressure inside the eye can rise very high, holding high values ​​for several hours. The patient at the same time feels a strong pain, spreading to the eyebrows and temples. Such seizures often occur only in one eye, which becomes red, and vision is markedly reduced and becomes vague. In this case, the patient should immediately be hospitalized.

Possible complications

The most terrible consequence of glaucoma is loss of vision.If we consider that glaucoma develops rapidly, then the risk of such a dangerous prospect remains for all patients with this disease. That is why it is very important to notice the first symptoms of increased intraocular pressure and consult an oculist for advice and assistance.

Diagnostics

The diagnosis of closed-angle glaucoma is based on instrumental methods of investigation, such as:

• Ophthalmotonometry(measurement of intraocular pressure). This examination reveals the glaucomatous deepening of the optic nerve.
• Gonioscopy(determines the level of closing the angle of the anterior chamber of the eye).
• Slit Biomicroscopy(allows you to notice changes in the structures of the eyeball).
• Optical coherence tomography(helps visualize the structures of the anterior chamber of the eye).

  Ophthalmological examination

Treatment

Therapy of closed-angle glaucoma can be divided into 2 stages:by nature and after.

Initial therapy

Primary treatment is carried out with an acute form of closed-angle glaucoma.In this case, you need to act quickly, turning as soon as possible to the oculist. If the patient does not have the opportunity to do it quickly, then it is possible to take urgent measures on his own. Recommendations for patients with acute glaucoma:

• Do not try to cover the affected eye with a bandage.In this case, your pupil will expand even more, and this will only worsen the situation.
• Do not lie in a darkened room: the horizontal position of the body will increase the pressure in the eye even more. The darkened space expands the pupil, and this only aggravates the situation.

Medications

The task of the initial stage of treatment is reduction of intraocular pressure. Pharmacies have a variety of medicines and eye drops with a similar effect. Means can be used in various combinations. Initial therapy may include:

• Eye drops with beta-blockers(reduce the production of intraocular fluid) and steroids (eliminate inflammation), for example, Timolol.
• Injections of acetazolamide.
• Eye drops Pilocarpine (contribute to the narrowing of the pupil, which will help to remove the iris from the trabecular network and remove the blockage of the outflow of watery moisture).
• Steroid eye drops.
• Intravenous injections, reducing the level of intraocular fluid, for example, Mannitol.
• Painkillers;
• Tablets from nausea(if necessary).

  Pilocartin is used to treat occlusive glaucoma

Further treatment

When the pressure in the eye drops, the patient needs further treatment to prevent a relapse of an acute angle-closure glaucoma.These methods include laser and surgical treatment, which are aimed at creating small holes in the iris. These holes allow the produced liquid to flow freely from the posterior chamber of the eye into the anterior chamber, which, in turn, stops the iris protrusion forward and blocking the trabecular network in further.

Laser treatment

It is called peripheral iridotomy.The essence of the interference is that two microscopic holes are drilled through the laser in the iris shell, which will not be noticeable when viewed from the side. The aim of the procedure is to equalize the pressure between the chambers of the eye.Laser intervention is performed under local anesthesia on an outpatient basis.

Surgery

Surgical iridectomy is another option for treating an acute attack of angle-closure glaucoma. The purpose of the intervention is to remove parts of the trabecular tissues. After this procedure, a message is opened between the front chamber and the subconjunctival cavity.

Laser or surgical treatment the doctor often recommends performing for both eyes simultaneously. This is necessary to prevent the development of an attack of glaucoma in the other eye.

Treatment between seizures

When closed angle glaucoma is recommended daily instillation of the eye with one of the antihypertensive drugs, such as:

• Pilocarpine;
• Timolol;
• Brinzolamide;
• Dorzolamide.

  Timolol is used to treat occlusive glaucoma

If the treatment of glaucoma is started quickly, then the prognosis is usually good. Vision can be restored, and laser or surgical operation will help to prevent the recurrence of an attack. If treatment is delayed, then high pressure in the eye can damage blood vessels and the optic nerve. As a result, eyesight in the affected eye will constantly deteriorate.

Prevention

Prevention measures involve regular examination by an ophthalmologist, especially for people with a hereditary factor of glaucoma.In some people, the risk of developing an angle-closure glaucoma is elevated due to a small anterior chamber of the eye or a narrow drainage angle.The doctor may notice this with a normal eye examination.In this case, the oculist necessarily advises to be careful with certain medications and eye and can also recommend prophylactic treatment, for example, a laser iridotomy.

One should remember the symptoms of angle-closure glaucoma and immediately consult a doctor if a person has developed a red-eye effect along with symptoms such as pain, nausea, loss of vision.

If you are taking a new medicine and you develop symptoms of angle-closure glaucoma, seek medical help immediately. Tell your doctor about the drug and symptoms. This will help to identify the problem at an early stage.

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conclusions

So, glaucoma is a very serious disease of the eye.The closed-angle variant of this pathology can develop rapidly, with periods of exacerbation and remission, or long-term.Remember the symptoms of glaucoma, and in acute form, call for emergency medical attention.With glaucoma, jokes are bad, so listen to your body and take good care of the uncomfortable sensation and redness in the eyes.

Read also what it is open-angle glaucoma.