Glaucoma: causes, symptoms, treatment, prevention

The optic nerve is one of the most important eye structures, allowing to perform the vision function in full. Any violations in his work invariably affect the visual perception and, accordingly, the standard of living of the patient. Perhaps, most often such deviations occur when the properties of tissues and eye structures change. For example, intraocular pressure. And although not always a decrease in visual perception occurs with an increase in IOP, but this factor in most cases affects the development of such a serious disease as glaucoma. Glaucoma of the eye: what is it, how to identify and how to treat it?

Definition of disease

In fact, glaucoma means a number of pathological conditions caused by a constant or periodic increase in IOP.As a result of such changes in the properties of the intraocular fluid, negative changes occur in the eye structures: the level of vision gradually decreases, there appears a restriction of the peripheral fields of vision and the development of defects in central field,

and also the most severe and irreversible disturbance occurs - atrophy of the optic nerve.

Intraocular fluid is constantly produced by the processes of the ciliary body and is an important component for the normal functioning of the eye structures.Its important property is continuous renewal, however, the issue of constant outflow to external structures arises.Up to 85-95% of watery moisture is removed through the front chamber and the drainage system of the eye. The remaining 5-15% are removed through the uveoscleral path: seep through the ciliary body and sclera into the veins of the choroid and scleral veins.

If there is a violation in one of the ways of outflow of intraocular fluid, IOP starts to increase, causing changes in the optical environment of the eye and adversely affecting the eye structures.

Causes

The disease can develop in 3 main types:

• Primary.It occurs in most cases in people over 40 years of age and is almost asymptomatic. Risk factors in this case may be severe short-sightedness, elderly age (over 60 years), genetic predisposition, and also a number of systemic diseases: hypertension, diabetes, thyroid disorders, diseases of the nervous system and and so forth. ;
• Congenital.It develops with an increase in IOP due to the presence of congenital or hereditary disorders in those eye structures that are responsible for the production and outflow of intraocular fluid. The primary signs of such violations are diagnosed as early as 6-12 months. In the absence of timely treatment, the risk of blindness by 5-7 years is 50%;
• Secondary.The disease develops as a consequence or complication of the previous pathology. In this case, the risk factors include the following diseases: inflammation of the eye structures, cataracts, dystrophic eye lesions, lens shift, traumatic injuries, postoperative complications, neoplasms in the eyes.

Increased IOP does not always lead to glaucoma, just as glaucoma can develop with reduced IOP. In the absence of damage with high IOP, the disease is called "hypertension".

Symptoms

To suspect the development of the disease is sometimes very difficult, because at the initial stage, signs are almost absent.The field of view may narrow, defects appear in the central field in the form of spots, there may be a fuzzy outline when looking at light bulbs or lanterns. Only with certain types of pathology pain syndrome appears, which spreads to the adjacent area of ​​the head. It is almost impossible to detect changes without the help of an ophthalmologist. That's why you should constantly undergo preventive examinations, especially for the elderly.

Symptoms of progressive disease manifest themselves differently for different types of glaucoma:

• Primary open angle glaucoma- the most common form, characterized by an inconspicuous decrease in peripheral vision;
• Primary angle-closure glaucoma- a relatively rare type and is due to anatomical features of the structure of the eye structures. It also flows almost asymptomatically, with periodic blurring of vision and pain in the temple and eye (subacute attack);
• Normotensive glaucoma- occurs at normal IOP indices and is characteristic of hypotonic patients. The risk factor is cervical osteochondrosis;
• Congenital glaucoma- develops with an incorrect structure of intraocular structures and, in addition to increased IOP, is accompanied by edema of the cornea;
• Secondary glaucoma- a consequence of both systemic diseases and long-term use of medications (eg, secondary steroid glaucoma).

Possible complications

In the absence of specific treatment, glaucoma can lead to the most severe consequences,up to loss of vision and even removal of the eyebecause of uncontrolled bouts of pain at the terminal stage of the disease.

Other possible complications include:

• Atrophy of the optic nerve- most often a consequence of the destruction of blood vessels and a violation of their nutritional function for the eye structures;
• Corneal damage- this complication is characteristic of a closed-angle form and is usually accompanied by corneal edema;
• Myopia- the relationship of these two diseases was recently proved by a group of scientists in the Netherlands, who revealed the dependence of glaucoma on the degree of myopia;
• Strabismus- the development of visual impairment can lead to strabismus, when a patient in an attempt to obtain a high-quality image can reduce his eyes to the nose.

In addition, closed-angle glaucoma can cause chronic edema in the tissues cornea, fibrosis of the cornea and the germination of new vessels into it, as well as the development of malignant forms disease.

Treatment

For the diagnosis of glaucoma, the traditional measurement of IOP is not enough, therefore the ophthalmologist recommends more detailed types of examination:

• Perimetry- study of visual fields, both peripheral and central;
• The study of refraction- properties of various refractive media of the eye;
• Ultrasonography- obtaining detailed images of internal structures;
• Gonioscopy- Evaluation of the structure of the angle of the anterior chamber, which serves as a path for the outflow of liquid;
• MeasurementThe depth of the anterior chamber and the thickness of the lens.

A comprehensive examination allows us to draw conclusions about the nature and duration of the pathological process, if any, and start treatment on time.

Medication Therapy

The choice of therapeutic tactics is directly dependent on the nature of the disease, the degree of damage and the state of health of the patient. For treatment, drugs from the following drug groups can be prescribed:

• β-blockers: Timolol, Betaxolol. Drugs reduce the production of eye moisture and are in demand in the open-ended form of the disease;
• Holinomimetics: Pilocarpine, Carbacholin. The drugs act on the pupil and iris, facilitating the opening of the angle of the anterior chamber, thus paving the way for the exit of the ocular moisture;
• Prostaglandin analogues: Latanoprost, Travoprost. Increase the rate of penetration of ocular moisture through the choroid;
• Inhibitors of carbonic anhydrase: Dorzolamide. Reduces the rate of production of intraocular fluid;
• α-2-adrenomimetics: Clonidine. Oppresses the production of watery moisture, while contributing to its accelerated outflow;
• Vitamins: thiamine (B1), pyridoxine (B6), nicotinic acid (PP). Necessary to restore the functioning of nerve cells and protect them from toxic effects.

  Pilocarpine is used in the treatment of glaucoma

With the development of an acute attack of glaucoma, the patient needs urgent help - in this case, the account goes for hours. Otherwise, the visual function can be completely lost due to damage to the optic nerve.

First aid preparations for an attack are:

• 1% rrpilocarpineevery 15 minutes, after - after 30 minutes. ;
• , gdiacarpinside (or another diuretic).

As ancillary tools can be usedbeta-blockers, carbonic anhydrase inhibitors, osmotic and distracting agents. However, their use should only take place under the supervision of a physician. If there is no effect within 12 hours, it is recommended that the patient be hospitalized for the operation.

Surgically

If conservative treatment does not have the proper effect when using medicines, and especially when repeated attacks of glaucoma, surgical intervention is recommended, which can be carried out on 4 main types:

• Sinustrabekulectomy- the creation of a small window for outflow of intraocular fluid under the conjunctiva;
• Nonpenetrating deep sclerectomy- creating outflow paths without through holes. This type of surgery is carried out with the lowest traumatism and in a short time, which allows its outpatient application;
• Laser iridectomy- with the aid of a directed laser beam, the pupillary block is eliminated, in which the iris root overlaps the drainage zone;
• Scleranguloreconstruction- operation of choice with far-gone glaucoma.

Often glaucoma is combined with cataract, especially in old age. Therefore, the doctor can recommend a joint

replacing the lens.

Folk remedies

If you have been diagnosed with glaucoma, then conservative treatment will be lengthy and not always successful, but it will surely slow the progress of the disease. Therefore, when changing drugs, the use of folk remedies is possible:

• Squeeze juice from the grass of the lice. The course of treatment will need 6 liters of juice (8 kg of grass) with the addition of 600 ml of alcohol. Store the remedy in the refrigerator and take 50 ml shortly before meals in the morning and in the evening, washing down with boiled water. For the cure, all the juice is drunk;
• Squeeze the juice from the leaves of aloeand diluted with pure distilled water in a 1: 10 ratio. The product is used for eye rinsing 4-5 times a day for 14 days, after which it takes 16 days. For a complete cure should be 2-3 courses;
• Razirayut in a mortar for 1 hour. l. fennel seeds, then pour 200 ml of boiling water and insist for an hour. Take 1 tbsp. l. three times a day shortly before meals. The course of treatment is 2 weeks, after 10 days break and repetition of the course. Such treatment is taken several times a year;
• In 1 hour. l. of beet juice dissolve, g mumiyeand take half an hour before breakfast every day for 10 days, after which they take a break for 4 days. To cure are 4-5 courses.

Do not forget to get an ophthalmologist's advice before using folk remedies - some of them have allergenic properties, while others are contraindicated in a number of systemic diseases.

Prevention

Among the measures that prevent the development of a dangerous disease include:

• Hygiene of sight: feasible load for the eyes, gymnastics, good lighting;
• Timely treatment of ophthalmic diseases;
• Balanced and vitamin-rich diet;
• Moderate physical activity;
• Regular preventive examinations.

If the disease is already diagnosed, attention should be paid to preventive measures, as well as follow all medical recommendations. An important point here is the restriction of consumed liquids and alcohol, compliance with the diet.

Video

conclusions

Detection of glaucoma at an early stage gives good chances for inhibiting the deterioration of vision and even reversing the pathological process.

However, in the absence of a successful conservative treatment, there are still operational methods that have proven to be highly effective in practice.