Glaucoma: methods of treatment and prevention measures

There are diseases of the eyes that develop imperceptibly, but can lead to blindness. One such pathology is glaucoma. This chronic eye disease develops against a background of increased intraocular pressure. If the pressure inside the eye is constantly high, then the optic nerve dies, and this, in turn, leads to a complete loss of vision.

Glaucoma is a common disease. According to statistics, 14-15% of all the blind on the globe lost sight precisely for this reason.Can I stop the development of glaucoma and keep my eyesight?

Definition of disease

Glaucoma is an eye disease that develops almost asymptomatically.As a result, the optic nerve and the retina of the eye are damaged. Glaucoma is associated with increased intraocular pressure; without timely detection and treatment of the disease leads to blindness.

Damage to the optic nerve in glaucoma is irreversible and leads to a complete loss of vision, so it is important to identify and treat this disease in time.

The mechanism of development

In our eyes, a special liquid is constantly formed - watery moisture, which focuses in the anterior (between the cornea and the iris) and the posterior (between the iris and the lens) eye chambers.In the corner of the anterior chamber is a complex drainage system, through which watery moisture flows into the bloodstream.The balance between formation and outflow of watery moisture and determines the intraocular pressure that exerts the contents of the eyeball on its walls. In most healthy people, it ranges from 16 to 22 mm Hg.

When glaucoma in the diseased eye, the circulation is disturbed: fluid accumulates and the intraocular pressure increases. As a result, the eyeball begins to press on the optic nerve, causing its destruction.At first the patient begins to see worse, then peripheral vision is disturbed, as a result of which the zone of visibility is limited.If the optic nerve dies, there is complete blindness; these changes are irreversible.

With glaucoma, there is a sudden loss of vision as a result of an acute attack.

Forms

There are 2 main forms of glaucoma:

1. Open-angle;
2. Closed-angle.

In the second form, the fluid inside the eye accumulates because the iris overlaps the angle of the anterior chamber of the eye and closes the access to the natural drainage system of the eye. With open-angle form, access is open, but the functions of the drainage system itself are disrupted.

There is also a mixed form of glaucoma.

Causes

Intraocular pressure increases in those cases when the excretion of intraocular fluid is disrupted. There are 3 main types of glaucoma: primary, congenital and secondary.The most common primary glaucoma. There are no obvious reasons for people older than 40 years.

Congenital glaucoma is caused by abnormalities of the embryonic development of the eye: the dysgenesis of the anterior chamber angle, and also a consequence of other eye diseases (tumors, inflammation, trauma), transferred by the mother before or during childbirth.

Secondary glaucoma is a consequence of a previous eye disease. Its causes can be:

• Inflammatory eye diseases: keratitis, uveitis, scleritis;
• Lens shift;
• Cataract;
• Dystrophic diseases of the eyes;
• Contusions, burns, wounds to the eyes;
• Operations on the eyes;
• Tumor of the eye.

Myopia is a local factor affecting the development of glaucoma. Common factors include:

• Age (from 60 years);
• Heredity;
• Diabetes;
• Hypotension;
• Diseases of the thyroid gland, nervous system, etc.

Symptoms

Manifestations in which you should seek help from an ophthalmologist:

• Changing the field of view (narrowing the appearance of the lateral space);
• "Circles" or veil before your eyes;
• Sharp drop in vision;
• Frequent headaches in the frontal lobe.

Symptoms that indicate an attack of acute glaucoma:

• Strong, burgeoning pain in the eye;
• Pain near the eye;
• Nausea, vomiting;
• Heartache;
• Puffiness of the eyes;
• Increase in blood pressure.

These symptoms indicate a dangerous condition that requires emergency care and prompt treatment.

Possible complications

The complication of glaucoma is a complete loss of vision and a painful glaucoma, which can lead to the removal of the eye.

With timely treatment begun, the symptoms of glaucoma remain at the stage where the disease has been identified. It is likely that with constant therapy, the symptoms will not progress.

Treatment

There are 3 main methods of treating glaucoma:

1. Medicated (conservative);
2. Laser;
3. Surgical.

The choice of tactics for treating a patient depends on the type and form of glaucoma.

Medication

Currently, the conservative treatment of glaucoma is carried out in three main directions:

1. Therapy aimed at reducing intraocular pressure (ophthalmic hipotensive therapy);
2. Treatment, contributing to the improvement of blood supply to the inner shells of the eye and the intraocular portion of the optic nerve;
3. Therapy aimed at the normalization of metabolism in the tissues of the eye in order to influence the dystrophic processes characteristic of glaucoma.

The key point in the treatment of glaucoma is the normalization of the level of intraocular pressure (IOP). The remaining types of therapy, aimed at improving blood circulation and affecting the metabolic processes in the eye, are only auxiliary.

Medicines used in the treatment of glaucoma, are divided into 2 large groups:

1. Means that improve the outflow of intraocular fluid (VGZ) from the eye;
2. Drugs that suppress the production of watery moisture.

The first group includes:

• Myotics(Pilocarpine, Carbachol);
• Sympathomimetics(Epinephrine, Dipivefrin, Oftan-dipivevephrine);
• ProstaglandinsF2 alfa (Patanoprost, Travoprost).

Means that inhibit the production of intraocular fluid:

• Selective sympathomimetics(Clonidine, Clophelin);
• Beta-blockers(Timolol, Timogexal, Arutimol, Kuzimolol, Niolol, Betaxolol);
• Inhibitors of carbonic anhydrase(Dorzolamide, Brinzolamide);
• Combined preparations(Proxopheline, Fotil, Normoglaukon, Kosopt).

Laser treatment

Laser surgery is aimed at eliminating intraocular blocks that appear on the way outflow of intraocular fluid in the eye.

The action of lasers is based on the application of one of two methods:

1. Coagulating Lasers: application to the trabecula zone of a local burn with subsequent atrophy and scarring of its tissue.
2. Lasers-destructors: the creation of microexplosion, which is accompanied by tissue rupture and shock wave.

Many types of antiglaucomal laser operations have been proposed, but the most common are:

• Laser iridotomy (iridectomy);
• Laser trabeculoplasty.

Pros of laser surgery:

• Restoration of outflow of intraocular fluid along natural paths;
• Use of local anesthetic;
• Conducting an operation in an outpatient setting;
• The minimum period of rehabilitation;
• Absence of complications;
• Low cost.

Minuses:

• Limited effect of the operation;
• The emergence of a reactive syndrome: an increase in IOP in the first hours after laser intervention and the development of the inflammatory process in the future;
• The probability of damage to the cells of the corneal posterior epithelium and the capsule of the lens and the vessels of the iris;
• Formation of adhesions in the field of influence.

Surgical intervention

At present, the question of indications for surgical treatment of glaucoma remains open.

Most ophthalmologists believe that the main indications for the surgical treatment of glaucoma are:

• Strong and strong increase in intraocular pressure, despite the use of local medications;
• Progressive deterioration of the visual field;
• Negative dynamics of clinical data, i.e. unstabilized nature of the glaucomatous process.

The main tasks of antiglaucoma operations are:

• Decrease and normalization of IOP;
• Creation of conditions for microcirculation in the optic nerve;
• Removing the phenomena and consequences of hypoxia;
• Improvement in the nerve supply and tissue metabolism.

Types of operations for glaucoma:

• Penetrating operations, for example, trabeculectomy;
• Non-penetrating operations, among which the most popular is sclerectomy;
• Operations that normalize the circulation of aqueous humor of the intraocular apple(iridectomy, iridocyclotretraction);
• Operations aimed at reducing the production of aqueous humor (cyclocrycoagulation and laser cyclocoagulation).

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Patients with glaucoma can not:

• Drink alcohol, strong coffee and tea;
• Smoking;
• Work on harmful industries, for example, in the production of kvass and other fermentation products;
• Long to be in a position with a tilted body and head:

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Avoid a long stay in a dark room: a sudden change in light is harmful to the eyes. You can watch TV and read only in the lighted room. From visits to the cinema you need to refuse.

Prevention

After 40 years, each person should be examined by an ophthalmologist at least once or twice a year. This is especially important for people with myopia, hyperopia, hereditary glaucoma and those who have undergone eye surgery.

It should be remembered:

• Contamination of the environment, constant work at the computer and food in a hurry lead to a sharp decline in vision at a young age.
• Long work at the computer, when a person forgets to blink his eyes, provokes dry eye syndrome and a variety of chronic diseases- conjunctivitis, blepharitis. Active users of the computer should take breaks of 10-15 minutes every hour and a half of work, doing special gymnastics for the eyes, and applying special moisturizing drops.
• Continuously watch TV can not longer than 1 hours at a distance of 3 or more meters from the screen.
• Reading is safer for eyesight than working at a computer and watching TV: the eyes move all the time, which means they are moisturized.
• Children under 18 can improve their eyesight with special exercises, drops and glasses-simulators.
• It is recommended to eat foods rich in vitamin A:carrots, tomatoes, persimmons and other fruits of orange color. Useful substances are better absorbed with butter or sour cream. A good friend of the eyes is blueberry. In the season, you should eat at least 1 cup of berries a day, the rest of the time you can take blueberry preparations.
• To keep your eyesight naturally, you need to practice tennis, swimming and spend more time outdoors.

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conclusions

Early diagnosis of glaucoma is the best way to avoid blindness. The asymptomatic nature of the current of this disease makes it insidious. This means that the main measure of prevention is regular check-ups with the oculist. The patient's commitment to serious and timely treatment is one of the main factors of success in the fight against glaucoma.

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