Primary open-angle glaucoma. Open-angle glaucoma: its essence and methods of treatment Treatment of open-angle glaucoma at the initial stage
Open-angle glaucoma is a chronic pathology of the visual organs, accompanied by increased intraocular pressure and gradual atrophy of the optic nerve, which threatens complete blindness. How to recognize this disease, which is increasingly occurring in young people, as well as how to treat it, we will consider further.
Closed-angle and open-angle glaucoma - differences
There are two known forms of pathology – open-angle and closed-angle glaucoma. In both cases, the result of pathological processes in the tissues of the eye is the death of the optic nerve, leading to blindness. In our eyes, aqueous fluid is continuously formed, the outflow of which occurs through the hole located between the cornea and the iris (filtering angle).
Due to the balance of the inflow and outflow of moisture, a special constant pressure is maintained inside the eyes. If, due to various reasons, the outflow of intraocular fluid becomes difficult, it begins to accumulate, which leads to an increase in pressure. As a result, the optic nerve and other nearby tissues begin to experience constant stress, blood supply is disrupted, hypoxia occurs, and the person loses vision.
With open-angle glaucoma, the filtering angle remains as wide and open as it should be, and an obstacle to the release of moisture occurs in the deep layers of the eye. This form of the disease develops slowly, gradually. With angle-closure glaucoma, a sharp blockage of the outlet channel occurs, i.e. the anterior chamber angle becomes closed. In this case, intraocular pressure increases rapidly, and an acute attack may occur that requires immediate help.
Open-angle glaucoma - causes
Depending on the mechanism of development of the pathology, primary open-angle glaucoma and secondary are distinguished. The first type develops independently and is associated with genetic factors. It has been established that the tendency to develop pathology is determined by the structural features of the angle of the anterior chamber of the eyes. Along with this, changes in the drainage system are somewhat dependent on disorders in the endocrine system, nervous system, and blood vessels. Therefore, the disease may be associated with the following pathologies:
Secondary glaucoma develops against the background of other destructive or infectious-inflammatory eye diseases, consequences of injuries, burns, tumor processes, and intoxications. According to recent studies, the development of the disease is also influenced by factors such as a sedentary lifestyle, lack of regular physical activity, bad habits, and excess body weight.
Open-angle glaucoma - degrees
Taking into account gradual pathological changes in the tissues of the eye, often sequentially developing processes, open-angle glaucoma is divided into several degrees (stages). In this case, the level of intraocular pressure can be normal (less than 27 mmHg), moderate (from 28 to 32 mmHg) or high (more than 33 mmHg). Let us characterize all stages of open-angle glaucoma.
Open angle glaucoma 1 degree
At this stage, which is the initial stage, no pronounced pathological changes are observed. There may be increased intraocular pressure and a slight change in the visual field. A special ophthalmological examination reveals changes in the fundus - the appearance of a depression in the center of the optic nerve head (excavation). If open-angle glaucoma is detected at this stage, the prognosis of the pathology is favorable for the work capacity and life of patients.
Open angle glaucoma 2 degrees
The second stage of the pathology is called developed. Patients diagnosed with advanced open-angle glaucoma have specific complaints, and they are associated with a narrowing of the peripheral field of vision by more than 10 degrees on the side of the nose. In addition, at this stage, a concentric narrowing of the boundaries of the visual field may already be noted, not reaching 15 degrees. Upon examination, it is revealed that the excavation of the optic nerve head reaches its edge.
Open angle glaucoma grade 3
Pathological processes at this stage are considered far advanced. Secondary open-angle glaucoma detected at this stage is considered very dangerous. The visual defect is getting worse. There is a concentric decrease in the field of view in one or more segments, exceeding 15 degrees. Excavation of the optic nerve disc worsens. Often, patients with third degree glaucoma are left with tube vision, in which they look as if through a narrow pipe.
Open angle glaucoma grade 4
Diagnosed grade 4 glaucoma is the terminal stage of the disease. In most cases, a person has already completely lost vision in one or both eyes. Some patients are still able to see poorly due to a small “island” of the visual field. In addition, it is possible to preserve light perception, however, if the projection of light rays is incorrectly determined. If it is possible to examine the fundus, optic nerve atrophy is established.
Open-angle glaucoma - symptoms
In the early stages of primary open-angle glaucoma, the symptoms are so mild that few patients worry and consult an ophthalmologist. You should be alert to the following signs that appear regularly or from time to time:
Open-angle glaucoma - diagnosis
Often, the diagnosis of “open-angle glaucoma” is established by chance during routine professional examinations or examination in an optician’s office. The complex of diagnostic measures when open-angle glaucoma is suspected includes the following studies:
How to treat open-angle glaucoma?
From the moment open-angle glaucoma is discovered, treatment must be carried out continuously. It is not yet possible to completely heal the organs of vision, but the disease can be controlled and its progression can be stopped. Treatment for open-angle glaucoma is based on conservative and surgical techniques, depending on the characteristics of the pathology. The main medical task in this case is to prevent or reduce damage to the optic nerve. This requires:
- reduce intraocular pressure;
- reduce or eliminate hypoxia of the ocular tissues (especially the optic nerve head);
- restore impaired metabolism in the eyeball;
- correct concomitant pathologies.
In the early stages, conservative therapy is often effective, providing various drugs for open-angle glaucoma, both local and systemic. In addition to them, physiotherapeutic techniques are sometimes used, including electrical stimulation of the optic nerve head. If such treatment achieves good results, the patient continues it, periodically, at least twice a year, being examined by an ophthalmologist. Treatment adjustments may be necessary if deterioration of the optic nerve is detected.
Drugs for the treatment of open-angle glaucoma
As a local therapy, eye drops are used for open-angle glaucoma, which should be used regularly, strictly on time. These drugs have different directions of action. Let's look at what drops can be prescribed for open-angle glaucoma (list):
If eye drops do not sufficiently control the pressure inside the vowel apple, additional systemic drugs are prescribed:
In addition, to improve blood supply to the optic nerve and protect nerve cells, vascular drugs, antioxidants, and vitamins are prescribed:
Surgical treatment of open-angle glaucoma
In severe cases, conservative therapy does not bring the desired effect, and surgical techniques are recommended to reduce intraocular pressure. At the same time, regardless of the type of operation, vision cannot be improved and completely cured. In cases where grade 4 open-angle glaucoma is diagnosed, surgery may be useless, and if residual vision is preserved, even lead to its complete loss.
Operations are divided into two types:
Glaucoma
Glaucoma is a group of diseases often characterized by increased intraocular pressure (IOP), but not always, changes in the visual field and pathology of the optic nerve head (excavation up to atrophy).
This is what a person with glaucoma sees:
Causes of glaucoma
Risk factors for developing the disease:
- increased IOP (ophthalmohypertension)
- age over 50 years
- ethnicity (glaucoma is more common among the Negroid race)
— chronic eye diseases (iridocyclitis, chorioretinitis, cataracts)
- history of eye injuries
– general diseases (atherosclerosis, hypertension, obesity, diabetes mellitus)
- stress
- long-term use of certain medications (antidepressants, psychotropic substances, antihistamines, etc.)
— heredity (in families where one of the relatives has glaucoma, there is a risk of developing the disease)
Glaucoma can be congenital or acquired. The first type is associated with disorders of eye development in the embryonic period of development. Often these are intrauterine infections - rubella, influenza, toxoplasmosis, mumps, or maternal diseases and the influence of damaging factors (severe endocrine pathologies, exposure to high temperatures and radiation).
The main types of acquired glaucoma are primary (open-angle, closed-angle, mixed) and secondary (inflammatory, phacogenic, vascular, traumatic, postoperative).
Symptoms of glaucoma
Signs of open-angle glaucoma include ocular hypertension (periodic or constant increase in pressure), loss of the visual field (in this case, a person cannot see part of the surrounding objects).
Open angle glaucoma
Open-angle glaucoma is divided into stages (according to the degree of development of clinical signs) and the level of intraocular pressure.
Stages of primary open-angle glaucoma:
Stage I (initial) - there are no changes in peripheral vision, but there are small changes in central vision (paracentral scotomas, in the Bjerrum zone, widening of the blind spot), excavation of the optic nerve nipple, not reaching its edge.
Stage II (developed) - narrowing of the peripheral visual field by more than 10 degrees on the nasal side or concentric narrowing not reaching 15 degrees from the point of fixation, excavation of the optic disc (marginal)
Stage III (far advanced) - characterized by a concentric narrowing of the field of view and in one or several segments more than 15 degrees from the point of fixation, excavation of the optic disc.
Stage IV (terminal) - complete absence of vision or light perception with incorrect projection, possible residual vision in the temporal region. If the media of the eye are transparent and the fundus is visible, then optic nerve atrophy is present.
Stages of glaucoma
There are 3 degrees of intraocular pressure:
A-normal IOP (up to 27 mm Hg)
B-moderate IOP (28-32 mm Hg)
C-high IOP (more than 33 mm Hg)
Glaucoma with normal intraocular pressure is distinguished separately. In this case, characteristic loss of the visual field is present, excavation develops with subsequent atrophy of the optic nerve nipple, but IOP is normal.
Angle-closure glaucoma
Angle-closure glaucoma occurs in cases of complete or partial block of the iridocorneal angle, through which the outflow of aqueous humor occurs. Provoking factors: small eyes (farsightedness often develops), small anterior chamber, excessive production of intraocular fluid, large lens, narrow iridocorneal angle (UCA). There is a periodic increase in IOP, the extreme manifestation of which is an acute attack of glaucoma, which can be caused by prolonged exposure to a dark room or at dusk, a large amount of fluid drunk, or emotional stress. Severe pain appears in the eye, radiating to the corresponding half of the head, redness, rainbow circles when looking at a light source.
Acute attack of glaucoma
This condition requires immediate treatment.
Depending on the degree of progression, stabilized and unstabilized glaucoma is also distinguished (according to acuity and visual field).
Depending on the degree of compensation, glaucoma can be compensated (no negative dynamics), subcompensated (there are negative dynamics) and decompensated (an acute attack of glaucoma with a sharp deterioration in visual functions).
Glaucoma can be asymptomatic for a long time and patients seek help when some visual functions have already been irretrievably lost.
Symptoms for which you should see a doctor to stop the progression of the disease:
— loss of field of vision (some objects are not visible)
- rainbow circles when looking at a light source
- blurred vision
- frequent changes of glasses
- pain in the superciliary area
Diagnosis of glaucoma
1. Ophthalmological examination:
— visometry (even with tubular vision, visual acuity can be 100%)
— perimetry, incl. computer Detects the slightest changes in the field of view.
- campimetry - study of the blind spot (an area in the visual field that a person normally does not see) - normally 10-12 cm
- biomicroscopy (dilation of conjunctival vessels, emissary symptom (deposition of pigment along the anterior ciliary vessels), cobra symptom (dilation of the episcleral veins in the form of a funnel before their perforation of the sclera), iris dystrophy and pigmented precipitates are visible)
- gonioscopy - examination of the iridocorneal angle using a goniolens (determine the size of the anterior chamber angle)
— tonometry according to Maklakov (norm 16-26 mm Hg), non-contact tonometry (not an accurate method, used for mass research)
— tonography — tonometry for 4 minutes using an electronic tonograph. Normal indicators:
P0=10-19 mmHg (true intraocular pressure)
F=1.1-4.0 mm3/min (minute volume of intraocular fluid)
C=0.14-0.56 mm3/min/mmHg. (outflow ease factor)
KB= 30-100 (Becker coefficient= Р0/С)
- ophthalmoscopy (excavation of the optic nerve head is determined) and examination with a Goldmann lens
Excavation of the optic nerve head
- optical coherence tomography of the retina (determines the slightest changes in the optic nerve head)
- Heidelberg retinotomography
- rheoophthalmography (determine the degree of ischemia or hypervolemia of each eye)
- stress tests (help in the diagnosis of angle-closure glaucoma - dark, orthoclinostatic, with mydriatic). At the same time, the pupil dilates, the angle of the anterior chamber closes, and symptoms of an acute attack occur.
2. General examination - clinical blood and sugar tests, biochemical blood test, consultations with a therapist, cardiologist, neurologist, endocrinologist to identify concomitant pathologies that can provoke the onset or development of complications in patients with glaucoma.
Glaucoma treatment
There is no cure for glaucoma, you can only stop the progression of the disease. Treatment is prescribed only by a doctor.
Types of treatment used for glaucoma:
1. Local medicinal treatment:
- prostaglandin derivatives (increase the outflow of intraocular fluid) - Travatan, Xalatan - instill 1 drop into each eye before bedtime
- β-blockers - reduce the production of aqueous humor - (non-selective (do not have side effects on the heart and bronchi, contraindicated for people with bronchospasm) and selective) - Timolol (Arutimol, Kusimolol 0.25% or 0.5%), Betoptik and Betoptik S. Instilled every 12 hours.
- miotics - pilocarpine 1% - used for angle-closure glaucoma (the pupil is narrowed, the root of the iris extends from the angle of the anterior chamber, thereby opening it) - 1 drop up to 3 times a day.
— carbonic anhydrase inhibitors reduce the production of intraocular fluid (Azopt, Trusopt) - 1 drop 2 times a day.
First, 1 drug is prescribed (usually prostaglandin derivatives). If there is no effect, add other drops, for example?-adrenergic blockers. Treatment is selected only by a doctor, because Some drugs are toxic and have many contraindications.
Antihypertensive drops are used continuously to slow the progression of glaucoma.
2. Neuroprotectors are necessary, because Glaucoma affects nervous tissue. There are direct and indirect (they improve microcirculation and indirectly affect neurons). Direct vitamins include vitamins C, A, group B, emoxipine, mexidol, histochrome, neuropeptides (retinalamine, cortexin), indirect - theophylline, vinpocetine, pentoxifylline, nootropics, hypocholesterolemic drugs. The patient undergoes a course of drug therapy in the hospital 1-2 times a year.
3. Physiotherapeutic treatment includes the use of methods such as electrical stimulation of the optic nerve, magnetic therapy, laser therapy.
4. If drug therapy is ineffective, surgical treatment (laser or traditional) is indicated.
Glaucoma attack
An acute attack of glaucoma requires immediate treatment. There is bursting pain in the eye, radiating to nearby areas, nausea and vomiting, and there may be oculocardial syndrome. On examination, a mixed injection, an edematous cornea, a small anterior chamber, a dilated pupil, bombardment (bulging) of the iris, the fundus of the eye is not clearly visible, and the optic nerve with hemorrhages are found. The eye acquires a stone density.
First of all, they ask the patient when was the last time he had bowel movements and urination, and measure blood pressure (BP). These conditions contribute to increased blood pressure. When you have a bowel movement, vasospasm is relieved, and there is a high probability that IOP will quickly decrease.
Be sure to frequently instill pilocarpine 1% and timolol 2 times a day. Intramuscular anesthetics (promedol, analgin). Distraction therapy is used (for example, mustard plasters on the back of the head). They take Diacarb with asparkam and Lasix intramuscularly under blood pressure control. After stopping the attack, surgical treatment is recommended.
Surgical treatment of glaucoma
Main types of laser treatment: laser iridectomy(form a hole in the iris), trabeculoplasty(improves trabecular permeability).
Iridectomy
There are many methods of microsurgical treatment. The most widely used method is sinustrabeculectomy. in which a new path for the outflow of aqueous humor is formed under the conjunctiva, and from there the liquid is absorbed into the surrounding tissues. Other operations are also possible - iridocycloretraction(expand the angle of the anterior chamber), sinusotomy(improved outflow), cyclocoagulation(production of aqueous humor decreases).
Folk remedies are ineffective. Patients only waste valuable time on their treatment while the disease progresses.
Complications of glaucoma
Complications due to untimely or irrational treatment: blindness, terminal painful glaucoma leads to removal of the eye.
Prevention of glaucoma
Prevention consists of early detection of the disease. If you have risk factors, you should regularly visit an ophthalmologist for examination and measurement of intraocular pressure.
Patients with glaucoma must observe a work-rest regime, dosed physical activity is not contraindicated, bad habits are excluded, you should not drink large amounts of liquid, wear clothes that may impede blood flow in the head area (tight ties, collars).
Ophthalmologist Letyuk T.Z.
Causes
Open-angle glaucoma develops when the outflow of fluid (aqueous humor) from the anterior chamber of the eye is impaired due to obstruction of the drainage system. This leads to the accumulation of fluid in this area, an increase in intraocular pressure and gradual long-term compression of the optic nerve. Open-angle glaucoma causes a slow, gradual and invisible decrease in vision for the patient.
Open-angle glaucoma can be primary or secondary. Primary open-angle glaucoma develops independently, causing the appearance of the main symptoms of the disease. The causes of this disease most often cannot be determined. Many researchers believe that this is due to imperfect diagnostics. The development of glaucoma is promoted by myopia, family history, difficult working conditions, emotional stress, intoxication, and so on.
Secondary open-angle glaucoma develops against the background of various eye diseases, which lead to a “breakdown” of the drainage system. These can be infectious-inflammatory, metabolic-dystrophic diseases, intoxication, tumors, consequences of injuries, burns, etc.
In addition, provoking factors causing primary and secondary forms of glaucoma are:
Open-angle glaucoma is predominantly diagnosed in elderly patients. Open-angle glaucoma, which often has no symptoms at all, is characterized by a gradual increase in intraocular pressure, which occurs as a result of the slow aging process of the channel through which the outflow of fluid is ensured. Given the absence of symptoms, patients, accordingly, often have no idea at all that they are developing glaucoma. Meanwhile, the course of the disease is sometimes accompanied by symptoms such as some blurred vision, as well as the appearance of rainbow circles when focusing on light sources. As for other types of subjective sensations, most patients do not have them.
A characteristic feature of open-angle glaucoma is the development of dystrophic changes affecting the tissues of the canals, and these changes can correspond to different levels of severity. In addition, Schlemm’s canal is blocked, which acts as a channel that ensures the outflow of intraocular fluid. Open-angle glaucoma can also manifest itself as a variant in which intraocular pressure is low, quite often combined with such a common disease as persistent vegetative-vascular dystonia. Based on the characteristics of the development of open-angle glaucoma, the following stages are distinguished:
- Stage I. This stage is the initial one, no changes in peripheral vision are observed within its framework, however, within the framework of central vision of a small type, changes are still present, excavation is noted affecting the optic nerve nipple (this manifests itself in the form of the appearance of a depression formed in its disk, which can be detected during ophthalmoscopy);
- Stage II. This stage is defined as developed, it is characterized by a narrowing in the peripheral field of vision exceeding 10° on the nasal side or a concentric narrowing, the limits of which do not exceed 15° from the point of fixation.
- Stage III. This stage is defined as the advanced stage. It is characterized by a narrowing either in segments (in one or several), in which there is an excess of 15° from the point of fixation, or by a concentric narrowing characteristic of the visual field.
- Stage IV. This stage is defined as terminal, which means in a particular case either absolute loss of vision or light perception due to incorrect projection. If the media of the eyes are transparent and the fundus can be seen, we can talk about optic nerve atrophy.
The narrowing that is relevant for the peripheral visual field can be explained by a change in vision to such a variant in which patients are able to clearly see only the space that is located directly in front of them, but with the exclusion of visibility of the rest of the space surrounding its visible part. In considering the later stages of the disease, it can be noted that patients retain only tubular vision, in which the visible area is perceived as a small picture; according to the definition of this type of vision, an analogy can be drawn with the perception of visible areas, in which the patient could look at them, using a long tube.
In accordance with the level of current intraocular pressure, the patient can be classified into one of the following degrees: normal intraocular pressure (A) - within 27 mm Hg. Art.; moderate intraocular pressure (B) – within 28-32 mm; high (C) – pressure exceeding 33 mmHg. Art.
Separately, it is customary to distinguish glaucoma, in which intraocular pressure corresponds to normal values. The symptoms are accompanied by loss of the visual field characteristic of glaucoma, the development of excavation and further atrophy of the optic nerve, which is also accompanied by normal intraocular pressure.
The following can be identified as negative factors influencing the course of this form of glaucoma and its subsequent development:
Due to these factors, the blood supply to the brain deteriorates, as does the blood supply to the eye, as a result of which, in turn, visual functions also suffer.
Primary
Chronic glaucoma, also known as primary open-angle glaucoma (POAG), is often called the “silent thief of vision” because it develops asymptomatically. The pressure in the eye slowly increases, and the cornea adapts to this without any protrusion. Therefore, most often the disease goes unnoticed. If there is no pain, then the patient usually does not even suspect that he is slowly losing vision until the disease reaches a later stage. However, vision gradually deteriorates and the damage becomes irreversible.
In open-angle glaucoma, there is an imbalance between the production and outflow of clear fluid (aqueous humor) filtering through the anterior chamber of the eye. This can occur if the ciliary body produces very large amounts of this fluid or the drainage channels (trabecular meshwork) in the anterior chamber are blocked, causing increased intraocular pressure.
However, more than 2/3 of patients with increased intraocular pressure (more than 21 mm Hg) do not experience loss of visual fields or widening and deepening of the optic disc excavation. This condition is called ocular hypertension.
It is known that factors in the development of open-angle glaucoma are trauma, uveitis, and treatment with steroid drugs. While steroid therapy of any kind can increase intraocular pressure, topical and parabulbar steroids are more likely to increase intraocular pressure.
As with other forms of glaucoma, treatment includes anti-glaucoma eye drops. Laser or other surgical treatments may also be recommended as a way to lower IOP.
Taking prescribed medications regularly is extremely important to prevent vision-threatening damage. Therefore, it is important for the patient to discuss side effects with the doctor in order to choose the most suitable drug for himself.
Treatment
Open-angle glaucoma can be controlled, but it cannot be completely cured, so treatment must be carried out continuously, from the moment it is detected in the patient. If glaucoma is detected, before prescribing and selecting a therapy method, the patient is examined in an inpatient or outpatient setting.
Treatment of open-angle glaucoma can be conservative or surgical, depending on the stage and severity of the disease. The goal of any therapy is to control and reduce intraocular pressure.
In the initial stages of the disease, conservative therapy, which includes topical eye drops, is successfully used. The principles that are used in conservative therapy are as follows:
In addition, conservative therapy can use physiotherapeutic methods of treatment (for example, electrical stimulation of the optic nerve head) and intraocular injections with a mixture of vitamins and minerals. If such therapy gives good results and the blood pressure normalizes, then the patient is simply examined periodically (once every 6 months), using eye drops regularly and strictly by the hour.
Treatment of open-angle glaucoma with surgery is carried out in cases where conservative therapy methods do not have the expected effect. This form, compared to angle-closure glaucoma, is easier to treat, including surgery.
The operations are performed using a laser and conventional eye microsurgery. Laser treatment is one of the innovative methods of therapy and is successfully used in the initial stages of the disease, as long as there is no atrophy of the optic nerve.
Primary open-angle glaucoma is simple chronic glaucoma, usually bilateral, but not always symmetrical.
Primary open-angle glaucoma is characterized by:
1. Defeat of adults.
2. Level of intraocular pressure (IOP) > 21 mm Hg. Art.
3. An open angle of the anterior chamber (ACA) without changes in its structure.
4. Glaucomatous damage to the optic nerve.
5. Visual field defects.
Primary open-angle glaucoma is the most common type of glaucoma (1:100) in the population aged 40 years. The incidence of the disease in men and women is approximately the same.
Risk factors and their relationship
1.Age.
Primary open-angle glaucoma is usually diagnosed after 65 years. A diagnosis of glaucoma at age 40 is not typical.
It has been reliably established that in people with black skin, primary open-angle glaucoma develops earlier and is more aggressive than in people with white skin.
3. Family history and heredity.
Primary open-angle glaucoma is often inherited in a multifactorial pattern. Intraocular pressure, ease of aqueous humor outflow, and optic disc size are genetically determined. First-degree relatives are at risk for developing primary open-angle glaucoma, but the degree of risk is unknown, because the disease develops at an older age and requires long-term observation to confirm the fact of inheritance. A conditional risk of developing the disease in siblings (up to 10%) and offspring (up to 4%) is assumed.
4.Myopia.
Patients with myopia are more susceptible to the damaging effects of increased levels of ophthalmotonus.
5.Retinal diseases.
Central retinal vein occlusion is often associated with long-term primary open-angle glaucoma. Primary open-angle glaucoma occurs in approximately 5% of patients with retinal detachment and 3% with retinitis pigmentosa.
Source zrenue.com
As a result of increased IOP, pressure increases on the fibers of the optic nerve, which transmit visual images to the brain. This leads to a deterioration in blood supply, depriving tissues of oxygen and nutrients. Over time, high blood pressure leads to irreversible damage to the optic nerve and loss of vision.
POAG is a chronic disease that can be inherited. There is currently no treatment for this pathology, but its progression can be slowed down or stopped. Due to the lack of symptoms, many patients find it difficult to understand the need for lifelong use of expensive drugs, especially when taking these drugs is burdensome and has a lot of side effects.
Source vseoglazah.ru
Symptoms
The onset is sudden and usually asymptomatic. The patient may not even notice the progressive narrowing of visual fields until late in the course of the disease. Routine intraocular pressure testing and optic disc ophthalmoscopy can detect open-angle glaucoma in the absence of symptoms. The diagnosis is based on an anatomically normal state of the anterior chamber angle and outflow tract (gonioscopically), increased resistance to the outflow of intraocular fluid (tonographically), and narrowing of the peripheral visual fields (measured by quantitative perimetry).
Although with open-angle glaucoma, intraocular pressure is usually more than 21 mm. rt. Art. it may be within the normal range, but still too high to be acceptable for a given eye. Over time, atrophy of the optic disc is observed (expressed in the appearance of pathological excavation and blanching of the disc), indicating advanced disease. When the pressure is more than 21 mm. rt. Art. but the patient has no visual field defects, the diagnosis is ocular hypertension. The optic nerve usually appears normal. Patients with this condition should be followed up at least every 6 months for visual field testing, but treatment is usually not indicated at this stage.
Differential diagnosis
Differential diagnosis should be carried out with megalocornea, traumatic lesions of the cornea, congenital dacryocystitis, combined congenital glaucoma (Peters syndrome, Marfan syndrome, sclerocornea, etc.).
Source ophthalmolog.com.ua
The slightest suspicion of glaucoma requires a detailed examination in specialized offices or even in a hospital.
Patients with glaucoma should be monitored by an ophthalmologist (visit a doctor 2-3 times a year, and more often if necessary), who monitors the field of vision, visual acuity, level of intraocular pressure, and the condition of the optic nerve. This makes it possible to judge the dynamics of the pathological process, promptly change the medication regimen, and, in the absence of normalization of intraocular pressure under the influence of drops, recommend a transition to surgical treatment - traditional or laser. Only such a set of measures can help preserve visual functions for many years. Any antiglaucoma operation aims only to reduce intraocular pressure, i.e., in essence, it is a symptomatic method of treatment. It does not imply improvement in visual function or elimination of glaucoma.
Source ilive.com.ua
Drug treatment
Typically, treatment for glaucoma begins with the use of medications that reduce intraocular pressure. This traditional approach to treating the disease can be quite effective in some cases, but often has serious drawbacks. Very often, drugs cannot provide a sufficient level of blood pressure reduction. With prolonged use, the effectiveness of drugs may decrease. Eye drops must be instilled at specified intervals, which is not always possible and somewhat complicates the patient’s life. In addition, drugs that reduce intraocular pressure worsen the already reduced blood supply to the eye, and often have side effects such as progression of existing cataracts, pupil constriction, and progressive narrowing of the visual field. It is absolutely obvious and proven that glaucoma cannot be cured with the help of medications: the fight is not with the disease, but only with the symptom. At the same time, the fight is very, very expensive. In this regard, the feasibility and even necessity of early surgical treatment of glaucoma at the slightest signs of progression is recognized by the majority of domestic and foreign ophthalmologists.
Surgical treatment of glaucoma
To treat glaucoma, filtering operations are most often used, with the help of which new pathways for the outflow of fluid from the eye are created - deep sclerotomy (DSE) and non-penetrating deep sclerectomy (NGSE). The peculiarity of the latter is that for the outflow of fluid from the anterior chamber of the eye, not through holes are used, but the natural permeability for moisture of the surgically thinned peripheral portion of the inner membrane of the cornea (see diagram below). The most important advantage of NGSE is that the operation is performed without opening the eyeball, reduces the risk of complications, and allows the time of postoperative treatment of the patient to be reduced to several days.
The main problem of the listed antiglaucomatous operations is, in some cases, rapid scarring and, as a result, partial closure of the created pathways for the outflow of fluid from the eye. Therefore, we use implantation of artificial drainages that maintain a constant outflow of fluid from the eye.
Source kozhuhov.ru
Operation
Surgery for open-angle glaucoma is performed to improve the outflow of intraocular fluid by creating new pathways for the outflow of aqueous humor. Some forms of surgery are used to open old drainage pathways. The most commonly used procedures are laser trabeculoplasty, laser cilioablation, or filter surgery.
It must be remembered that surgery does not prevent the development of degenerative processes, especially if the patient is of advanced age and has a lot of concomitant diseases. Therefore, in some cases, repeat surgery may be necessary. In any case, you must adhere to the following rules:
After 40 years, undergo an examination by an ophthalmologist once a year and measure intraocular pressure.
In case of existing family history and other eye diseases (myopia, cataracts and others), regardless of age, undergo a preventive examination.
If vision deterioration and other symptoms of glaucoma occur, immediately seek help and undergo a full examination.
Source tvoelechenie.ru
All operations for glaucoma can be divided into four types:
fistulizing (penetrating) operations, of which the most common is trabeculectomy; during this operation, a hole (fistula) is made in the wall of the eyeball for permanent drainage of the eye cavity;
non-fistulizing (non-penetrating) operations; an example of such an operation is non-penetrating deep sclerectomy (NSDS); the integrity of the eyeball is not compromised, fluid is removed from the eye due to the thinning of a small area of the sclera through natural pores;
operations that normalize the circulation of intraocular fluid inside the eyeball; such operations include iridectomy, iridocycloretraction and some others;
operations aimed at reducing the production of intraocular fluid; these are cyclocryocoagulation and laser cyclocoagulation.
Surgeries for open-angle glaucoma
Open-angle glaucoma is characterized by the fact that a violation of the outflow of intraocular fluid from the anterior eye chamber occurs due to “breakdowns” in the drainage system, through which excess moisture is removed from the room. Today, non-penetrating deep sclerectomy (NPDS) is most often performed for open-angle glaucoma. This operation is much less traumatic than a conventional fistulizing operation, since it is performed without violating the integrity of the eyeball.
The advantages of NGSE are the absence of gross disruption of the natural mechanism of outflow of intraocular fluid, IOP is reduced to normal and remains stably at this level, it is possible to perform several operations on one eye (for example, NGSE and cataract removal), low risk of infection and postoperative complications
Source womenhealthnet.ru
Drugs
In order to normalize ophthalmotonus, the use of antihypertensive drugs or increased drop regimen is indicated if the diagnosis of glaucoma has already been made and an increase in intraocular pressure has occurred during the treatment. A hypotensive effect can be achieved by using agents that affect the outflow of aqueous humor and its secretion. The first group includes the miotic pilocarpine.
Timolol maleate (arutimol, timoptic, ocupress, optimol) affects the level of ophthalmotonus through inhibition of the secretion of intraocular fluid. Currently, clonidine is one of the drugs for the treatment of both open- and closed-angle glaucoma. A contraindication to its use is arterial hypotension.
Patients with glaucoma need to receive courses of maintenance therapy 1-2 times a year, including vasodilators, B vitamins. If intraocular tone is not normalized by local therapy, you can try to reduce intraocular pressure by prescribing drugs orally. If well tolerated, Diacarb can be used in courses while taking drugs containing potassium (panangin, potassium orotate). However, if drug treatment for glaucoma is ineffective and in the absence of contraindications from the general health of the patient, it is necessary to switch to more radical methods of treatment at an early stage - laser or pathogenetically targeted surgery.
Source megabook.ru
Treatment of patients with primary glaucoma usually begins with instillation of solutions of cholinomimetic drugs, most often a 1% solution of pilocarpine hydrochloride 2-3 times a day. Pilocarpine improves the outflow of aqueous humor from the eye, which leads to a decrease in intraocular pressure.
If treatment with a 1% solution of pilocarpine hydrochloride does not lead to normalization of intraocular pressure, instillation of a 2% solution of pilocarpine 3 times a day is prescribed. If 3-fold instillations are insufficient, extended-release pilocarpine solutions are used. These drugs are used 3 times a day. Pilocarpine hydrochloride in ophthalmic medicinal film is also used 1-2 times a day and 2% pilocarpine ointment at night.
Other cholinomimetic agents (1-3% solutions of carbacholine or 2-5% solutions of aceclidine) are used much less frequently.
If cholinomimetic drugs are insufficiently effective, prozerin, phosphakol, armies or tosmilen are additionally prescribed; the frequency of administration 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.
For patients with open-angle glaucoma with low or normal blood pressure and insufficient effectiveness of pilocarpine hydrochloride, 1-2% solutions of adrenaline hydrotartrate, dipivalyl epinephrine, isoptoepinal are added, or adrenopilocarpine is prescribed 2-3 times a day. The hypotensive effect of adrenaline is due to a decrease in the production of aqueous humor and partly by improving its outflow.
For the treatment of patients with open-angle glaucoma, 3% and 5% solutions of fethanol are used along with pilocarpine. Compared to adrenaline, fethanol has a longer and milder effect on blood vessels, therefore it is indicated for patients with glaucoma combined with the initial stage of hypertension. The hypotensive effect of fethanol is mainly due to a decrease in the secretion of aqueous humor.
It is possible to use instillation of a 0.5% solution of clonidine (hemiton). The hypotensive effect of clonidine is explained by the inhibition of the secretion of aqueous humor, as well as the improvement of its outflow. Monitoring the effectiveness of treatment should be carried out 2-3 times a month.
1% anaprilin, 1% propranolol, 0.25-0.5% optimol are also used in the form of eye drops. The hypotensive effect of these drugs is due to a decrease in the secretion of aqueous humor; they do not change the size of the pupil and do not affect blood pressure.
If local antihypertensive therapy for open-angle glaucoma is insufficiently effective, it is supplemented with short-term prescription of general antihypertensive drugs: carbonic anhydrase inhibitors (Diamox, Diacarb), osmotic (glycerol) and neuroleptic drugs (aminazine).
Carbonic anhydrase inhibitors reduce the production of intraocular fluid, which leads to a decrease in intraocular pressure. These drugs are especially effective for hypersecretory glaucoma. Diacarb is prescribed orally at 0.125-0.25 g 1 to 3 times a day. After 3 days of taking Diacarb, it is recommended to take a break for 1-2 days. Glycerol and aminazine are prescribed once for acute increases in intraocular pressure.
Source medkurs.ru
Treatment is more successful if it is started early. When vision is already severely affected, treatment can only prevent further deterioration, but it is usually not possible to completely restore vision.
Eye drops with appropriate medications can control open-angle glaucoma. As a rule, first of all, drops with beta-blockers are prescribed, which reduce the production of fluid in the eye, for example, timolol, betaxolol. Pilocarpine, which constricts the pupil and increases the outflow of aqueous fluid from the anterior chamber, is less effective. Other drugs used, such as epinephrine, dipivefrin and carbachol, either improve outflow or reduce fluid production. Carbonic anhydrase inhibitors, such as acetazolamide (Diacarb), can be taken orally, and dorzolamide 2% (Trusopt) can be used as eye drops.
If the drug fails to control intraocular pressure or if severe side effects occur, the eye surgeon may restore outflow from the anterior chamber using laser energy or microsurgical techniques. The purpose of such surgery is to create new pathways for the outflow of moisture or open existing ones.
Source zdorovieinfo.ru
Prevention
To prevent the occurrence of open-angle glaucoma, patients should adhere to certain rules. So, patients over forty years of age, and without exception all sixty-year-olds, who have a greater risk of developing glaucoma than others, need to measure their intraocular pressure every day and undergo examination by an ophthalmologist. This may not be the most effective method, but still, with its help, more than half of the people with glaucoma were identified. Intraocular pressure is measured using an anaplanation tonometer or a Schiotz tonometer. A special substance is instilled into the eye and then a tonometer is carefully and gently placed directly on the center of the cornea. The patient, at this time, should be in a supine position and look at the finger of his straight raised hand. The doctor takes readings from the tonometer and converts this value, using special charts, into millimeters of mercury.
Glaucoma is one of the most dangerous eye diseases, second on the list of eye pathologies leading to complete blindness. The most common form of the disease is open-angle glaucoma - this is such an asymptomatic disorder in the functioning of the eye that sometimes a person notices his blindness too late.
It is impossible to predict or prevent this disease; the disease develops independently, against the background of complete well-being. At risk, in terms of the frequency of pathology diagnosis, are primarily older patients over 45 years of age, but young people are not insured either. Even babies suffer from congenital open-angle glaucoma.
is a disruption of the normal circulation of aqueous humor in the chambers of the eye, which leads to increased intraocular pressure (IOP) and gradual loss of vision from the periphery to the center, with tunnel vision syndrome.
The eye has two chambers: the anterior one, in which the outflow of intraocular fluid occurs, and the posterior one, in which aqueous humor is produced by ciliary cells from the blood. Between these chambers is the iris and lens. They do not have their own vessels to supply oxygen and nutrients, since they are part of the optical system of the eye and must be as transparent as possible. They are supplied with all the necessary microelements by aqueous humor, which normally circulates and is maintained in a certain amount by the hydration system of the eye.
Problems begin when the outflow of fluid that occurs through the drainage system of the eyeball becomes difficult. This leads to a gradual increase in IOP, displacement of the lens and cornea, and pressure on the vitreous body, behind which the vasculature and retina are located. Mechanical compression of the vessels of the eye leads to disruption of microcirculation and oxygen supply to the retina, and without oxygen, visual cells die, which leads to loss of part of the visual field.
The open-angle (hidden) form of glaucoma over time, in chronic latent mode, leads to complete atrophy of the optic nerve and blindness. Unfortunately, this condition is irreversible, so early diagnosis is important to avoid disability.
You can learn more about what open-angle glaucoma is from the video:
Classification
Pathology with obstructed outflow in the drainage network of not a mechanical, but a dystrophic nature occurs:
- open angle;
- narrow angle.
Narrow-angle glaucoma is also often called acute-angle or wide-angle glaucoma.
Primary open-angle glaucoma – newly diagnosed. Divided into types:
- Simple glaucoma – age-related degenerative and dystrophic changes.
- Pigmentary glaucoma is the exfoliation of iris pigment, which leads to the blocking of drainage channels by these particles.
- Exfoliative glaucoma is the release of a white protein substance of unknown nature into the cavity of the chambers, which mechanically blocks the outflow.
- Pseudoexfoliative glaucoma is a violation of the production of intraocular fluid and the release of atypical fibers of the protein structure.
Secondary(acquired) is divided into types:
1. Phacogenic glaucoma is a consequence of complications of diseases or injuries, it happens:
- phacotopic glaucoma – violation of the integrity of the lens, displacement, dislocation;
- phacomorphic form - an increase in the volume of the lens, the initial stages of cataracts;
- phacolytic form - overripe cataract, the outflow is clogged with protein compounds from the lens.
2. Uveal – after inflammatory processes.
3. Vascular – associated with thrombosis and increased pressure in the eye.
4. Traumatic – based on damage to the eyes by chemical, thermal and other means.
5. Degenerative – in patients with uveopathy.
6. Neoplastic – precedes the appearance of malignant and benign neoplasms.
Primary open-angle glaucoma by stages:
- Glaucoma of the 1st degree is an asymptomatic period; the presence of open-angle glaucoma can be determined using hardware at an appointment with a doctor. Changes are noticeable in the fundus; a depression appears in the center of the optic nerve head. Increased intraocular pressure can also be diagnosed.
- Pathology 2nd degree - at this stage, tangible clinical signs of damage to the optic nerve already appear in the form of a narrowing of the visual field and tunnel vision syndrome.
- Pathology 3 degrees - almost the entire visual field is affected, possibly asynchronously between both eyes, advanced stage.
- Pathology of the 4th degree is the stage of blindness, it is impossible to restore at least some vision at this stage, this is a stage of disability.
Pigmentary glaucoma and pseudoexfoliative glaucoma have not been fully studied, and the exact cause has not yet been identified. True, the tendency to secrete a protein deposit, which characterizes the pseudoexfoliative form, can be detected in the early stages before the onset of the disease.
Difference between closed-angle and open-angle glaucoma
As we have already found out above, according to the mechanism of disruption of the outflow of intraocular fluid, there are open-angle and glaucoma. The difference between these two forms lies in the nature of the disruption of outflow through the trabecular meshwork. The fact is that anatomically the drainage network is located in the corner of the anterior chamber of the eye, between the cornea and the iris. This angle in the open-angle form is not changed (open), and the outflow is disrupted due to the narrowing of the vessels of the drainage network itself. In the case of the angle-closure form of the pathology, the angle is blocked by the iris and outflow is simply impossible mechanically.
Also, these two forms differ in symptoms. The open-angle form is characterized by a gradual increase in IOP, an asymptomatic period, a period of manifestation of the first visual disturbances and exacerbation at critical values of aqueous humor pressure. In the angle-closure form, the clinic is represented by an acute attack, during which, if medical care is not provided (decreased intraocular pressure), the patient becomes completely blind within 2-3 hours.
Causes of the disease
There is no specific cause of the disease. The main reason, which we described above, is an increase in intraocular pressure due to impaired outflow of aqueous humor while maintaining its production rate.
The open (open-angle) form is the most common. To reduce the risk of developing the disease, you should pay attention to the following factors:
- age from 45 years – characterized by age-related, physiological changes in the structures of tissues and cells;
- metabolic disorders are one of the causes of exfoliation syndrome;
- gender – women have anatomically smaller eyes;
- injuries, bruises, concussions;
- previous operations and infectious diseases;
- heredity;
- as complications of farsightedness and myopia;
- diabetes mellitus and vascular atherosclerosis.
Symptoms of the disease
Early signs of the open-angle form of pathology are practically invisible. This can simply be expressed by discomfort in the eyes, fatigue, tension in the eyeball, pain, redness of the eyes, decreased night vision, rainbow halos appear when looking at bright light.
At the next stage, a clear clinical picture begins, which is expressed by a distinct narrowing of the visual fields. This is already the beginning of degenerative processes in the retina and the death of optic nerve cells. The field of view changes from the periphery to the center, in a circle, in the form of a tunnel that narrows.
At the last stage, the tunnel will block all light, this is an irreversible stage of complete blindness.
Diagnostics
As a rule, in the early stages, the open-angle form is diagnosed accidentally, during standard medical examinations by an ophthalmologist. The main symptom that raises suspicion at this stage is increased intraocular pressure.
- Optical coherence tomography (OCT) is an informative examination that allows you to study the structure of tissues for changes and lesions. In terms of the level of intervention, it is similar to a regular ultrasound, and in terms of information content, it is similar to a biopsy.
- Perimetry examination - determining the size of the visual field.
- Tonometry – measurement of IOP.
- Ophthalmoscopy – examination of the fundus of the eye, examination of the vascular network, shape and color of the optic nerve.
- Pachymetry – measurement of thickness and examination of the structure of the cornea.
Treatment of open-angle glaucoma
Once open-angle glaucoma is identified, all treatment is aimed at maintaining the level of vision and stopping the progression of the pathology. Treatment of open-angle glaucoma involves lowering intraocular pressure and depends on the severity of the disease.
In the early stages, a conservative approach is used with an emphasis on drug support plus preventive recommendations for the patient. In advanced stages, it is necessary to resort to radical surgical methods, mainly during attacks of acute increase in intraocular pressure. For example, pigmentary glaucoma, when the outflow is clogged with melanin, requires radical treatment in the form of microsurgical intervention.
Folk remedies
You can find out from the following video:
Drug treatment
Open-angle glaucoma primarily requires antihypertensive treatment; drugs that lower IOP are taken both locally and systemically. The main therapy is, which includes. It consists of:
- medications to reduce the production of aqueous humor;
- drugs to improve the outflow of intraocular fluid;
- diuretics to generally reduce fluid content in the body;
- vitamins, in particular ascorbic acid to strengthen the vascular wall;
- neuroprotectors;
- adrenergic agonists for treatment can only be prescribed by a doctor.
Learn more about drug treatment from the following video:
Surgical methods
In the open-angle form of the disease, operations are performed either in advanced stages or during an acute attack, since this disease mainly has a chronic course. Microsurgical interventions are divided into microsurgical interventions (installation of a drainage system, trabeculectomy, plastic surgery of outflow canals) and (iridectomy, cycloablation and others).
Prevention of open-angle glaucoma
No, standard prevention of any eye diseases will do; the main emphasis is on early diagnosis; preventing open-angle glaucoma is much easier than treating it.
Remember:
- In any case, neglected pathology will lead you to blindness.
- Loss of your field of vision at the time of contacting an ophthalmologist cannot be restored.
- The treatment that is possible for the open-angle form of the pathology is effective relative to the stage at which it is prescribed.
- Age after 45 years is a risk zone.
- Do not neglect preventive examinations at least once a year and be healthy!
Primary open-angle glaucoma is a complex of eye disorders that includes high blood pressure, nerve damage, and changes in vision. This is one of the most dangerous ophthalmological diseases, the causes of which have not yet been precisely studied.
This pathology is otherwise referred to as “green cataract” or “green water”, since the eye during an acute attack of glaucoma has a greenish tint, the pupil is motionless, and the eye itself is enlarged.
What is glaucoma
Glaucoma is a pathological process of the eyes that develops against the background of high blood pressure, internal processes in the body and neurological disorders. During the course of the disease, the patient's eye acquires a specific color, vision deteriorates greatly and complete blindness occurs.
It is quite difficult to prevent this process, since the main and only reason for this phenomenon does not exist. The risk group includes older people over 50 years of age, as well as patients who have undergone surgery that was complicated by increased eye pressure or nerve damage.
This is a chronic disease accompanied by a group of pathological changes in the function and structure of the eye. Intraocular pressure in the open-angle form of the disease increases periodically or remains high for a long period of time. Trophic changes occur in the eye itself, which is manifested by a violation of the outflow of fluid. The lacrimal ducts and the passages of fluid outflow from the nerve are disrupted, which is why vision defects appear.
The open-angle type of glaucoma combines more than 60 pathological processes, which to this day are actively studied by ophthalmologists and surgeons to find the pattern of their appearance and create the most effective method of treatment.
Advice! Each glaucoma disorder has similar manifestations, which unites them into one large group. One disease cannot trigger a destructive process.
Features of all changes in glaucoma: 
- temporary or permanent increase in intraocular pressure;
- damage to the optic nerve: neuropathy, atrophy;
- visual dysfunction.
This serious disease develops gradually, becomes chronic and often provokes acute attacks. The main symptoms depend on the degree of the disorder, the age of the patient and his individual characteristics. For each stage of the disease, different medications are used, aimed at improving trophic processes and restoring refraction.
Complicated primary open-angle glaucoma is the most dangerous, and in some cases cannot be treated. That is why it is so important to know the first symptoms of the disease, its severity and preventive medications that will help prevent complications and progression of the disease. 
Forms of glaucoma
There are several types of glaucoma, each with its own symptoms and degrees of impairment. Young adults and children can develop juvenile glaucoma, which strikes between the ages of 3 and 35. Other forms of the disease occur only in adulthood in patients with risk factors:
- Primary glaucoma is the most common type of disease, develops slowly, leads to other abnormal eye disorders, but its onset is independent.
- Secondary glaucoma develops against the background of other destructive or inflammatory diseases of the eye. These are cataracts, foreign bodies entering the eye and other pathological processes. Its treatment is quite complicated, since nerve atrophy and transition to the last stages of glaucoma can occur in a short period of time.
- Congenital glaucoma - manifests itself from the birth of a child, is characterized by clouding of the eye, the pupil is not visually detectable, the child does not move the eye. The main causes of congenital disorders are maternal illness, bad habits, infections, and traumatic injuries. Medicines that a woman uses without a doctor’s recommendation also affect the child’s vision.
Advice! The congenital disease can be diagnosed in newborns in 60% of cases; it is also called “dropsy” or “buphthalmos”. The child is diagnosed with increased intraocular pressure and significant enlargement of the cornea on both sides.
There are also pigmentary, hypersecretory, and pseudofoliative glaucoma. In the case of pigmentary glaucoma, vision decreases due to pigment entering the visual areas and disruption of the outflow of moisture, which increases intraocular pressure. 
Prefoliation disorder is accompanied by the deposition of pseudofoliation on the structures of the eye. This condition is almost always accompanied by cataracts. The last form is hypersecretory, accompanied by an increase in moisture production, which entails all the disorders and symptoms typical of glaucoma.
Stages of the disease
Most often, primary open-angle glaucoma develops in several stages, starting with a violation of the outflow of ocular fluid and ending with the appearance of neuropathy. The stages and degrees of glaucoma are quite difficult to observe from the very beginning of the pathological process, since the first symptoms are insignificant and may be completely absent. Stages of the open-angle form of the disease:
Advice! Detection of the disease in the first stage allows glaucoma to be completely cured with medications or surgery. You need to pay attention to such primary symptoms as blurred vision and promptly contact an ophthalmologist, especially if there is a genetic predisposition.
Causes of open angle glaucoma
Predisposing factors such as myopia, inflammation, and farsightedness can provoke the appearance of this disease. But this is always a whole complex of interconnected pathological conditions, which together give rise to a disease such as open-angle glaucoma. The main causes and risk factors for the development of glaucoma:
- Age – by the age of 40, many chronic diseases accumulate in the body, and the structure of tissues changes. If a person also has bad habits, the risk of developing glaucoma increases several times. The deterioration of blood circulation and tissue trophism occurs gradually, and at a certain point an acute period of eye disease begins.
- Compression of the optic nerve by neoplasms, hematoma after injury. When compression occurs for a long time, the functional ability of the nerve is impaired and it dies.
- Dysfunction of the outflow of ocular fluid - this disorder underlies the development of the disease, as it provokes increased intraocular pressure. The accumulation of fluid due to blockage of the canal or another cause leads to the acute onset of glaucoma.
- Dystrophic processes in the eye - disruption of the nutrition of the optic nerve and structures, tissue ischemia, breakdown of fibers trigger the mechanism of destruction of the eye and blindness occurs against the background of acute-angle glaucoma, and in this case treatment is ineffective.
- Hypoxia and circulatory failure are associated factors of the disorder.
As the disease develops, the optic nerve gradually atrophies and part of it is in a passive state, that is, it does not take part in functional processes. In this case, it is still possible to completely restore vision by activating nerve endings.
Advice! The primary disease manifests itself mainly at the stage of nerve death, when vision begins to deteriorate more and more. This is a dangerous period, and in a short time the function of eye movement can completely stop. Early identification of symptoms and effective prevention of complications is a chance to restore vision using medications and surgical treatment, but it will not be possible to return the eye to its previous condition.
How does glaucoma manifest at different ages?
The clinical picture of the open-angle form of the pathology extends to both eyes. Very rarely, a patient’s vision is impaired on one side, since the cause lies within the body, and not in a particular eye.
Predisposing factors such as myopia, astigmatism, inflammation cannot be the main causes. There are many patients with refractive error, but not all of them experience glaucoma.
When considering the symptoms of this disease, it is important to take into account concomitant ailments and separate the signs of various diseases. The initial stage of the open-angle form of the disease occurs unnoticed by the patient and others, but already at the stage of nerve atrophy, visible and tangible manifestations of glaucoma begin.
How to cure glaucoma?
Glaucoma is treated surgically and conservatively, depending on the degree. Anti-inflammatory medications that reduce intraocular pressure are used. Each patient receives an individual treatment program, individual eye medications and recovery techniques.
Surgery for glaucoma is aimed at restoring fluid balance in the eye in open-angle form of the disease. It is necessary to begin treatment with the use of special drops; the doctor prescribes effective topical medications at the time of examination and choice of treatment in order to stop the pathological process.
Among the well-known surgical operations, laser correction can be performed: iridotomy, trabeculospasis. Patients after surgery need medicinal recovery, but all drugs are prescribed individually, depending on the clinical picture. These are eye drops that are anti-inflammatory, reduce intraocular pressure, and sedative.
Lack of treatment leads to complete loss of vision, but if treated at an early stage, the disease can be maintained with medication; in advanced cases, only surgery will help.
Prevention of open-angle glaucoma
It is recommended that all people at risk be involved in the prevention of glaucoma. This is age after 40 years, refractive eye diseases, previous eye surgeries, cataracts. Some medications also cause vision abnormalities, so long-term treatment should be monitored by an ophthalmologist.
General rules for the prevention of open-angle glaucoma:
- Visual hygiene – proper lighting of the working surface, normalization of visual load.
- The use of eye drops (natural-based preparations that moisturize the eyes).
- Gymnastics for the eyes.
- Regular visits to the ophthalmologist.
Glaucoma occurs quite often, but it is dangerous only in advanced cases. Drug therapy, prevention and laser correction will help restore normal vision and prevent the transition of a mild form of glaucoma to a severe stage.
Open-angle glaucoma is an eye pathology characterized by high intraocular pressure, degenerative changes in the optic nerve and decreased visual acuity.
It has chronic and progressive course. This form of the disease occurs in 80% of all cases diagnosed with glaucoma. There is also angle-closure glaucoma, which is paroxysmal in nature.
During an attack of this type of disease, the outflow of fluid between the chambers of the eye is disrupted and intraocular pressure increases.
Primary open-angle glaucoma: why it is dangerous, differences with the closed-angle form, reasons for its appearance
Primary open-angle glaucoma is a chronic glaucoma, most often two-way, but not always symmetrical.
Open-angle glaucoma is the most dangerous due to the fact that its initial stages occur asymptomatic, therefore, it is extremely difficult to suspect the disease without contacting a professional.
Photo 1. The difference in the structure of open-angle and closed-angle glaucoma, demonstrated in the diagram.
Unlike attacks of angle-closure glaucoma, accompanied by pain in the eye, dizziness and a sharp deterioration in vision, this type of disease lasts for a long time. doesn't reveal itself. But the earlier the disease is diagnosed, the more favorable the prognosis. People at risk are:
- over 40 years of age- the older the person, the higher the danger;
- with other eye pathologies, for example, with pseudoexfoliation syndrome;
- with neoplasms and injuries eyeball;
- having visual impairments, such as farsightedness, myopia, astigmatism;
- with systemic and chronic diseases associated with metabolism(diabetes, thyroid pathologies and others);
- using hormones: glucocorticoids and mineralocorticoids;
- having pathologies of the circulatory and heart systems such as high or low blood pressure, ischemia, heart failure, heart attack, migraines, vascular spasms);
- having aggravated heredity, that is, close relatives had a similar disease;
- having African American roots, since their risk of glaucoma is several times higher;
- leading a sedentary lifestyle, smoking and drinking alcohol, overweight people.
Attention! Patients at risk only have an increased likelihood of disease. Regular preventive consultation with an ophthalmologist necessary for everyone.
With open-angle glaucoma, there is a delay in the removal of fluid from the anterior chamber of the eye, often accompanied by an increase in the production of this fluid. There is an imbalance between inflow and outflow, which causes a slow but progressive increase in intraocular pressure. Gradually this leads to the fact that the optic nerve atrophies.
Most common symptoms
- sensation of a foreign body in the eye, discomfort and fatigue;
- periodic blurred vision, decreased peripheral visual acuity;
- sensation of floaters before your eyes;
- redness, weakness ocular vessels;
- difficulty focusing on the object;
- in later stages general visual impairment.
Glaucoma 1, 2, 3, 4 degrees
Disease progression occurs in several stages:
- Glaucoma 1 degree. Fluid circulation is disrupted, and sometimes intraocular pressure increases slightly. There are no dystrophic changes. In some cases there is a slight decrease in visual acuity. Field of view within 45 degrees.
- Glaucoma 2 degrees. It is characterized by increased pressure, which already affects the functioning of the optic nerve. The patient's visual field narrows and is in the range from 15 to 45 degrees.
- Glaucoma 3 degrees. High eye pressure, serious disturbances in the functioning of the optic nerve. Narrow field of view ( up to 15 degrees) and only partial areas of visual sensitivity.
- Glaucoma 4 degrees placed when there is almost complete atrophy of the nerve and practically complete blindness. Sometimes the eye's reaction to light persists.
Important! The appearance of areas of black fields begins from the nasal side.
Diagnostics
If you are at risk, there is a need Get checked regularly by a professional. To identify glaucoma and determine its stage, ophthalmologists conduct the following manipulations:
- collecting anamnesis, interviewing the patient;
- pneumotonometry- measurement of intraocular pressure, normally it is in the range from 10 to 23 mm Hg. Art.;
- examination and assessment of the condition of the fundus;
- determination of the angle of the anterior chamber of the eye, detection of increased pigmentation and sclerotic changes - gonioscopy;
- perimetry— measurement of the patient’s visual field angle.
Used to diagnose the disease methods of ultrasound, optical tomography and others.
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Treatment
After determining the stage of glaucoma, the ophthalmologist prescribes therapy that adequate to the patient's condition. At those stages in which vision is still preserved, medications are prescribed to reduce eye pressure and to reduce the development of pathology in the organ of vision.
The purpose of the drugs is reduction in eye pressure by at least 25%. The whole process is observed in dynamics, and as the disease progresses, the pressure decreases until the condition stabilizes. There are three types of treatment for open-angle glaucoma: medication, laser surgery, surgery.
Medication
The basis of medical treatment is eye drops. The purpose of their use is to lower the pressure inside the eye, reduce damage to the optic nerve, improve metabolic processes, and eliminate the causes of the formation and progression of glaucoma. To reduce the production of fluid and its removal from the anterior chamber of the eye, diuretics are used, such as Mannitol, Indapamide.
The list of main drugs against glaucoma includes prostaglandins, for example, Latanoprost and Travatan. M-cholinomimetics are used - Pilocarpine. Combination products are also used, which combine two active ingredients - Xalacom, Azarga, Duotrav.
Photo 2. Packaging of the drug Travatan with a dosage of 40 mcg of the active substance (travoprost) per 1 ml. Manufacturer: Alcon.
The choice of drugs is quite large and the doctor prescribes the necessary based on the stage of the disease, financial capabilities the patient and his responsibility for treatment. If the patient is uncomfortable using the medicine several times a day, the drug is prescribed with a single daily instillation.
Reference. To improve metabolism and restore the eye, patients are prescribed vitamins A and B, ascorbic acid.
The use of any product is carried out in hygienic conditions, according to the instructions and recommendations of the doctor. Sometimes use is required several drugs at the same time, in this case, each medicine is instilled at intervals at least 5 minutes. It is extremely important to regularly monitor the pressure and condition of the optic nerve during treatment. This is necessary in order not to start the disease and prevent it from moving to the next stage.
Important! Any drug can cause allergic reaction. If you suspect it, you should consult a doctor.
In addition to drops, the patient may be prescribed physiotherapeutic procedures in the form of nerve stimulation and magnetic therapy.
Laser treatment
If drug therapy is not enough, laser surgery may be used. With this intervention, the laser directed to the drainage channels of the eye, due to which the outflow of fluid improves.
For some patients, even one laser intervention can significantly improve the condition of the organ of vision and reduce intraocular pressure. If after several similar manipulations the pressure does not normalize and degenerative processes occur, a decision is made about surgery.
Laser treatment is only effective in cases of minimal damage to the optic nerve.
Surgery
There are several types of surgical operations; the appropriate option is selected by an ophthalmologist. Intervention creates either new drainage channel (trabeculectomy), or a device is installed to remove fluid from the eye (drainage implantation).
It is important to know how open-angle glaucoma differs from closed-angle glaucoma, since the possibility of timely detection of symptoms, early diagnosis of the disease, and, accordingly, timely and adequate treatment depends on this. Since glaucoma cannot be completely cured, responding correctly can help slow the progression of the disease and avoid irreversible consequences such as complete loss of vision.
There are certain factors, both internal and external, that increase the risk of this disease.
What kind of diseases are these?
Glaucoma is a general name for various eye diseases, which are characterized by high pressure inside the eyeball, gradual destruction of the optic nerve and, as a result, visual impairment, visual field defects, and blindness. There are several forms of glaucoma:
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- open angle;
- closed angle;
- acute-angled;
- mixed.
Characterized by periodic attacks of increased pressure inside the eyeball. It is quite rare, characterized by pronounced symptoms and periodic acute attacks. Open-angle occurs much more often than other types of this disease - in approximately 70% of cases. It is chronic in nature, develops gradually, occurs in both eyes, and is asymptomatic for a long time. Acute angular occurs in less than 10% of cases and is the only form of this disease that is completely treatable. Mixed combines the pathogenesis, etiology and symptoms of different forms.
Causes and symptoms
The exact causes of glaucoma are unknown. There are significant differences between the factors that provoke the development of closed-angle and open-angle glaucoma. The latter form of the disease is more difficult to diagnose because it is asymptomatic for a long time. Angle closure, on the contrary, has a pronounced clinical picture, but it is often confused with other diseases.
| Glaucoma | ||||||
| Form | Causes | Symptoms | At-risk groups | |||
| Open angle | Heredity, diabetes mellitus, long-term use of corticosteroids, sclerotic changes in blood vessels, cervical osteochondrosis, anatomical structure of the eye, obesity, atherosclerosis, early presbyopia, arterial hypotension, metabolic disorders, pigment dispersion syndrome, myopia, stress. | Blurred vision, lacrimation, pain in the brow ridges, swelling and redness of the eyes, loss of lateral vision, nausea, blurred objects, decreased visual acuity, eye fatigue, headache, narrowing of visual fields, blindness. | Female gender, age after 45 years. | |||
| Closed angle | Functional changes, nervous strain, size of the eye cavity, hypermetropia, anatomical predisposition, age-related changes, structural features of the eyes, heredity, trauma and mechanical damage, chronic eye fatigue, taking tranquilizers. | Sharp pain in the eye, lacrimation, bradycardia, blurred vision, severe headache, swelling of the eyelid, bright circles when looking at the light, redness of the eye, nausea, lack of reaction to light, vomiting, blurred vision, pain in the heart or abdominal cavity, general malaise , dilated pupil, sudden blindness. | Middle and old age, female gender. | |||
Differences between closed-angle and acute-angle glaucoma
With open-angle glaucoma, access to the natural drainage system is open, but in the second case, on the contrary, the pressure increases. Closed-angle and open-angle glaucoma have significant differences. The main features of the open-angle shape:
- more common;
- intraocular pressure increases due to the lack of necessary outflow;
- sluggish, chronic course;
- absence of symptoms for a long time.
The main features of the closed-angle shape:
- quite rare;
- painful course;
- a sharp and significant increase in pressure inside the eyeball, accompanied by severe symptoms;
- acute or subacute attacks.
The main difference from angle closure is the need for medical care. The open-angle form can be treated for a long time at home, periodically observing a doctor and adjusting the therapy. The angle-closure form requires more careful attention, since physical or emotional stress, as well as drinking large amounts of water, sometimes cause an acute attack of glaucoma in patients. This condition is characterized by a severe course and requires immediate hospitalization, since due to untimely or incorrectly provided medical care, a person can become completely and irreversibly blind in a matter of days.
