home Auditorium 8 How does glaucoma manifest in adults – who is at risk? What are the main reasons for the development of glaucoma in the human eye and methods of its treatment?

How does glaucoma manifest in adults – who is at risk? What are the main reasons for the development of glaucoma in the human eye and methods of its treatment?

Glaucoma: the “green star” leading to blindness

It is known that vision is the main source of information: a person obtains more than 90% of information about the outside world by analyzing the energy of light quanta falling on the retina of our eyes. Therefore, a significant decrease, and even more so, loss of vision can lead to pronounced social maladjustment.

Glaucoma is one such disease that can lead to blindness. More than 100 million people on our planet are simultaneously affected by this disease. 2% of them have already completely lost their sight, and that’s more than 5 million people!

By the time you have time to read this article, two people will have gone blind due to glaucoma, and 5-6 children will go blind every hour. If we talk about our country, then this disease is the sad “leader” in the registration of disability among eye diseases.

In total, about 900 thousand patients are registered in our country, and 0.1% of the total population annually acquires this diagnosis, or every thousandth person of any age and gender. It is known that what older man- the higher his chance of developing glaucoma: for example, among forty-year-olds this diagnosis occurs in 1.5% of all cases, and in people twice as old – already in 15%.

If we talk about the causes of vision loss, then 16% of all blind people with acquired bilateral amaurosis (the so-called blindness in both eyes) received it due to glaucoma.

This is a beautiful name that is more like female name, translated from Greek, sounds like “green spot”, sometimes it is called “green cataract”. It is this greenish color that the pupil of the eye has during an acute attack of this disease. In addition, the pupil is dilated and motionless.

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Glaucoma - what is it?

Glaucoma, photo 1

In fact, the name of the disease is collective - these are several diseases that arise due to various reasons, but lead to one outcome - blindness. In this case, the main mechanism will be a violation of the production, outflow and exchange of fluid inside the eye - the disease is associated with the concept of “hydrodynamics of the eye”.

Therefore, glaucoma is a condition leading to an increase in intraocular pressure, persistent disorders occur in the fundus, retinal atrophy and persistent cell damage occur. optic nerve leading to blindness.

Hydrocephalus, glaucoma and hypertension

To some extent, a person with synthetic thinking may find many similarities in these three diagnoses. It's all to blame physical property liquid - its density. It is known that water is practically incompressible. Therefore, when there is excess pressure in the arteries, arterial hypertension with damage to the vessels of the retina and kidneys.

In case of metabolic disturbance cerebrospinal fluid“water” of the brain, or hydrocephalus, occurs. With it, congestion in the fundus of the eye again occurs, and atrophy of brain structures, and an increase in the circumference of the skull, especially in children.

As for glaucoma, the simplest definition for people without medical education is “dropsy of the eye.” Why does a violation of hydrodynamics occur in the eye, and what mechanisms generally regulate these processes?

Pressure-creating intraocular fluid appears in rear camera eyes, it is produced by the ciliary body, more precisely, its processes. Then, through the “hole” of the pupil, in which the lens is located, it enters the anterior chamber of the eye. In the figure, arrows indicate the fluid paths.

In the angles around the anterior chamber there are two (anterior and posterior) pathways for its outflow. It may flow through Schlemm's canal, or venous sinus sclera.

This is the main route, through which 85% of the volume is utilized. It can also flow in another way, through the thickness of the sclera and the ciliary body. If the intraocular fluid experiences resistance to outflow, the result is an increase in intraocular pressure - glaucoma occurs.

Of course, glaucoma, like any disease, can have different classifications, depending on the need. So, it can be primary and secondary, congenital and acquired. Based on the pressure of the ocular fluid, normotensive and hypertensive forms of the disease are distinguished.

But the main thing to remember is by what mechanism the pressure increases. There are two main types:

1) The open-angle form is a condition in which access to the angle of the anterior chamber, where the outflow system is located, is free, but the outflow is impaired because the outflow system does not work well. This option occurs in 90% of cases. Trabeculopathy, or “clogging” of Schlemm’s canal, usually occurs in old age.

This form of the disease lasts for many years and manifests itself by a gradual narrowing of the visual fields. When the patient pays attention to this, it is often discovered that a significant part of the retina and the optic nerve have died.

2) Angle-closure form: The iris closes the angle in the anterior chamber. With this option, since there is a mechanical obstruction, severe attacks of glaucoma occur, which are acute, and can lead to rapid loss of vision as the accumulated intraocular fluid continues to be produced.

About the stages of the disease

There is a conditional division of the course of this disease into several stages. Since the sad ending is damage to the retina and optic disc, it is by assessing the visual fields and the condition of the disc during ophthalmoscopy that the progression of the disease can be determined:

Beginning: Visual fields are normal, blind spot(the exit point of the optic nerve) is slightly dilated, there is a slight increase in the optic disc;
Developed stage. The field of view is narrowed and there is a rise of the disc from the edge;
Third stage: the process has gone far. Fields of vision are narrowed on all sides, and there are strong changes optic nerve head;
Terminal stage. There is no vision, but there is a simple sensation of a light spot, and even with the wrong orientation. A small spot of vision (island) in the temporal region may be preserved.

Symptoms of glaucoma, signs in the early stages

In the open-angle form, the symptoms of glaucoma in the early stages are practically absent: sometimes patients complain of the appearance of circles with a rainbow color inside the eye, but the main symptom is a progressive decrease in vision, and it does not consist in a decrease in acuity, but in a decrease in the field of vision, and this is precisely patients don't even feel it.

As for closed-angle forms, all clinical picture- this is the appearance of a “pupillary block”: the root of the iris protrudes and simply blocks the angle for the outflow of fluid. A typical picture of an acute attack of glaucoma consists of the following symptoms:

Severe pain in the eye, which radiates according to the branches of the trigeminal nerve: to the cheekbone, to the frontal part, to the temple. Therefore, sometimes an attack is regarded as trigeminal neuralgia, as a result of which precious time is lost;
An increase in intraocular pressure is regarded by the brain as a rise intracranial pressure(which is natural), and compensatory mechanisms of “liberation” from excess liquid: nausea and vomiting occurs;
Characterized by the appearance of rainbow circles before the eyes and progressive loss of vision.

When examined by a doctor, you can identify the following signs and symptoms of eye glaucoma:

corneal edema and congestive scleral vascular injection;
the anterior chamber is very small or slit-like, it is “pressed” against the cornea by increased pressure;
a characteristic opalescence of stagnant fluid may occur in the anterior chamber - this is the “turquoise star” - this symptom occurs during a prolonged attack that lasts for several days;
the iris is protruded forward and atrophied, it is swollen;
the pupil is dilated (mydriasis), and there is no reaction to light;
intraocular pressure is sharply increased.

Normally, the average intraocular pressure in an adult is 15.5 mm Hg. Art. with minor fluctuations - up to 2.75 mm. With glaucoma, the pressure may be normal (especially in the open-angle form), but it is increased especially significantly during an acute attack: over 33 mm.

Of course, not all the signs are given here, but they are enough to make a preliminary diagnosis and remember that the open-angle shape “softly spreads,” but when a person realizes it, vision has already been lost. And the closed-angle form is “extremely frank”, and is manifested by acute attacks that can completely deprive vision in a few hours, but it is diagnosed much earlier than its “colleague”.

Treatment of glaucoma - drugs and methods

It must be remembered that this is a chronic disease, and no matter what treatment methods for glaucoma are used, there is a risk of renewed outflow disturbance intraocular fluid. But the modern arsenal of both therapeutic and surgical techniques allows you to stop this process and preserve your vision for many years.

Of course, each type of glaucoma has its own treatment. Open-angle and closed-angle forms are treated different ways, and “generic” drugs are rarely used.

Open angle therapy

In order to stop the process of vision loss in this type of pathology, medications, surgeries, laser treatment and the use of neuroprotectors are used. Treatment of glaucoma begins with the prescription of drops, naturally, after determining the intraocular pressure.

Usually they start with the use of beta blockers: timolol, betaxolol. Pilocarpine is sometimes used. As an agonist (enhancer) of m-cholinergic receptors, it constricts the pupil and lowers intraocular pressure, and is therefore used in the treatment of all types of glaucoma. Treatment with drops is long-term.

When the target figure for reducing intraocular pressure is achieved, neuroprotective therapy can begin. For this purpose, antihypoxants, antioxidants, drugs are used succinic acid, angioprotectors, antispasmodics, nootropics.

These drugs prevent attacks of glaucoma, increase vascular stability, and improve trophism of the retina and optic nerve.

How to remove acute attack glaucoma?

You need to act quickly: an acute attack is considered an emergency. The scheme might look something like this:

Every 15 minutes, 1% pilocarpine is dripped for 2 hours, then using it less often, according to a certain scheme;
Then timolol 0.5% is dripped, one drop twice a day;
Acetazolamide, also known as Diacarb, is taken orally, a diuretic and carbonic anhydrase inhibitor. It helps reduce intracranial and intraocular pressure;
IN severe cases. And in a hospital setting, osmotic diuretics (mannitol, glycerin) are prescribed intravenously;
If ineffective, a mixture of chlorpromazine, promedol and diphenhydramine is prescribed.

To prevent acute attacks of glaucoma from recurring, you can remove the iris, which obstructs the outflow of fluid. The best thing to do is laser beam by performing an iridectomy. Also an indication for surgical intervention is an attack that does not stop within 12 hours.

Prevention measures

We talked about glaucoma: we looked at its causes, symptoms and treatment - all that remains is to talk about preventive measures. In fact, they are nothing more than “rules for a healthy lifestyle, and not only for the eyes:

Visual activity (reading, computer work) should be interrupted every hour for at least 5–10 minutes;
Do not lift weights exceeding 10 kilograms;
You should not work at an angle, for example, on personal plot, try not to play wind instruments, do not wear tight collars and ties (all this leads to an increase in all kinds of pressure, including intraocular pressure);
Do not work with your head down or in poor lighting;
Do not overuse TV and computer, walk more;
You should not abuse coffee: caffeine increases intraocular pressure;
You need to quit smoking. Smoking worsens the course of the disease;
To prevent glaucoma, you must carefully follow the regimen prescribed by your doctor. This is especially true for the schedule for instilling drops into the eye, as this sometimes needs to be done frequently;
Get plenty of sleep and don't worry. Try to avoid stress and get rid of worries, both at home and at work - they worsen the course of the disease;
Follow a certain diet. Shown are fish, vegetables, fruits, vegetable oils, gray porridge, fiber. An excess of refined products (smoked meats, lard, fried, pickled, seasonings) can “clog” not only blood vessels, but also the outflow pathways of intraocular fluid;
Try to avoid constipation - they lead to excessive straining, which can lead to an attack of glaucoma;
If you have angle-closure glaucoma, do not change the lighting too sharply - for this type of disease abrupt change(when moving from a brightly lit room to a dark one, for example, when watching a movie) can lead to pupil dilation, which is undesirable. Therefore, be prepared and instill a miotic - pilocarpine, or another drug that constricts the pupil.

Glaucoma is a chronic disease. It occurs more often after 40 years of age due to the fact that intraocular pressure increases and the optic nerve dies. Vision can decrease to the point of blindness and is not restored.

Juvenile or congenital glaucoma is very rare. It is important to know the signs of eye glaucoma in order to begin its treatment in a timely manner and not lose vision, because losing it in at a young age could turn into a disaster.

The causes of glaucoma may be the following:

heredity;
anomalies;
diseases endocrine systems s;
problems of the vascular and nervous systems.

All these and other problems can lead to the development of glaucoma.

Types of glaucoma

Distinguish different types glaucoma.

Congenital.
Juvenile from 3 to 35 years.
Adult: primary and secondary. Secondary glaucoma is diagnosed if it occurs from another eye disease.

In addition, glaucoma is divided into types such as open-angle and closed-angle. This classification can often be found in medical diagnoses.

Open-angle often appears after 40. This type is characterized by blurry outlines of objects. A person sees poorly both far and near. In addition, glowing circles around light bulbs or other light sources are characteristic.

Angle closure most often occurs in people over 30 who have been diagnosed with farsightedness. The problem in this case is a violation of the drainage system. The fluid is poorly removed, and intraocular pressure increases. The following symptoms are distinguished:

thickening and redness of the eyes;
headaches, nausea and even vomiting;
blurred vision;
rainbow circles around light sources.

In these cases it is necessary emergency help with increased intraocular pressure, otherwise blindness may occur.

Congenital glaucoma is most often diagnosed in the first year of a child’s life or in the near future of his development. It is characterized by some manifestations that are very important to pay attention to.

Photophobia and increased outflow of tear fluid.
Slow response to light flux and increased intraocular pressure.
Enlarged and clouded cornea.

Most often, the disease affects both eyes of the child.

Causes of increased intraocular pressure and the formation of glaucoma

Intraocular fluid is poorly removed.
Liquid is formed in more than necessary.

High intraocular pressure leads to the death of the optic nerve. You need to be especially careful if your relatives have a history of glaucoma. So what are the first signs of glaucoma and symptoms of the disease that can be identified on early stage? Diagnosis is made during an examination by an ophthalmologist, but a person can walk for many years, gradually losing vision and not even knowing that he already has signs of glaucoma of the eye. An attack can occur suddenly and after it a person can lose vision forever.

What is the danger of high intraocular pressure and what symptoms indicate an attack of glaucoma? This:

pain in the area above the eyebrows and temples;
blurred vision;
halo from light sources;
nausea, severe general condition.

Even at the first signs of the disease, you should consult a doctor, as increased intraocular pressure and blindness may occur. If the pupil and surrounding tissues become blue-green, then it is necessary to be examined by a specialist, and the appearance of the above symptoms may already indicate the presence of a serious illness.

Why is it necessary early diagnosis vision?

It’s not for nothing that doctors advise that after 40 years, you should check your vision with an ophthalmologist as often as possible, because diseases often go unnoticed. Sometimes, after a heavy load, blurred vision and blurred images occur; these are all symptoms of an impending problem. Head pain after exertion or bending can also be a harbinger of glaucoma. Impaired twilight vision, blurry colored circles from light sources - these are all symptoms of the disease. A person simply does not pay attention to them, believing that he is tired.

Symptoms and signs of advanced glaucoma

Typically, an increase in intraocular pressure is accompanied by nausea, vomiting, and distension with a headache. A narrowing of the visual field may occur. There are also pain sensations around the eyes. In addition, when examined by an ophthalmologist, changes in the fundus of the eye are detected.

Secondary glaucoma can develop after injury, inflammatory processes in the eye.

The causes of secondary glaucoma are as follows:

injuries, lens shift;
keratitis, scleritis;
cataract;
tumor;
surgical interventions on the eyes.

Secondary glaucoma appears pressing pain in the orbital area, corneal edema and blurred vision. The shape of the lens may also change, clouding may occur, the field of vision narrows and visibility deteriorates. These are the main symptoms of secondary glaucoma. Glaucoma is a fairly complex disease and can occur unnoticed, so it is important to have an annual examination with an ophthalmologist.

Methods for treating glaucoma of the eye

There are several ways to treat glaucoma: medication, surgery or laser correction. Medication route depends on the symptoms and is aimed primarily at reducing intraocular pressure. For this purpose, medications are used that accelerate the outflow of intraocular fluid: Pilocarpine, Epinephrine and others. There are other medications that inhibit the development of excess moisture: Timolol, Clonidine. Operations and laser correction carried out in order to stop excess moisture and reduce intraocular pressure.

From folk remedies many use a mixture of honey, aloe juice and water, a teaspoon at a time, and then drop 1 drop into each eye. In addition, it is very useful to consume red viburnum juice, red currants, blueberries, rowan berries, and strawberries internally. This is an excellent vitamin support for vision.
If you start treating the disease in time, the prognosis for treatment can be favorable. Many people live with such symptoms for a very long time and do not lose their vision. The main thing is to carry out supportive therapy and constantly see a doctor. If necessary, laser vision correction can be done.

Most people have heard of the disease glaucoma, but few know what it is. terrible disease. Why is glaucoma dangerous? Every fifth patient with glaucoma becomes blind due to this disease, which indicates the danger and social significance pathology. Currently in Russia there are more than a million patients with glaucoma. And this is far from complete statistics, since many, due to the lack of symptoms, and sometimes due to an inappropriate attitude towards their health, do not seek help. medical care. Often patients come to ophthalmologists with very low vision, at advanced stages of the disease, when the doctor can no longer restore and save vision.

Every year, 1 person per thousand of the population gets sick. Even 10 years ago, the diagnosis of glaucoma was mainly made to patients over 60-65 years of age. Now the disease has become much younger and is often detected at the age of 40-45, which is due to the availability of ophthalmological care. Disability for glaucoma is assigned only to those people whose vision in both eyes is less than 0.1 with correction.

What is glaucoma?

So, eye glaucoma - what is it? This group chronic diseases eyeball associated with increased intraocular pressure and gradual atrophy of the optic nerve. Normal eye pressure ranges from 9 to 22 mmHg. This disease is chronic, and, therefore, it will not be possible to get rid of it once and for all. But it is possible, with the help of treatment and following some recommendations, to preserve vision for many years.

Causes of glaucoma

Currently, there are about 30 theories trying to explain the occurrence of glaucoma.

Since the etiology of the disease is not completely clear, all these theories can be combined into the following basic principles:

Heredity. Most noted frequent occurrence diseases in people whose parents suffered from glaucoma.
Anatomical features of the structure of the eyeball. One of these features is a change in the angle of the anterior chamber of the eye, which is formed by the root of the iris and cornea. In the closed-angle form, the angle is significantly narrowed, which impedes the outflow of intraocular fluid from the eye into the vasculature through Schlemm’s canal, which causes hypertension.
Concomitant diseases of the cardiovascular and endocrine systems. Glaucoma is often detected after strokes, heart attacks, and also in diabetes mellitus.

The mechanism of glaucoma development

It can be divided into several stages:

Initially, there is a deterioration in the outflow of intraocular fluid from the eyeball.
As a result of outflow disturbance, increased IOP.
Increased intraocular pressure causes deterioration of blood supply to the structures of the eye.
In places of deteriorated blood supply, zones of ischemia and hypoxia appear, which affects the optic nerve.
Further increase in IOP, ischemia, hypoxia cause gradual cell death optic nerve, which inevitably leads to his atrophy and blindness.

Types of glaucoma

Since the concept of “glaucoma” includes about 60 diseases, the classification of pathology is quite extensive.

According to the time of onset of the disease, they are divided into the following types glaucoma:

Congenital. Detected before the age of 3 years. Almost always, childhood glaucoma leads to absolute blindness by adulthood.
Infantile. A rare form, manifests itself in childhood, from 3 to 10 years.
Juvenile. Also a rare form of the disease, it is found in young people from 11 to 35 years old.
Adult glaucoma. The main form of the disease occurs in people over 35 years of age.

According to the origin, glaucoma can be:

primary;

In its turn, primary glaucoma is divided into, colloquially called cornerstone, and closed-angle.

The open-angle form is characterized by the fact that the stages gradually progress, despite the fact that the anterior chamber angle is open. This type the most common, occurring in 90% of all patients.

In angle-closure glaucoma, the main cause is blocking or significant narrowing of the anterior chamber angle. With this type of pathology key point Gonioscopy is used in diagnosis. This type of disease is most often accompanied by eye pain, redness, rapid decline vision.

There are four types of primary open-angle glaucoma:

primary;
pseudoexfoliative;
pigmentary glaucoma;
glaucoma normal pressure.

Pigmentary glaucoma is an uncommon form of the disease in which there is an excessive release of iris pigment, as a result of which the trabecular apparatus becomes clogged and intraocular pressure increases. This type of pathology can occur with pseudophakia, iridocyclitis, pseudoexfoliation syndrome. All of the above reasons contribute to increased pigment release.

Normal pressure glaucoma is a rare disease in our country in which visual impairment due to optic nerve atrophy occurs without an increase in intraocular pressure.

Angle-closure glaucoma, formerly known as narrow-angle glaucoma, is also divided into 4 types, each of which describes the mechanism of the disease:

With pupillary block.
With a flat iris.
Creeping.
With vitreolens block.

Secondary glaucoma occurs as a result of other diseases or injuries to the eyeball.

The classification of secondary glaucoma is as follows:

inflammatory;
phacogenic (associated with lens diseases);
vascular (neovascular and phlebohypertensive);
dystrophic;
post-traumatic;
postoperative;
neoplastic.

Stages of glaucoma

Like most chronic diseases, glaucoma has stages.

In total, there are 4 stages of glaucoma, each of which has its own clear boundaries:

Stage I, or initial. The boundaries of the visual fields are most often not changed, the excavation of the optic nerve head is insignificant. If the disease is detected at this stage, the prognosis is very good. Treatment consists of using one of the first-line drugs and following the doctor's recommendations.
Stage II, or advanced. There are already pronounced narrowings of the visual fields in the upper-nasal and lower-nasal segments by 10-15°, scotomas (areas of loss of visual fields) appear in central departments. Visual acuity is usually reduced to 0.6-0.7 and cannot be corrected. For stage 2 glaucoma, the drug Latanoprost is most often used, sometimes combination drugs. If they are ineffective, they resort to laser treatment.
Stage III, or advanced. The narrowing of the visual fields reaches 30-40° (or 15° from the point of fixation - the center), atrophy of the optic nerve head is greatly expanded. Glaucoma of the 3rd degree is almost always accompanied by decreased vision (only 0.1-0.3) and, of course, spectacle correction not amenable due to atrophy of nerve fibers.
Stage IV, or terminal glaucoma. Visual acuity is most often absent or very close to zero, that is, a person distinguishes between day and night. Fields of vision are narrowed to a point or are not defined. With stage 4 disease, the main task of the patient and the doctor is to maintain the target pressure so that there is no pain in the blind eye and atrophy of the eyeball. Most patients with terminal glaucoma two eyes are disabled group I.

Symptoms of glaucoma

Symptoms of glaucoma in the early stages, especially open-angle, are most often absent. Recently, glaucoma is often detected in the early stages, which is associated with the introduction of screening diagnostic methods: IOP measurement during preventive examinations and direct ophthalmoscopy.

The first signs of eye glaucoma most often appear only at stages 2 and 3 of the disease, and therefore there is a very high level of disability due to vision loss.

Most often, patients present such complaints:

Deterioration of vision. The most common and characteristic symptom glaucoma in adults.
Pain and discomfort in the eyes. Characteristic of the closed-angle form, as well as the open-angle form with very high intraocular pressure.
Redness of the eyes. Very common symptom glaucoma, associated with overload and pressure on the blood vessels of the eye.
Loss of visual fields, their narrowing. A typical complaint for late stages diseases.
Glare, black spots, rainbow circles in the eyes. Characteristic signs glaucoma in the early stages.

When glaucoma occurs, the symptoms can be very varied.

Diagnosis of glaucoma

Examination for glaucoma is uniform throughout the world; it consists of several stages:

Visometry - determination of visual acuity.
Tonometry is the determination of intraocular pressure, both by the contact method (according to Maklakov) and non-contact (using a stream of air on a special apparatus).
Perimetry is a type of study of visual fields that allows you to identify changes in the fields, their narrowing or loss of parts.
Gonioscopy - special method a study that allows you to evaluate the angle of the anterior chamber; a gonioscopic lens is used for this.
Biomicroscopy - general method examination, which makes it possible to assess the degree of glaucomatous excavation of the optic nerve head, as well as other changes in the iris, fundus, blood vessels, lens.
Heidelberg retinal tomography (HRT) - new and very informative method examinations that allow us to evaluate on a microscopic scale changes in the head of the optic nerve and the macular region.

Glaucoma treatment

Let's look at the main types.

Conservative

For open-angle glaucoma, treatment begins with first-choice drugs, which include:

Timolol. An old proven drug that helps well with initial stages diseases. Unfortunately, it has many contraindications, especially from the cardiovascular system. Such restrictions on intake often occur in older people.
Latanoprost (Xalatan, Glauprost, Prolatan) and Travaprost (Travatan). Modern, highly effective drugs that act for up to 24 hours (they are instilled only once a day, usually at night). Side effects data medicines practically none, and their use is limited only by their high cost.

General treatment and vitamins

Ophthalmologists around the world have long noticed that a person suffering from glaucoma begins to show symptoms of other diseases, and not only in the eyes, but throughout the body. This suggests that metabolic (metabolic) processes are disrupted throughout the body: in most cases, glaucoma appears and, at the same time, various neurological, endocrine and cardiovascular diseases occur.

Exactly for the reason general violation metabolic processes twice a year, ophthalmologists recommend undergoing a course of vascular therapy, which includes:

Eye drops Taufon.
Emoxipin 1%.
Vitamins for glaucoma.
Mexidol.

Physiotherapeutic treatment

Along with classical treatment special medicines Various physiotherapeutic procedures are used.

The most commonly prescribed treatments for the disease are::

Electrophoresis with B vitamins, miotics (pilocarpine) and biogenic stimulants(aloe extract).
The Vitafon device is widely used, which, thanks to microvibration effects, improves blood circulation inside the eyeball.
Hirudotherapy. Leeches have been used for a long time and effectively in the treatment of glaucoma. The use of this method improves lymphatic drainage, reduces intraocular pressure, and removes decay products from the cells of the eye and paraorbital area. They usually place leeches on temporal part from the side of the affected eye.

Surgery

If drug treatment is ineffective, they often resort to surgical treatment. Surgery does not mean that glaucoma can be removed. The purpose of surgical treatment is to lower intraocular pressure by creating additional pathways for the outflow of intraocular fluid.

There are several types of surgical treatment:

Non-invasive - and trabeculoplasty. Effective, safe, quick methods to achieve a hypotensive effect. But these types of treatments provide only a temporary effect - intraocular pressure is reduced for a period of 1 month to 3 years.
Penetrating (invasive) operations. They were first made in the mid-19th century and have been improved many times since then. Such operations include trabeculectomy and many drainage operations. All operations are carried out under local anesthesia. Trabeculectomy involves removing part of the trabecular system of the eye, thereby removing excess intraocular fluid that creates high blood pressure, exits under the conjunctiva, forming the so-called “filtration cushion”. Drainage operations are carried out, in most cases, if they are ineffective laser treatment and trabeculectomy. In this case, a special drainage is installed at the site of the removed trabecular system of the eye - the Ahmed valve. When intraocular pressure increases to a certain level, the valve opens and releases excess moisture under the conjunctiva. The operation is technically complex and expensive, and is performed infrequently and only in a few specialized ophthalmological hospitals.

What not to do with glaucoma

Just as with other diseases, there are contraindications for eye glaucoma:

the drug atropine, as well as nitrates, is strictly contraindicated;
It is not recommended to lift weights of more than 7 kg, prolonged work with the torso bent, or excessive physical activity;
visiting saunas and steam rooms is prohibited;
drinking alcohol and smoking;
Diet for glaucoma is gentle; you should not eat spicy or salty foods.
long periods of working on the computer and watching TV.

Acute attack of glaucoma

An acute attack of glaucoma is an ophthalmological emergency that requires prompt attention. qualified assistance. This phenomenon occurs with a closed-angle shape.

Symptoms of an attack of glaucoma - severe pain In eyes, sharp deterioration vision, which is associated with corneal edema (with phacogenic glaucoma due to swelling of the lens), headaches.

What to do in case of an acute attack of glaucoma? Urgent Care in case of illness is the prompt use of 1% Pilocarpine. These eye drops instilled into the conjunctival sac every 5 minutes for an hour, then every 20 minutes for an hour, then hourly for 24 hours.

Along with drops, Diacarb tablets are prescribed, up to 3 times a day (but not more than 3 days), to achieve low pressure intraocular fluid. If there is no positive dynamics within 24 hours, they resort to surgical treatment of glaucoma - trabeculectomy or lens replacement (if the glaucoma is phacogenic).

Sometimes, after all the efforts made by doctors, the pressure during an acute attack of glaucoma does not fall, and so-called malignant glaucoma develops. This disease occurs rarely and cannot be treated - the eye is removed.

Prevention of glaucoma

Preventive measures for glaucoma are aimed at preventing the development of the disease.

To avoid such an unpleasant disease, you should follow a few simple rules:

If you are over 40 years of age, you should check your intraocular pressure annually, especially if you have a family history;
exclude bad habits, lead healthy image life;
avoid spicy, salty, too hot foods, limit fluid intake to 2 liters per day.

The prognosis for glaucoma directly depends on the stage at which the disease was detected. On early stages It is possible to maintain vision for life using only eye drops. If a person is diagnosed with glaucoma, and he fulfills all the doctor’s requirements, then vision is preserved for high level. Only 20% of patients suffering from glaucoma experience deterioration in vision even with treatment. The consequences of the development of glaucoma in these patients are the same - irreversible vision loss and blindness.

Everyone has heard the term “glaucoma”. But few people know what is hidden under it and how to protect themselves from the disease. The name of the disease comes from the Greek word "azure" (or color sea water) due to the appearance of a greenish tint in the fixed pupil during an attack of glaucoma. What do you need to know about the disease?

The mechanism of development of glaucoma in adults

The term “glaucoma” is usually used to refer to an eye disease that is characterized by an increase in intraocular pressure, followed by the formation of visual field defects, a decrease in visual acuity and, subsequently, atrophy of the optic nerve.

We can say that in general, glaucoma is a whole group of diseases with certain characteristics

There is no age threshold for glaucoma. It can appear even in infancy, but most often the disease is observed in people old age. Of the causes of blindness that cannot be cured, glaucoma is at the forefront.

How does the disease develop?

It is very difficult to accurately decompose the disease development pattern point by point. Glaucoma is caused by a number of factors rather than any one cause.

And its appearance occurs in (roughly) a certain way

The outflow of intraocular fluid is disrupted.
There is an increase in intraocular pressure.
Further, blood circulation in the tissues and directly in the structure of the eye is disrupted.
There is tissue hypoxia/ischemia in the area of the optic nerve.
Nerve fibers are compressed as they exit the organ of vision. The consequence is their impaired functionality and death.
Nutrition is disrupted, followed by destruction and subsequent atrophy of the optic nerve fibers.
Large retinal neurons decay.
This is followed by optical glaucomatous neuropathy and complete death of the optic nerve.

At a certain stage of the disease, in which part of the optic nerve fibers die, and the other part is still viable (“falls asleep”), it is possible to save vision. But treatment (surgical or medicinal) must be timely and, most importantly, aimed at stabilizing the level of intraocular pressure.

Types and stages

Glaucoma is classified according to various criteria.

According to the age

All forms, except congenital, are acquired.

According to the origin of the disease

Primary (independent pathology).
Secondary (complication of intra/extraocular disorders).

According to its flow

Stabilized. In this case, the disease is characterized by the absence of negative dynamics for six months.
Unstabilized. There is a tendency for negative changes in the visual field.

By IOP level

Normotensive option (pressure up to 25 mm Hg).
Hypertensive variant (26-32 mm Hg/st).
Very high pressure(above 33 mmHg).

By stage of disease

1st stage

Features: expansion of the optic disc, excavation of the optic disc not reaching its edge, and identification of paracentral scotomas.

2nd stage

Features: change in the field of view in the paracentral region, marginal excavation of the optic disc and narrowing of the field of view by 10 degrees or more in the superior/inferior temporal segment.

3rd stage

Features: marginal subtotal excavation of the optic disc, concentric narrowing of the boundaries of the field of view.

4th stage

Features: total excavation of the optic disc, shift vascular bundle, destruction of the neuroretinal girdle. Complete loss of central vision of the patient or preservation of light perception.

Closed angle

This type is a consequence of primary glaucoma. This form manifests itself actively - with tension in the organs of vision, with discomfort, with pain in the temples and in the areas of the eyebrows. Sometimes there is a sudden blurring of vision and the appearance of a halo around any light source. An acute attack may also occur - a sharp and strong increase in intraocular pressure with sudden loss visual acuity, eye pain, weakness and nausea, attacks of abdominal/heart pain.

Open angle

This form may be asymptomatic. Not visible sharp drop vision - the narrowing of the spectrum occurs gradually over several years. And one day the patient realizes that one eye simply does not see anything. This form typically affects both eyes. Key Features- worsening vision at night and narrowing of the field of vision. Unfortunately, these manifestations reveal themselves already at the “advanced” stage, when the optic nerve is atrophied.

Pigmented

A very rare form. Features: obstructions in the outflow of intraocular fluid, the development of inflammation in the blocked angle of the anterior chamber and damage to the drainage system.

Pseudoexfoliative

Features: deposits of flocculent layers on back surface cornea, in the iris and ciliary body, as well as in the iridocorneal angle of the anterior chamber.

Neovascular

Features: growth of blood vessels on the iris, blocking of outflow aqueous humor, increased intraocular pressure.

Iridocorneal endothelial syndrome

This rare form is characterized by the development of the disease in the 1st eye. Features: spread of cells on the posterior surface of the cornea into the drainage system and further across the entire surface of the iris, subsequent increase in intraocular pressure, damage to the optic nerve.

Is it possible to avoid the disease, and who is at risk?

As mentioned above, the occurrence of glaucoma requires a number of reasons, which together give impetus to the development of the disease.

The most important reasons

Is it possible to avoid the disease?

Can! But only if you follow certain recommendations.

Do not delay visiting your doctor if you experience discomfort or any unusual sensations.
Go regularly full examination from a specialist. Especially if there is a risk factor (heredity).
When making a diagnosis, strictly follow all doctor's instructions. Even if it seems to you that you are completely healthy. Remember: the disease can be completely asymptomatic.
Don't overuse physical activity and beware of sudden changes in temperature.
Adjust your daily routine and nutrition. Overvoltage is contraindicated.

Symptoms of glaucoma in adults

At an early stage, a patient with glaucoma does not notice any signs of the disease.

As it progresses, as a rule, various complaints appear

How is glaucoma treated?

Today there are 3 known treatment methods: surgical, laser and drug treatment. The choice of method is carried out in accordance with the stage and severity of the disease.

Glaucoma is a chronic degenerative disease eye, associated with increased intraocular pressure. The latter, if not reduced to normal, leads to the death of the optic nerve, which becomes the cause of irreversible blindness.

Types and stages

There are several types of disease. So, congenital glaucoma develops as a result of intrauterine development anomalies and in most cases is diagnosed in newborns, juvenile glaucoma occurs in children from 3 years of age, as well as in adolescents and young people, primary adult glaucoma is associated with age-related changes in the eye, and secondary glaucoma occurs due to other eye diseases or general diseases.

There are two forms of the disease. Open-angle glaucoma is characterized by impaired outflow of intraocular fluid, which leads to its accumulation and a gradual increase in pressure, which can ultimately lead to destruction of the optic nerve.

Angle-closure glaucoma is much less common. Her main hallmark– a rapid increase in intraocular pressure when the pupil dilates (for example, in dim light), which leads to pain and blurred vision.

The course of glaucoma is conventionally divided into 4 stages. At stage I there are minor pathological changes in the paracentral parts of the visual field, at stage II these changes become more pronounced, at stage III there is deterioration of vision and loss of certain visual zones, and at stage IV there is a complete loss of vision.

Causes of glaucoma

Predisposing factors to the development of glaucoma are myopia and farsightedness, diabetes, atherosclerosis, hormonal disorders or age over 60 years. It has also been proven hereditary predisposition to the disease.

Symptoms and signs

At the early stage, there are practically no symptoms of eye glaucoma, but as the disease progresses, patients begin to complain of severe headaches, blurred vision, and the appearance of iridescent halos around light sources. Over time, visual acuity decreases and its fields narrow.

With the angle-closure form of the disease, an acute attack of glaucoma may develop, characterized by sharp increase intraocular pressure. Sometimes an attack may be accompanied by nausea and a general deterioration of the condition. In this case, assistance must be provided as quickly as possible, otherwise the risk is very high total loss vision.

However, sometimes the signs of eye glaucoma are very for a long time practically do not manifest themselves at all, and the process of onset of blindness lasts for several years. Therefore, in order to identify the problem in a timely manner, it is important to undergo regular examinations by an ophthalmologist.

Diagnosis of glaucoma

Diagnosis is made based on the results ophthalmological examination, during which intraocular pressure is measured, the fundus is examined and visual acuity is checked, indicators of the outflow of intraocular fluid are examined, and the boundaries of the visual fields are checked.

Glaucoma treatment

How to treat glaucoma of the eye? Depending on the form and stage of the disease, one of three main methods is used: surgical, laser or medication.

Surgery for glaucoma

Antiglaucomatous operations are divided into several groups:
— fistulizing (penetrating);
- non-fistulizing (non-penetrating);
— operations aimed at normalizing the circulation of intraocular fluid;
- operations that reduce the production of intraocular fluid.

Laser treatment of glaucoma

The most commonly used treatments for glaucoma are laser iridotomy and laser trabeculoplasty. The operations are performed under local anesthesia and allow you to restore the outflow of intraocular fluid through natural pathways.

Eye drops for glaucoma

Drug therapy for glaucoma involves the use of numerous drugs that improve the outflow of intraocular fluid, inhibit the production of intraocular fluid, or do both at the same time.

Homeopathy for glaucoma

Many are used to treat the disease homeopathic medicines(Aconitum, Arnica, etc.), however, clinical effectiveness this method treatment has not been studied enough.

Treatment of glaucoma with folk remedies

Treatment of glaucoma at home, using folk remedies, will help increase effectiveness drug therapy. Let's talk about some of the most popular ways to combat this disease.

So, good results brings a special infusion to reduce intraocular pressure. To prepare it, mix 1 teaspoon each of lingonberry, birch, plantain, knotweed, horsetail, string and nettle leaves, 2 teaspoons of St. John's wort leaves and 3 teaspoons of rose hips and rowan. Pour 2 tablespoons of the resulting mixture into 3 cups of boiling water and leave it in a thermos to infuse overnight, then drink the entire infusion during the day.

Another recipe is based on healing properties dill seeds Pour 1 teaspoon of seeds into a glass of boiling water and boil for a few minutes over low heat, then let it brew for an hour and strain. Drink ¼ glass 3 times a day 30 minutes before meals. The course of treatment is 3 weeks, then a break for 10 days and repeating the course.

Treating glaucoma with honey is also effective. Mix 1 teaspoon of aloe juice and honey, add 1 tablespoon of water and drop 1 drop of the resulting product into the sore eye every evening.

Gymnastics for glaucoma

While talking about how to cure glaucoma, we will also mention special exercises for eyes. Here they are:
1) Close your eyes tightly for a few seconds, then open your eyes. Repeat the exercise 8-10 times.
2) Blink your eyes rapidly for 2 minutes.
3) Look to the left, hold your gaze for a few seconds and then look to the right. Repeat the exercise 10 times.
4) Rotate your eyes in a circle, first in one direction and then in the other.

Nutrition for glaucoma

Prevention of glaucoma

There are currently no effective methods for preventing the disease. For timely detection of glaucoma, it is necessary to monitor eye pressure and undergo regular eye examinations.

Finally, let us remind you that if you have been diagnosed with glaucoma, then you need to avoid heavy lifting, bending work, and certain sports (for example, weightlifting). In this case, if you follow all the doctor’s recommendations and use folk remedies correctly, you have a high chance of maintaining visual acuity.