Glaucoma — this disease of eyes for which periodic or continuous increase of the intraocular pressure (VGD) is characteristic. Violation of circulation of intraocular liquid (decrease in its outflow) is the reason of increase of VGD. The atrophy of an optic nerve occurs owing to the raised VGD that eventually conducts to full loss of sight.
Glaucoma first of all threatens what relatives were subject to this disease (the illness is transmitted to a thicket through generation: if the grandfather was ill, at the grandson glaucoma almost for certain will develop). Also the people having short-sightedness, diabetes, endocrine diseases get to group of risk. Glaucoma can be congenital, has value and age: the acquired glaucoma most often develops after 60-65 years, and in some cases after 40 years.
As there is a glaucoma
In an eye watery moisture which then passes into a back chamber — small space between a raduzhka and a crystalline lens is constantly developed. Then through a pupil moisture gets to a forward chamber — between a cornea and a raduzhka. In a corner of a forward chamber where the cornea and a raduzhka meet, there is a drainage system of an eye. Through drainage system moisture leaves an eye and gets to a blood-groove. If outflow is broken — VGD raises. The more long VGD remains raised, the optic nerve is squeezed more strongly. Over time fibers of an optic nerve start perishing and the person gradually grows blind. That VGD remained normal, the balance between a producing moisture and its outflow has to be observed.
In norm eye pressure does not exceed 16-27 mm of mercury. Though at glaucoma of VGD can be as normal (or not strongly to go beyond norm), and raised. But if pressure exceeds 35 mm of mercury. also there is such long time, treatment surely is required.
If intraocular pressure increases, the person tests a number of unpleasant symptoms: sight becomes obscured, the feeling that you look "through a grid" is created. At a view of a lamp or any other light source before eyes there are blurring iridescent circles. Sight in twilight worsens, there are gripes in eyes, lachrymation, feeling of weight and tension, pain round eyes.
It happens and so that the person does not notice the raised VGD (glaucoma can proceed bessimptomno at the first stages) and addresses to the doctor only when the field of vision starts being narrowed. InfoAdvisor.net pays your attention that in this case it is only possible to stop sight loss, it is already impossible to return a normal field of vision.
The bad attack of glaucoma develops suddenly. There is a severe pain in an eye and the corresponding half of the head, a nape pain, nausea, vomiting, the general weakness. Symptoms of an attack are very similar to manifestations of hypertensive crisis or poisoning — because of it the patient does not receive the help in time and can lose sight.
Here symptoms by which it is possible to determine a glaucoma attack: there is a puffiness of eyelids, , the cornea grows turbid, the pupil is expanded and has the wrong form. Sight sharply decreases. If to touch fingers of eyes (closed), it will be very firm – because of the raised VGD. To help the patient, it is necessary to dig immediately 2% solution of a pilokarpin, to accept 0,25 g of a diakarb (the diuretic necessary for removal of liquid from an organism) and as soon as possible to address to the doctor.
Diagnosis of glaucoma
For statement of the diagnosis the ophthalmologist needs to carry out a row simple (for the patient) inspections: determination of visual acuity (vizometriya), measurement of intraocular pressure (tonometriya), research of a field of vision (perimetry), definition of a condition of an optic nerve during survey of an eye bottom (oftalmoskopiya). All necessary devices are in any office of the ophthalmologist. The skilled doctor can diagnose glaucoma even after a palpation of eyeballs and an oftalmoskopiya.
Classification of glaucoma
As it was already told, glaucoma can be both congenital, and acquired during life.
The congenital can be shown as in the childhood (till 10 years, the majority of cases), and at later age.
The acquired glaucoma depending on the reason of its development divide on primary and secondary. Primary glaucoma develops because of violation of outflow of watery moisture from an eye and, as a result, increase of VGD. All carry to secondary glaucomas that appeared as complication of other diseases (diabetes, a cataract, thrombosis), injuries and inflammations of an eye and other bodies.
On the mechanism of increase of VGD — the acquired glaucoma is subdivided on open-angle and closed-angle.
At open-angle glaucoma the drainage system of an eye gradually changes, why pressure periodically increases and the optic nerve suffers. At closed-angle glaucoma outflow of intraocular liquid is blocked by a root of an iris of the eye which closes a corner of a forward chamber of an eye.
Depending on that, the optic nerve glaucoma is how struck subdivide into 4 stages. At the 1st stage (initial) the field of vision is not narrowed yet, but at survey of an eye bottom changes are visible. For the 2nd stage (the developed glaucoma) narrowing of a field of vision is already characteristic, and changes at an eye bottom are expressed more strongly. At the 3rd stage (far come glaucoma) the field of vision is narrowed concentric, and on the 4th (terminal glaucoma) the patient completely loses sight or there is only a svetooshchushcheniye.
Treatment of glaucoma
In treatment of glaucoma there are three main directions: therapeutic, laser and surgical.
At therapeutic treatment to the patient the preparations lowering intraocular pressure, and in addition to them — the drugs improving blood supply of an eye and normalizing a metabolism in tissues of eyes are appointed.
The drugs reducing VGD have to regularly , but happens and so that the patient possesses resistance to action of drops – and then it is necessary to select other preparation. In the first weeks of purpose of antiglaukomny drops the patient has to visit regularly the oculist to control behind a condition of intraocular pressure. If drops render a positive effect, the patient will need to visit the doctor only once in 2-3 months. In certain cases drops work so successfully that with their help VGD manage to control within several years — it is necessary to change only once in a year the preparation lowering pressure that there was no accustoming.
To lower eye pressure, use two types of drops: the drops improving outflow of intraocular liquid (Pilokarpin, Izokarpin, etc.) and the drops reducing production of intraocular liquid (the Clonidine, Betoptik, Okumed). InfoAdvisor.net recommends strongly: never mix drops. This wild "cocktail" from different drugs will not bring any benefit to eyes, on the contrary, drops will lose the medicinal properties.
If drops do not give effect, it is necessary to do operation. Most often at first perform laser operation. The most effective are the laser iridotomiya (iridektomiya) and a laser trabekuloplastika.
The essence of a laser iridektomiya is that the doctor, using a laser beam, does a small opening in a raduzhka. Through this opening intraocular liquid starts leaving an eye without obstacles, VGD is normalized. Resort to this operation for treatment of a closed-angle form of glaucoma.
The laser trabekuloplastika is carried out at open-angle glaucoma. It also promotes normalization of VGD, but the principle of its action is a little another: the laser beam applies some microscopically small burns that increases permeability of a raduzhka for liquid on a raduzhka.
Advantages of laser operations:
Shortcomings of laser operations:
- outflow of intraocular liquid happens on natural ways;
- for carrying out operation it is enough to dig the anesthetizing in an eye;
- operation can be performed in out-patient conditions;
- the term of rehabilitation is minimum.
- fragility of effect of operation (1-2 years);
- during operation damages of an epithelium of a cornea, a capsule of a crystalline lens and vessels of a raduzhka are possible;
- increase of VGD during the first hours after operation can become reaction to laser operation;
- after operation unions of fabrics in places of influence of the laser can be formed.
The decision on need of carrying out a surgery is passed in each separate case on the basis of a type of glaucoma, indications of intraocular pressure and level of outflow of liquid from an eye, a field of vision, and also the general assessment of health of the patient. The most widespread types surgical glaucoma operation are the trabekulektomiya and not getting deep sklerektomiya (NGSE).
At a trabekulektomiya new ways of outflow of intraocular liquid are created. During operation the doctor deletes a site of fabric and creates through service between a forward chamber of an eye and subconjunctival space. This operation in essence rather easy, also brings rather quite good results. But not seldom results of a trabekulektomiya not only do not remain for a long time, but also, on the contrary, there is a number of negative consequences. On a place of surgery there are hems, i.e. again blocks liquid outflow. And that is characteristic, repeated operation will not have due effect any more. In some cases, on the contrary, outflow of intraocular liquid starts going much quicker, than it is reproduced is will also negatively affect a condition of eyes.
The essence of NGSE consists in surgical thinning of peripheral sites of a cornea. Through these thinned places moisture circulates more freely and easily leaves an eye. After NGSE the patient can already return to a habitual way of life in 2-3 days. But that eye pressure remained stable, courses of the supporting therapy are required periodic (2 times a year): the drugs improving blood supply of an eyeball and an optic nerve (kavinton, pikamilon, mildronat), physioprocedures.
As you can see, glaucoma is quite serious disease. Therefore if feel that sight dimmed or even simply slight eye pain, be not too lazy to descend to the doctor. As prevention after 40 years it is desirable to visit periodically the oculist and without the reasons seen on that. Those violations of sight coming together with development of glaucoma are not restored any more – about it you have to remember and care of a condition of the eyes.