Glaucoma: Causes, Symptoms, Treatment and Prevention

Glaucoma is a disease that causes damage to the optic nerve and result in leading to visual impairment or blindness. This disease can occur at any age from birth, but is most common in the elderly and older. There is currently no single view of the causes and mechanisms of this disease.

Typically, glaucoma occurs due to an increase in intraocular pressure (IOP). In the front part of the eye between the lens and the cornea, there is a small space called the anterior chamber. Transparent fluid circulates therein, washing and nourishing the surrounding tissue. When the intraocular fluid begins to flow away too slowly from the anterior chamber and its accumulation causes increased intraocular pressure. If not controlled, it can lead to damage to the optic nerve and other structures of the eye, and then - and vision loss.

What it is?

Glaucoma - is a group of eye diseases that lead to damage of the optic nerve and loss of vision. The most common form of open-angle glaucoma. Less common forms of the disease include glaucoma and angle-closure glaucoma with normal pressure (MLA).

Causes of

The primary cause of the disease is increased intraocular pressure and disturbance of the outflow path. Due to the fact that the pressure becomes high, the tubules are deformed, and fiber optic infringed. In the future, nerve atrophy, and impaired vision in humans.

On the increase of intraocular pressure can be influenced by the following factors:

1. Atherosclerotic intraocular vessels;
2. Severe hyperopia;
3. Chronic ocular diseases (e.g., cataracts);
4. eye injuries;
5. GlaukomaSaharny diabetes;
6. Genetic predisposition;
7. Anomalies of the eye;
8. Taking medication that may affect intraocular pressure (antidepressants, antiallergic and psychostimulant drugs);
9. Alcohol abuse and smoking.

Quite common is also a version of the multifactorial nature of glaucoma. By a combination of factors that cause glaucoma, rank as hereditary reasons, the structure of the organs of vision abnormalities, trauma, diseases of the nervous, cardiovascular and endocrine systems.

According to this theory, summarizing the operation of all or more of the above factors can trigger the mechanism of glaucoma.

development mechanism

As mentioned previously, glaucoma is characterized by an increase in intraocular pressure (IOP), which normally is 9 - 20 millimeters of mercury. The reason is the increase in IOP violation circulation of intraocular fluids.

Under normal conditions, the aqueous humor is produced by special ciliary body cells, and its speed formation is controlled by the nervous system (in each eye is generated from 3 to 9 ml of the aqueous humor in day). The resulting fluid initially enters the rear chamber of the eye, and then passes through the pupil into the anterior chamber. In the front chamber, on the border of the iris and the cornea is called the angle of the anterior chamber, in which the aqueous humor flows out. Through anterior chamber angle she misses the trabecular meshwork (trabecula - a unique plate, partitions between which there is free space), and therefrom sucked into the veins of the vascular membrane and back into the system bloodstream. As described mechanism is removed from the eye cameras more than 85% of the liquid. At the same time, about 15% of the aqueous humor leaks through the ciliary body tissue and is absorbed directly into the scleral blood vessels.

In case of violation of outflow of intraocular fluid process, it begins to accumulate in the cells in the eye excess amount, which is the direct cause of increased intraocular pressure, and glaucoma.

Open-angle glaucoma

Open-angle glaucoma is more than 90% of all cases of this disease. In this form of glaucoma iridocorneal angle is open, and that led to its name. The outflow of intraocular fluid is reduced by reducing the gaps between comb trabeculae ligament (fontanovy space). This leads to its accumulation and the gradual but continuous increase in pressure, which in the end can destroy the long run the optic nerve and cause vision loss if not detected in time it is not to start drug therapy under the supervision of doctor.

Stage primary open-angle glaucoma:

1. Stage I (initial) - changes in the peripheral vision are absent, but there is little in the central (Paracentral scotomas in Bjerrum area extension of blind spots), excavation of the optic nerve papilla without reaching to its edges.
2. Step II (developed) - narrowing of the peripheral field of view greater than 10 degrees with nasal side or concentric constriction which does not reach 15 degrees from the fixation point, excavation of the optic disk (boundary value)
3. Step III (far advanced) - is characterized by narrowing of the field of view concentric and in one or more segments of more than 15 degrees from the fixation point, excavation ONH
4. Step IV (the terminal) - total absence of or with incorrect projection photoreception possibly remaining in the temporal vision field. If the eyes of the medium transparent and clear fundus, the optic nerve atrophy is present.

According to the level of intraocular pressure distinguish grade 3:

1. A normal IOP (to 27 mm Hg. Art.)
2. The moderate-IOP (28-32 mmHg)
3. Since the IOP-high (more than 33 mm Hg)

Form open angle glaucoma: primary, pseudoexfoliation and pigmentary.

angle-closure glaucoma

More rare form of glaucoma, which is mostly the case with farsightedness in people over the age of 30 years. In this form of glaucoma, the pressure in the eye rises rapidly.

Anything that causes the pupil to expand, for example dim light, some medicines and even extend eye drops that buried in front of the eye examination, may be the reason that some people iris blocks the outflow of intraocular liquid. When there is such a form of the disease, the eyeball quickly hardens and unexpected pressure causes pain and blurred vision.

glaucoma symptoms

Most types of glaucoma, particularly in the initial stages take place without simpttmov that is the cause of the late negotiability patients medical attention when the disease reaches an advanced stage, and are irreversible changes in the optic nerve.

Symptoms suggestive of glaucoma are: narrowing of the boundaries of the peripheral field of vision, visual field defects, sometimes iridescent circles when looking at the light source. Visual acuity at the same time can be quite high.

Thus, Glaucoma is an insidious disease asymptomatic in the early stages. If the patient and observes narrowing of the field of view of the borders, it is already at an advanced stage of the disease. And identify suspected glaucoma at an early stage can only ophthalmologist. Therefore, preventive examinations of ophthalmologist people older than 40 years are required.

An acute attack of glaucoma

Acute glaucoma attack - attack, resulting from a sharp increase in intraocular pressure (IOP), which causes poor circulation eye and can lead to irreversible blindness.

The attack begins suddenly. There is pain in the eye, in the corresponding half of the head, especially on the back of the head, nausea, sometimes vomiting, weakness. An acute attack of glaucoma is often mistaken for a migraine, hypertensive crisis, poisoning, resulting in serious consequences, for such assistance should be provided to the patient in the early hours of the disease.

In acute glaucoma attack eye red, swollen eyelids, cornea becomes turbid, the pupil is expanded, it takes an irregular shape. Vision dramatically reduced. When palpation sharply increased IOP study - hard eyes. You must immediately begin to dig into the eye of 2% pilocarpine solution every hour. You can add or burying phosphacol Armin 3 times a day. Inside give 0.25 g of the patient diakarba (contraindicated if the patient urolithiasis), 20 g of laxative salts do hot foot bath. At night to sleeping pills. The patient should be immediately (if possible - immediately) deliver to the ophthalmologist.

Chronic angle-closure glaucoma

Chronic angle-closure glaucoma develops as a result of frequently repeated acute attacks of the disease. In sharp tackle process outflow of intraocular fluid and the expression enhancing vascular narrowing parts of iris may occur intraocular pressure.

If the condition persists for an extended period, certain parts of iris tissue may undergo necrosis (destruction). Evolving wherein the inflammatory process may lead to formation of adhesions in the iridocorneal angle, which would prevent the normal outflow of intraocular fluid even after the acute attack glaucoma. The pupil can in this case become deformed (its edges are uneven).

The more often repeated attacks, the more adhesions may form, and the greater will be violated the process of outflow of aqueous humor, which in due course and will be the cause of chronic closure glaucoma. Clinical manifestations of this form of the disease are similar to those in open form, but interrupted periodically alternate exacerbations.

Diagnostics

The main problem in the diagnosis of glaucoma, especially open-is the lack of typical symptoms in the early stages. Many people with this disease are not aware of it. It is therefore very important, especially in old age, have regular eye exams. There are several methods for diagnosis of glaucoma.

1. Eye pressure is measured by tonometry. Check intraocular pressure - an important part of the diagnosis of glaucoma. The high intraocular pressure - often the first sign of the presence of disease. In some cases, before the measurement of the eye drops are buried painkillers. Using a special device - tonometer - cornea measured pressure resistance. The normal intraocular pressure from 10 to 21 mm Hg (P0-true). However, in people with normotensive glaucoma, in which the IOP less than 21 mm Hg. v., there may be damage to the optic nerve and visual field loss.
2. Ophthalmoscopy (examination of the optic disk for signs of damage) is performed using ophthalmoscope - a tool to examine the internal structure of the eye in increase. The pupil at the same time expanding with special drops. Glaucoma damages the optic nerve, causing the death of its constituent fibers. As a result, its appearance changed, it begins to resemble a cup. If its size increases, the field of view appear "dark" spots.
3. Gonioscopy (examination of the anterior chamber angle) allows you to get a clear picture of the state of the anterior chamber angle to determine the type of glaucoma. In a typical inspection make it difficult. Using mirror lens makes it possible to examine the angle of the anterior chamber and presence of open set (if the angle of the anterior chamber operates inefficiently) or closure (if the angle of the anterior chamber at least partially closed) glaucoma or dangerous narrowing of the anterior chamber angle (when the iris is located so close to the drainage system of the eye which may block it).
4. Pachymetry - a measurement of the corneal thickness. This indicator can affect the accuracy of IOP measurement. If the cornea is very thick, the intraocular pressure in fact be lower than according to the tonometry. Conversely, if very thin cornea true intraocular pressure is higher than the result of measurement indicates.
5. Perimetry reveals the "dark" spots in the visual field. The test results show their presence and location. Some of these patients may not even notice. The test is performed using a cup-shaped device, called the perimeter. At the same time it can be checked only one eye, so during the study the other eye is covered with a bandage. The patient should strictly look right on the mark. The computer sends a signal within the device and randomly flashing luminous spots. The patient must press a button when they see it. Not every beep accompanied by the appearance point. Perimetry is usually performed every 6-12 months to monitor changes.

glaucoma treatment

Glaucoma can be treated with eyedrops, medicines, laser surgery, conventional surgery or a combination of these methods. The goal of any treatment - to prevent vision loss as loss of vision in glaucoma is irreversible. The good news is that glaucoma can be controlled if it is detected at an early stage, and that with medical and / or surgical treatment, most people with glaucoma will not lose vision.

Regular intake of prescription drugs is crucial to prevent damage threatening the eyesight. It is therefore important for you to discuss side effects with your doctor. While every drug has some potential side effects, it is important to note that many patients do not experience side effects at all. You and your doctor should work as a team in the fight against glaucoma. Your doctor a lot of options.

Eyesight Enhancing Vitamins

As a result, a number of studies have shown that the use of specially designed for vision vitamin-mineral complexes can be very effective for a given disease.

• These drugs are used as a supplement to the basic course, and in many cases make it possible to save the patient's vision. The most popular are the lutein-containing agents: Complex Lutein, Lutein Forte.
• In spostav drugs include lutein in the correct form, necessary to improve vision vitamins (A, C, E), minerals (zinc, selenium, copper).

Together, these elements fully support the visual function: lutein is a protection against free radicals contained in bilberry anthocyanidins have a beneficial effect on visual acuity, vitamin and mineral components relieve fatigue and reduce the manifestations of age-related changes in tissue eye.

Eye drops

In glaucoma, the following types of eye drops:

1. Drops for reducing production of intraocular fluid. This group of drugs include antihypertensives eyedrops - Betaxolol solution Proksodolol, dorzolamide hydrochloride, timolol maleate, and so forth. One of the most used drug is timolol maleate, which is used for treatment of all forms of glaucoma. Preparations based on active ingredient timolol release titled: Arutimol, Oftan timolol, Okumed.
2. Eye drops to improve the outflow of intraocular fluid - nicotinic agents. Promote natural outflow of liquid and effective in reducing IOP. For treatment using hydrochloric acid, and pilocarpine. Eye drops based on such holinomimeticakih means as carbachol and aceclidine can be used only on prescription, since they cause a number of side effects. This group of drugs are new drugs, such as travoprost and Latanoprost. These eye drops are effectively increase the outflow of aqueous humor by the eye additional channels.
3. Combined eyedrops. To effectively reduce IOP, commonly used drugs with several active substances which not only normalize the intraocular pressure, but also reduce the production of aqueous humor. Such combination drugs include pilocarpine, Proksodolol, Latanoprost, etc. Fotil.

ophthalmic instruments

As an additional means ophthalmologists advise physiotherapeutic methods to normalize and stabilize the intraocular pressure of view.

It is recommended to use special equipment - for example, Points Sidorenko. They have on the eye and surrounding tissue through the combined effect of infrasound pneumomassage, phonophoresis and color pulses.

This device is used as in glaucoma, and in many other diseases of the eye: myopia, hyperopia, and cataracts, etc.

Surgical procedure (operation)

When applying medicaments fails or a person has intolerable side effects, the ophthalmologist may suggest surgery.

Glaucoma treatment lazeromom

Laser trabeculoplasty - a method of treating patients with open-angle glaucoma form. Treatment is based on the use of a laser beam to open the clogged channels of the trabecular meshwork. Before reaching full effect after this procedure may take several weeks.

The operation is performed under local anesthesia (eye drops with analgesic properties). Before the patient's eye is established a special lens through which the laser beam is passed. This beam makes small punctures in the trabecular meshwork through which the liquid outflow and intraocular pressure is reduced.

An alternative method is the so-called tsiklodiodnoe laser treatment. It is the destruction of certain parts of the eye, in which the liquid is formed. As a result, the eye produces less liquid and achieves a reduction in intraocular pressure.

Laser treatment is fast and painless. It can be done at any age.

peripheral iridectomy

When laser iridotomy unable to arrest acute attack or angle-closure glaucoma is not possible for other reasons, peripheral iridectomy can be performed.

Removed a small portion of the iris, which gives access to the intraocular fluid drainage system of the eye. Due to the fact that most cases of angle-closure glaucoma can be cured by intake of glaucoma medications and laser iridotomy, peripheral iridectomy is used quite rarely.

trabeculectomy

When medications and laser therapy is not enough reduce intraocular pressure, doctors may recommend conventional surgery. The most common of operations is trabeculectomy, which is used as in open and during closure glaucoma. In this procedure, the surgeon creates a passage in the sclera (the white part of the eye) for drainage of excess aqueous humor. Creates a valve to allow fluid to leave, but not allowing the eye to flow.

Above the hole on the eye surface often forms a small bubble of fluid, which is a sign that liquid flows into the space between the sclera and the conjunctiva. Sometimes created surgically drain hole begins to close, and IOP rises again. This is because the body is trying to heal a new hole. Many surgeons perform trabeculectomy with antifibrotic agent which is placed on the eye during surgery and reduce scarring during the healing period. The most common antifibrotic agent is mitomycin-C. The other is 5-fluorouracil (5-FU).

About 50% of patients require longer treatment of glaucoma after operation for a considerable period of time. From 35 to 40% of those who are still in need of treatment, better control their IOP. Trabeculectomy usually is an outpatient procedure. The number of postoperative visits to the doctor varies, some activities, such as driving a car, reading, bending and flexing, and weightlifting, it should be limited to two to four weeks after operations.

iStent

Currently underway to develop new treatments. For example, preliminary results shows positive iStent device. This first device for micro-invasive surgical treatment of glaucoma, which improves the natural outflow of the liquid to safely lower IOP. The device is used to create a permanent hole in the trabecular meshwork. The advantages iStent include:

1. installation safety;
2. Spreads ocular tissue, which under standard treatments simply cut;
3. It does not limit the use of other methods of treatment to preserve vision.

iStent - is the smallest device ever claimed for use in medicine. It is installed in the patient's eye during cataract surgery and treatment is so small that the patient does not see and does not feel.

This device creates a hole in the trabecular meshwork, which operates continuously, improving fluid outflow. Currently iStent, which is inserted through an incision of 1.5 mm in length, is the only approved by the new method in the treatment of open-angle glaucoma mild to moderate severity, which can be successfully applied in both young and elderly people.

Forecast

The prognosis depends on when the disease is detected. If the diagnosis is made before significant damage to the optic nerve, the prognosis is usually good if the patient agrees to the treatment proposed by the ophthalmologist.

Since the optic nerve damage is irreversible and the previously damaged optic nerves are more susceptible to further damage, delay in diagnosis (diagnosis when made after considerable damage to the optic nerve and partial loss of vision) leads to more aggressive therapy, and worsens forecast.

Prevention of glaucoma

The most effective way of preventing this is a permanent visiting ophthalmologist, especially after 40 years, when you fall into a risk group. It is also useful exercises for the eyes, which provides stress relief and normalization of pressure.

With age, the need to listen more to yourself and your body. Maybe you have long noticed that the vision falls and difficult to focus on an object. It is not necessary to delay the campaign to the doctor, because you run the risk of complete loss of vision. Glaucoma is treated very well today, and this treatment does not require expensive medicines or injections. Take care of yourself and your health!