Glaucoma of the eye is a disease characterized by an increase in intraocular pressure (IOP) with subsequent changes in the optic nerve. The process progresses, which leads to deterioration of vision, and sometimes to complete blindness. If ocular glaucoma is detected in the early stages, it is possible to stop the process of eye damage, to avoid vision loss.
According to statistics from the World Health Organization, about 15% of cases of blindness are caused by glaucoma. Eye pathology threatens not only the elderly, but also young people. In total, at least 3% of the world’s population suffers from this disease. Pathology can occur at any age, including congenital, but people over 40 years of age are most at risk. The most common increase in intraocular pressure occurs in the age group over 75 years.
The mechanism of development of degenerative changes in the retina and optic nerve are associated with impaired outflow of ocular fluid. Constant or periodic increase in intraocular pressure leads to pronounced trophic changes. Visual disturbances develop gradually, at first the field of vision narrows, a veil appears before the eyes.
Causes of glaucoma
The pathogenetic mechanism of eye disease is complex, its development is influenced by many factors. That is why the causes and symptoms of glaucoma are diverse. Let’s consider how this eye disease develops, how the mechanism of moisture removal from the visual apparatus normally functions.
All structures of the eye are washed with ocular fluid. It provides tissue trophism, their hydration, promotes the excretion of metabolic products. Ocular fluid is produced by the ciliary body. Its reservoir is the posterior chamber of the eye, located behind the iris. From there, watery moisture enters the anterior chamber through the pupil opening. In the corner of the anterior chamber of the eye there is a special channel that collects fluid and directs it to the venous vessels. With the normal functioning of this mechanism, intraocular pressure is maintained at a level of 18 to 26 mm Hg.
If the mechanism of outflow of ocular fluid is disrupted or its amount increases rapidly, intraocular pressure increases, the tissues inside the eye are squeezed, their hypoxia develops. With prolonged compression, nerve fibers and retinal cells are destroyed. This leads to irreversible changes, up to atrophy of the optic nerve.
Congenital causes of impaired outflow of ocular fluid are usually associated with anomalies in the structure of the eye chambers, neoplasms. Secondary eye pathology can develop as a result of eye injuries, inflammatory diseases, after surgical interventions, as well as visual disturbances, for example, hyperopia.
In total, more than 60 pathologies in children, adults and the elderly are combined under the concept of glaucoma, therefore, in each case, the causes of the disease are determined individually.
Classification of glaucoma by stages
Depending on the clinical changes of the disease, there are 4 stages of the disease. During an eye examination, not only intraocular pressure is assessed, but also visual fields and fundus changes are assessed.
Let’s consider what manifestations are characteristic of each of the four stages of the disease according to the classification:
- At the initial stage of the disease, when examining the fundus on the optic nerve disc, an excavation is determined that does not reach the edges. The disk itself is somewhat expanded. During the determination of visual acuity and assessment of visual fields, paracentral scotomas, or blind spots, are detected.
- At this stage, the excavation on the optic nerve disk reaches the edge. A narrowing of the visual fields by 10 degrees or more is recorded. Narrowing is noted in the upper or lower temporal segment.
- This stage, according to the classification, is called far gone. The marginal depression on the optic nerve disc is of a total nature. The narrowing of the visual fields is pronounced, has a concentric shape.
- The terminal phase of the disease is manifested by total excavation of the ZEN. Central vision is completely lost or only light perception is preserved. The pronounced changes are irreversible, the function of the visual organ is practically lost.
There are other classifications of eye diseases. Depending on the time of manifestation of changes, the pathology may be congenital or acquired. According to the level of intraocular pressure, a normotensive or hypertensive variant is distinguished. By the nature of the course, the disease can be stabilized or not stabilized. We can talk about a stable course in the absence of negative dynamics for six months.
Determining the stage of the disease and assessing the severity of disorders play a decisive role in choosing a method of treating glaucoma symptoms.
Symptoms of glaucoma
Signs of glaucoma, namely, an open-angle shape, are practically absent at an early stage. For several years, the patient may not notice any changes, as the fields of vision narrow gradually. Sometimes patients complain of fog and iridescent circles in front of their eyes, note a deterioration in the vision of one of the eyes, notice that they have become hard to see in the dark. The disease is also characterized by headaches localized in the region of the brow arches. The disease at an early stage is usually an accidental finding when examined by an ophthalmologist.
Angle-closure glaucoma proceeds differently. At the stage of preglaucoma, there are also no symptoms, changes in the anterior chamber of the eye can only be detected by an optometrist during an examination. Sometimes patients notice iridescent circles in front of their eyes, note a short-term deterioration of vision or discomfort.
The closed-angle form manifests as an acute attack, which is caused by a sharp increase in intraocular pressure. This happens when the angle of the anterior chamber of the eye closes completely. Usually, an attack develops against the background of stress, prolonged exposure to darkness, prolonged stay in an inclined position, as well as with pupil dilation with atropine. Patients complain of sharp pain in the eyeball, sudden deterioration or loss of vision. When examining the eyes, the pupil is dilated, has a greenish tinge, the sclera are hyperemic, the cornea loses its luster, the eyeball becomes dense. Many patients also have common manifestations: nausea, headache, unpleasant sensations in the heart area.
During an acute attack, a person needs emergency medical care. If intraocular pressure is not stabilized within a few hours, there is a high probability of complete loss of vision.
In the chronic course of eye disease, the manifestations are dimly expressed, the deterioration of vision and narrowing of the visual fields occurs gradually. In the absence of therapy, the patient is threatened with complete atrophy of the optic nerve with complete loss of vision.
Diagnosis of glaucoma
The earlier the diagnosis is carried out, the more likely it is to prevent irreversible changes and save vision. That is why, at the slightest suspicion of this pathology, as well as with a slight deterioration of vision, even if it is periodic, you need to contact an ophthalmologist and undergo a diagnosis.
A mandatory manipulation during the diagnosis is tonometry – measurement of intraocular pressure. But even with normal indicators, a diagnosis cannot be ruled out. The increase in IOP may be episodic. That is why such a study as daily tonometry is relevant.
To detect the symptoms of glaucoma, an examination of the fundus is necessary as part of the diagnosis. Changes in the optic nerve disc are already detected in the early stages. The doctor also examines the anterior chamber of the eye. Examination of the fundus is called ophthalmoscopy, and examination of the anterior eye chamber is called gonioscopy.
One of the fundamental signs is a narrowing of the visual fields, but the patient does not notice this. The doctor can identify the problem during diagnosis. Computer perimetry is used in modern ophthalmology clinics to determine the fields of vision.
Modern techniques such as laser ophthalmoscopy and polarimetry, ultrasound of the eyes, optical coherence tomography are used to examine the retina, the optic nerve disc. With the help of these diagnostic methods, even minor deviations can be detected. This allows you to determine the causes and start treatment of glaucoma at a stage when vision has not yet been affected.
Treatment of glaucoma
Conservative and surgical methods are distinguished. The best treatment for glaucoma is a tactic suitable for a specific patient, taking into account the causes of the disease, age, degree of visual impairment.
In case of an acute attack, therapy should be started immediately, this is an urgent condition. They try to stop the attack by conservative methods: the appointment of pilocarpine and diuretics. If it is not possible to reduce intraocular pressure with the help of medications, they resort to surgical tactics — iridectomy. When using laser techniques, the procedure is not traumatic, and recovery occurs quickly. Operative reduction of IOP prevents prolonged ischemia and degenerative changes of the retina, optic nerve.
For the treatment of glaucoma in adults, such surgical techniques as trabeculectomy, sclerectomy, and cycloyricoagulation are widely used. They allow you to reduce intraocular pressure, adjust the outflow of fluid, prevent an increase in intraocular pressure and degeneration of the optic nerve. Laser techniques have a minimum of contraindications, after such interventions, patients recover quickly.
Medications for glaucoma
Patients after the diagnosis of eye disease need serious therapy to help stabilize intraocular pressure. Treatment of glaucoma with folk remedies is not effective and can lead to irreversible changes in the visual apparatus, so you need to follow all the recommendations of an ophthalmologist.
What medications should I take for glaucoma? Therapy has three main directions:
- normalization of intraocular pressure;
- improvement of blood supply to the optic disc;
- improvement of trophic tissues.
Medications that reduce intraocular pressure are available in the form of drops.
They are selected individually after a full examination. The patient must strictly follow the scheme of application of drops and dosage. It should be borne in mind that in the course of therapy, addiction to certain means can occur, so the scheme has to be changed periodically. To do this, you need to visit an optometrist regularly, monitor intraocular pressure. If it is not possible to maintain indicators at the individual level, the therapy regimen is adjusted.
Among the drugs for glaucoma of the eye, there are also injectable drugs. They are injected into the ocular tissue.
Treatment of glaucoma with drops is the basic stage of therapy. It allows you to stabilize the disease. The mechanism of action of these funds can be different. Some reduce the amount of watery moisture, others improve its outflow from the eye chamber. There are also combination medications.
For the treatment of glaucoma in adults, such pharmacological groups of drugs in the form of drops as prostaglandins, beta-blockers, cholinomimetics, carbonic anhydrase inhibitors are used.
Prostaglandins reduce IOP by improving fluid outflow through additional pathways. Beta-blockers reduce the rate of formation of watery moisture. Cholinomimetics constrict the pupil, freeing the angle of the anterior chamber of the eye, which accelerates the outflow of fluid. Carbonic anhydrase inhibitors, like beta blockers, slow down the production of watery moisture.
Along with eye drops that reduce intraocular pressure, drugs that have a neuroretinoprotective effect, improve microcirculation and trophism, as well as vitamins and antioxidants are widely used. These drugs are widely used in the treatment of glaucoma in the elderly.
The list of medications for glaucoma of the eye is quite large, a competent combination of drops allows you to get an excellent result. That is why you should not self-medicate, entrust the selection of therapy to an ophthalmologist who will diagnose and take into account the manifestations and cause of pathology.
Injections for glaucoma
One of the effective methods of therapy is injections from glaucoma in the eye. This method is effective, but only a professional should perform injections after a comprehensive diagnosis.
In the treatment of glaucoma with injectable drugs, drugs are injected into the fatty tissue around the eye, behind the eyeball, as well as under the mucous membrane of the eyeball itself.. But the result of such therapy is excellent, since the active substance is delivered directly to the point of application.
Treatment of signs of glaucoma by injection is used when drops are ineffective, the disease progresses according to diagnostic results. Injections are carried out in courses, breaks between them — at least several months. The technique gives an excellent result, allows you to stop the pathological processes associated with degeneration of the retina and optic nerve.
Which injections for glaucoma are suitable for a particular patient is decided by an ophthalmologist after a comprehensive examination. The correct selection of drugs and injection techniques allows you to target the problem. Injection treatment of glaucoma is used both in the elderly and in young patients.
Peptides-based drugs are successfully used to combat degenerative changes in the retina and optic nerve. These tools allow you to keep the disease under control and avoid deterioration of vision and its loss.
Prognosis and prevention of glaucoma
Unfortunately, it is impossible to completely get rid of the disease. But modern methods of treating glaucoma in adults allow you to keep the pathology under control even in the elderly. Properly selected therapy allows you to stop pathological changes in the retina and optic nerve and preserve vision, you need to take it regularly. You need to visit a doctor every 2-3 months. Inspections allow diagnostics to be carried out in dynamics and, if necessary, adjust the scheme. If the recommendations are followed, the prognosis is favorable.
The key factor influencing the success of therapy is the timely diagnosis. If irreversible changes that have led to a significant deterioration or loss of vision have not yet occurred, the patient can be helped and keep his vision at its original level. If conservative therapy is ineffective, surgical operation is recommended. If you refuse surgery when it is necessary, you can lose your eyesight not only in the elderly, but also at a young age.
The main way to prevent eye diseases is regular checkups with an ophthalmologist. Especially close attention should be paid to their vision by patients over 40 years old, elderly people, as well as those with relatives suffering from increased IOP. It is also necessary to consult a doctor at the slightest decrease in vision, the appearance of a veil in front of the eyes, unpleasant sensations in the eyeballs.
To prevent the disease, it is important to lead a proper lifestyle, since it is external factors that cause changes in the eyeballs. Compliance with the regime of visual loads, good lighting of the workplace, sleep for at least 8 hours a day, as well as a diet rich in fresh vegetables, fruits and sea fish, significantly reduce the risk of developing eye pathology.