Glaucoma treatment

Glaucoma — this disease of eyes for which periodic or continuous increase of intraocular pressure (VGD) is characteristic. The reason of increase of VGD is violation of circulation of intraocular liquid (decrease in its outflow). The atrophy of an optic nerve occurs owing to raised VGD that eventually conducts to complete 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 almost glaucoma) for certain will develop. As the people having short-sightedness, diabetes, endocrine diseases get to group of risk. Glaucoma can be congenital, the age matters also: the acquired glaucoma appears after 60-65 years, and in some cases after 40 years more often.

As there is a glaucoma

In an eye watery moisture which then passes to the back chamber — small space between a raduzhka and a crystalline lens is constantly developed. Then through a pupil moisture gets to the forward chamber — between a cornea and a raduzhka. In a corner of the 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 more strongly squeezed. Over time fibers of an optic nerve start to perish and the person gradually grows blind. That VGD remained normal, the balance between a producing of moisture and its outflow should be observed.
In norm eye pressure doesn't exceed 16-27 mm of mercury. Though at glaucoma of VGD can be as normal (or not strongly to fall outside the limits norm), and raised. But if pressure exceeds 35 mm of mercury. also there is such long time, treatment surely is required.

Symptoms

If intraocular pressure raises, 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 is резь in eyes, a lachrymation, feeling of weight and tension, pain round eyes.
It happens and so that the person doesn't notice raised VGD (glaucoma can proceed bessimptomno at the first stages) and addresses to the doctor only when the field of vision starts to be narrowed. Mirsovetov pays your attention that in this case it is possible to stop only sight loss, to return a normal field of vision it is already impossible.
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 doesn't receive in time the help and can lose sight.
Here symptoms by which it is possible to determine an attack of glaucoma: there is a puffiness of eyelids, eyes redden, 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 appear very firm – because of raised VGD. To help the patient, it is necessary to dig immediately 2 % solution пилокарпина, to accept 0,25 g диакарба (a diuretic necessary for removal of liquid from an organism) and as soon as possible to address to the doctor.

Glaucoma diagnostics

For diagnosis statement it is necessary for doctor-ophthalmologist to carry out a row simple (for the patient) inspections: definition visual acuities (vizometriya), measurement of intraocular pressure (tonometriya), research fields of vision (perimetriya), 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.

Glaucoma classification

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, VGD increase. To secondary glaucomas carry all that appeared as complication of other diseases (diabetes, a cataract, thrombosis), traumas and inflammations of an eye and other bodies.
On the mechanism of increase of VGD — the acquired glaucoma subdivide on otkrytougolny and zakrytougolny.
At otkrytougolny glaucoma the drainage system of an eye gradually changes, why pressure periodically raises and the optic nerve suffers. At zakrytougolny glaucoma outflow of intraocular liquid is blocked by a root of an iris of the eye which closes a corner of the 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 isn't 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 remains only svetooshchushcheny.

Glaucoma treatment

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 fabrics of eyes are appointed.
The drugs reducing VGD, should lower regularly pressure, but happens and so that the patient possesses stability to action of drops – and then it is necessary to select other preparation. In the first weeks of purpose of antiglaukomny drops the patient should visit regularly the oculist to conduct control of a condition of intraocular pressure. If drops render a positive effect, it will be necessary for patient to visit the doctor only time in 2-3 months. In certain cases drops operate so successfully that with their help it is possible to supervise VGD within several years — it is necessary only once a year to change 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). Mirsovetov urgently recommends: never mix drops. This wild "cocktail" from different drugs won't bring any advantage to eyes, on the contrary, drops will lose the medical properties.
If drops don't give effect, it is necessary to do operation. More often at first perform laser operation. The most effective are a laser iridotomiya (iridektomiya) and laser трабекулопластика.
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 to leave an eye without obstacles, VGD is normalized. To this operation resort for treatment of a zakrytougolny form of glaucoma.
Laser трабекулопластику carry out at otkrytougolny glaucoma. It also promotes VGD normalization, but the principle of its action is a little another: the laser beam puts on a raduzhka a little microscopic small burns that increases permeability of a raduzhka for liquid.

Advantages of laser operations:

• outflow of intraocular liquid occurs on natural ways;
• for carrying out operation it is enough to dig the anesthetizing in an eye;
• operation can be carried out in out-patient conditions;
• term of rehabilitation is minimum.

Shortcomings of laser operations:

• fragility of effect of operation (1-2 years);
• during operation damages an epiteliya of a cornea, a capsule of a crystalline lens and raduzhka vessels are possible;
• VGD increase 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 taken out 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 operation at glaucoma 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 a fabric and creates through service between the forward chamber of an eye and podkonjyunktivalny space. This operation in essence rather easy, also brings rather quite good results. But not seldom results of a trabekulektomiya not only don't remain for a long time, but also, on the contrary, there is a number of negative consequences. On a place of operative intervention there are hems, i.e. again blocks liquid outflow. Also that is characteristic, repeated operation won't have any more due effect. In some cases, on the contrary, outflow of intraocular liquid starts to go much quicker, than it is reproduced is will also negatively affect a condition of eyes.
The essence of NGSE consists in a surgical istoncheniye of peripheral sites of a cornea. Through these istonchenny 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, are required periodic (2 times a year) courses of supporting therapy: the drugs improving blood supply of an eyeball and an optic nerve (кавинтон, пикамилон, милдронат), физиопроцедуры.

As you can see, glaucoma is quite serious disease. Therefore, if will feel that sight grew turbid or even eye simply slight 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, aren't restored any more – about it you should remember and care of a condition of the eyes.