Open-angle and closed-angle
- Open-angle (about 90% of cases): the outflow of fluid gradually worsens, the pressure increases slowly. No symptoms for years. Revealed only upon examination
- Closed angle: the outflow angle is blocked abruptly, the pressure jumps within hours. An acute attack occurs - severe pain in the eye and head, nausea, vomiting, rainbow circles, a sharp drop in vision. This is an emergency
Острый приступ закрытоугольной глаукомы часто принимают за мигрень, гипертонический криз или пищевое отравление из-за рвоты и головной боли. Отличие — красный болезненный глаз, твёрдый на ощупь, и радужные круги вокруг ламп. Без помощи в течение суток возможна необратимая слепота.
Who's at risk
- Age over 40 - risk doubles every decade
- Glaucoma in parents, brothers or sisters - the risk increases several times
- High myopia (for open-angle) and farsightedness (for closed-angle)
- Diabetes mellitus, hypertension and, importantly, episodes of low blood pressure
- Long-term use of glucocorticosteroids, including eye drops
- Previous injuries and inflammations of the eye
- Thin cornea
Diagnostics
- Тонометрия — измерение внутриглазного давления. Норма ориентировочно 10–21 мм рт. ст., но она индивидуальна и корректируется на толщину роговицы.
- Пахиметрия — измерение толщины роговицы: при тонкой роговице давление занижается прибором.
- Периметрия — исследование полей зрения, выявляет выпадения раньше, чем человек их замечает.
- Офтальмоскопия и ОКТ зрительного нерва — оценка экскавации диска и толщины слоя нервных волокон; самый чувствительный ранний метод.
- Гониоскопия — осмотр угла передней камеры, отличает открытоугольную форму от закрытоугольной.
There is normal pressure glaucoma, in which the nerve dies with formally normal numbers. Therefore, “pressure is normal” does not exclude the diagnosis—perimetry and OCT are needed.
Treatment
The goal of treatment is to reduce intraocular pressure to a level at which the nerve stops being destroyed. This target level is individual and determined by the doctor.
- Drops that reduce blood pressure are the basis of treatment. Buried DAILY and for life, at the same time
- Laser trabeculoplasty - improves outflow, used alone or in addition to drops
- Laser iridotomy - creating a hole in the iris; prevention and treatment of angle-closure form
- Surgical operations - if drops and laser are ineffective
- Regular monitoring: tonometry, perimetry and OCT usually every 3–6 months
Самая частая ошибка пациентов — прекращать капли, потому что «глаз не болит и вижу нормально». Отсутствие симптомов и есть цель лечения. Каждый пропущенный день — это погибшие волокна, которые не восстановятся.
What is important in everyday life
- Do not skip instillation; after the drop, press the inner corner of the eye with your finger for a minute - this way less of the drug will enter the blood
- Avoid prolonged bending of the head down, lifting heavy weights, or working in an inclined position.
- Avoid wearing tight collars and ties
- Drink liquid evenly throughout the day, and not in large volumes at once
- Do not stay in a dark room for a long time with a closed-angle form - the pupil dilates and can block the angle
- Tell any doctor if you have glaucoma: some medications, including some eye drops and cold medications, are contraindicated
- First-degree relatives should be examined annually after 40 years of age
