About all

Symptoms of angle closure glaucoma: Acute Angle Closure Glaucoma: Causes, Symptoms, Treatment

Содержание

Acute Angle Closure Glaucoma: Causes, Symptoms, Treatment

This serious condition makes the pressure inside your eye (your doctor may call it intraocular pressure, or IOP) go up suddenly. It can rise within a matter of hours. It happens when fluid in your eye can’t drain the way it should. It isn’t as common as other types of glaucoma, which cause pressure buildup much more slowly over time.Acute angle-closure glaucoma is caused by a rapid or sudden increase in pressure inside the eye, called intraocular pressure (IOP).

Causes

Fluid drains out of your eye through a system of canals. These canals live in a mesh of tissue between your iris (the colored part of your eye) and your cornea (the clear outer layer).

 

 

When your iris and cornea move closer together, it “closes the angle” between them. When this happens suddenly, it’s called an acute attack and is very painful.

Acute angle closure glaucoma completely blocks your canals. It stops fluid from flowing through them, kind of like a piece of paper sliding over a sink drain. The pressure that builds up can damage your optic nerve. If you don’t treat the problem quickly enough, you could lose your sight completely.

Continued

You might have an attack of angle closure glaucoma if you have narrow drainage systems and your eyes dilate (your pupil gets bigger) too much or too quickly. This can normally happen when you:

Some health conditions can also cause angle closure glaucoma:

Women are 2 to 4 times more likely to get it than men. You’re also more likely to have it if you’re:

Or if you:

  • Have a family history of it
  • Use medications that dilate your pupils
  • Use other medications that cause your iris and cornea to come together, like sulfonamides, topiramate, or phenothiazines

If you have acute angle closure glaucoma in one eye, you’re also more likely to get it in the other.

Symptoms

They come on quickly. You won’t be able to ignore them. They include:

  • Eye pain
  • Severe headache
  • Nausea or vomiting
  • Very blurry or hazy vision
  • Seeing rainbows or halos around lights
  • Redness in the white part of the affected eye
  • Pupils of different sizes
  • Sudden loss of sight

When your doctor examines you, they may also notice that your pupils no longer get smaller or bigger when they shine light on them.

Diagnosis

If you think you have acute angle closure glaucoma, you’ll need to see an ophthalmologist right away — it’s an emergency. They’ll examine you and ask about your symptoms. They may do one or more tests to find out more about what’s going on inside your eye:

  • Gonioscopy: The doctor uses a lens with a simple microscope called a slit lamp to look into your eye. A beam of light checks the angle between your iris and cornea and see how well fluid drains.
  • Tonometry: This test uses a tool to measure the pressure inside your eye.
  • Ophthalmoscopy: Your doctor checks for damage to your optic nerve with a small lighted device.

Treatment

The first thing your doctor will do to treat your acute angle closure attack is try to get rid of some of the pressure in your eye. They might use:

  • Drops that narrow your pupil
  • Medication to lowers the amount of fluid your eye makes

Once your IOP has dropped a little, your doctor may use a laser to:

  • Make a small hole in your iris. This is called a laser iridotomy, and it helps the fluid start flowing again inside your eye. It’s an outpatient treatment, and takes a few minutes.
  • Pull the edges of your iris away from your drainage canals. This called laser iridoplasty or gonioplasty.

If you have cataracts, your doctor may consider surgery to replace the lens in your eye. This type of surgery can be harder to do when you’re having an acute attack.

Even if your acute angle closure glaucoma is in only one eye, your doctor will probably treat both eyes, just to be safe.

Prevention

The best way to prevent an acute angle closure glaucoma attack is to get your eyes checked regularly, especially if you’re at high risk. Your doctor can keep tabs on pressure levels and how well fluid drains. If they think your risk is unusually high, they may suggest laser treatment to hold off an attack.

Signs of Angle Closure Glaucoma

Patients with angle closure glaucoma may first notice intermittent headaches, eye pain, and halos around lights.  Alternatively, they may have an acute angle closure attack, which is accompanied by severe eye pain, headache, blurry vision, and sometimes even nausea and vomiting.  An angle closure attack is a medical emergency and a patient should report to an emergency room or their glaucoma specialist immediately for appropriate treatment.

What is Angle Closure Glaucoma

Glaucoma comprises a group of diseases that cause damage to the optic nerve within the eye.  While eyes with open angle glaucoma have a drainage angle that appears anatomically normal, eyes with angle-closure glaucoma have a drainage angle that is blocked. This leads to elevated eye pressure, which causes damage to the optic nerve.

The following are signs of intermittent angle closure. If you or a loved one experiences one or more of the following symptoms, please see a glaucoma specialist as soon as possible.

  • Blurry or unfocused field of vision
  • Difficulty adjusting to dark rooms
  • Recurring mild pain around or in eyes
  • Recurrent headaches
  • Seeing colorful rings or halos around lights

The following are signs of an angle closure attack.  If you ever experience the symptoms below, please report to an emergency room or contact your on-call glaucoma specialist immediately for vision-saving treatment.

  • Red painful eye
  • Sudden blurring or loss of vision
  • Severe headache
  • Excessive tearing or watering
  • Sudden nausea or vomiting

Who is At Risk for Angle Closure Glaucoma?

The following factors put people at a greater risk of angle closure glaucoma.

Schedule an Appointment at USC Roski Eye Institute Today

In order to help spread awareness of this life-changing disease, the expert ophthalmologists at USC Roski Eye Institute would like to encourage people of all ages to share the above information as well as schedule regular eye exams for themselves and their loved ones. At the USC Roski Eye Institute, our exceptional ophthalmologists are experts at diagnosing and treating a wide variety of eye conditions, including glaucoma. To receive a comprehensive eye exam for yourself or a loved one, please complete our online contact form or call 323-348-1526 today!

To learn more about the services at the USC Roski Eye Institute or to support the Institute with a tax-deductible gift, please contact Rebecca Melville, senior director of development, via email at [email protected] or by calling USC Roski Eye Institute.

Next, read What are the Signs of Open Angle Glaucoma?

Acute Angle-closure Glaucoma | Symptoms and Treatment

Structure (anatomy) of your eye

You can learn more about how the eye works and the structure of the eye in the separate leaflet called Anatomy of the eye. Glaucoma is mainly to do with the fluid in the eye, called aqueous humour, not being able to drain away properly.

What is acute angle-closure glaucoma?

Dr Sarah Jarvis MBE

Acute angle-closure glaucoma occurs when the flow of aqueous humour out of the eye is blocked and pressure inside the eye becomes too high very quickly. It is an emergency because if it is not treated quickly, it can lead to permanent loss of vision. Acute angle-closure glaucoma is also sometimes referred to as acute closed-angle glaucoma or just acute glaucoma. For ease, this leaflet will use the term ‘acute glaucoma’.

There are other types of glaucoma which occur more gradually. The most common type is chronic open-angle glaucoma (also called primary open-angle glaucoma or simply chronic glaucoma). See the separate leaflet called Chronic Open-angle Glaucoma for details.

Other, less common types of glaucoma are secondary glaucoma and congenital glaucoma. ‘Congenital’ means that it is present from birth. The rest of this leaflet deals only with acute glaucoma.

What causes acute angle-closure glaucoma?

In acute glaucoma there is a sudden blockage of drainage of aqueous humour fluid out of your eye. As more fluid continues to be made, the pressure inside your eye rises quickly. This can start to damage the optic nerve at the back of the eye and vision can be affected.

What causes the blockage?

Some people are more prone to develop acute glaucoma because of the structure of their eye. For example, if the area near the base of the iris is very narrow, the trabecular meshwork can become blocked more easily. If the lens is thicker and sits further forward than normal, this can have the same effect. Both these cause what is known as a narrow drainage angle or a shallow anterior chamber and can make acute glaucoma more likely. In other people, the iris can be thinner and more floppy than usual, making it more likely to cause blockage of the trabecular meshwork.

The muscles of the iris control the size of your pupil. In someone who is prone to acute glaucoma the dilation of the pupil can mean their lens can ‘stick’ to the back of their iris. This blocks the route of the aqueous humour through the iris from the posterior chamber or through the pupil to the anterior chamber. The aqueous fluid collects behind the iris and causes the iris to bulge forwards and block the trabecular meshwork. This further prevents drainage of the aqueous fluid from their eye. The pressure within the eye rises rapidly. It is particularly likely to happen in people with a thinner, floppier iris or a shallow anterior chamber.

Can anything trigger acute glaucoma?

In people who are prone to acute glaucoma there are some situations that may trigger it. For example, acute glaucoma is more likely to come on when the pupil is dilated. This could be whilst watching television in dim light, during stress or excitement, or at night.

Some medicines can also trigger acute glaucoma in people prone to it, as can general anaesthetics in older people. For the population as a whole the chance of getting acute glaucoma with these medicines is extremely small, so they are commonly prescribed without serious concern. However, if you have been warned that you may be prone to acute glaucoma, you should tell your doctor before starting new medication or eye drops, especially if it is one on the list below.

Commonly used medicines which may trigger acute glaucoma are:

  • Eye drops used to dilate the pupil – these may be used for eye check-ups.
  • Antidepressants of the tricyclic or selective serotonin reuptake inhibitor (SSRI) types.
  • Some of the medicines used to treat feeling sick (nausea), being sick (vomiting) or the mental health condition called schizophrenia. (There is a type of medicine called phenothiazines, one of which is chlorpromazine.)
  • Ipratropium (used for asthma).
  • Topiramate (used for migraines and epilepsy).
  • Some medicines used to treat allergies or stomach ulcers, such as chlorphenamine, cimetidine and ranitidine.
  • Medication used during a general anaesthetic.
  • Steroid medicines (such as are used in asthma and emphysema) can sometimes cause high pressure in the eyes when used for long periods of time, but do not usually cause acute glaucoma.

Who develops acute angle-closure glaucoma?

About 1 in 1,000 people develop acute glaucoma in their lifetime, so thankfully it is a rare condition. It is more likely in people over the age of 40 years and most often happens at around age 60-70 years. It is more common in long-sighted people and in women. It is also more common in Southeast Asian and Inuit people.

If one of your close relatives (mother, father, sister or brother) has had acute glaucoma, you have an increased risk of developing it. This is because you may have inherited an eye shape which makes acute glaucoma more likely. If you have a positive family history like this you should speak with an optician regarding when, and how often, you should have eye checks.

What are the symptoms of acute angle-closure glaucoma?

The symptoms usually start suddenly. They include:

  • Sudden, severe pain within one eye and an ache around your eye.
  • Redness of your eye.
  • Blurred or reduced vision, often with circles (haloes) seen around lights.
  • The pain may spread around your head and be felt as a severe headache.
  • Some people develop a feeling of sickness (nausea) and are sick (vomit).
  • Your eye usually feels hard and tender.
  • You may feel generally unwell.
  • The clear surface of your eye (your cornea) can look hazy. 

This photo shows what the eye looks like in acute glaucoma:

Acute angle closure glaucoma of the right eye

James Heilman, MD, CC BY-SA 3.0, via Wikimedia Commons

James Heilman, MD, CC BY-SA 3.0, via Wikimedia Commons

Symptoms may begin in a situation of dim lighting, sudden excitement, after taking certain medicines or after a general anaesthetic.

The symptoms usually continue to worsen unless treated and you should seek help immediately. Either an optician or an eye specialist (ophthalmologist) can make the diagnosis. A family doctor will able to recognise the symptoms and will know to send the person directly to hospital.

Some people have milder symptoms, sometimes with intermittent attacks of blurring and haloes without pain. The attack may end when they go into a brighter room. Both of these cause the pupil to constrict and pull the iris away from the drainage channels. This is called intermittent acute glaucoma. The attack of acute glaucoma can last for a few hours and then symptoms can improve again. However, attacks will usually happen again and, with each attack, your vision may be damaged further. If you have these symptoms you should see a doctor urgently, in case you need treatment to prevent a more severe attack. 

How is acute angle-closure glaucoma diagnosed?

The diagnosis is made from the symptoms and the appearance of your eye. A likely diagnosis may be made by your GP, by an emergency doctor or by an optician. The diagnosis is confirmed by an examination done by an eye specialist (an ophthalmologist). This usually involves examining your eye using a special light and magnifier called a slit lamp and measuring the pressure in your eye. A specialist can also use a gonioscope to directly examine the outflow channels around the trabecular meshwork area of your eye.

Acute angle-closure glaucoma treatment

Initial treatment

Quick treatment is needed for acute glaucoma. You should be seen by an eye specialist as soon as possible. If it will take time getting to the ophthalmologist, some treatment can be started.

You should not try to cover the affected eye with a patch or a blindfold. If you do this, your pupil will dilate further and this can worsen the situation. Don’t lie down in a darkened room – lying down can tend to raise the pressure in your eye still further. A darkened room will further dilate the pupil, making things worse.

The first treatment is medication to lower the pressure within your eye. There are various types of medicine and eye drops that may be used in different combinations. Treatments may include:

  • Eye drops containing beta-blocker medication (to reduce fluid production in your eye) and steroids (to reduce inflammation) – for example, timolol.
  • An injection of a medicine called acetazolamide.
  • Pilocarpine eye drops which can cause your pupil to become smaller (constrict) and help to move the iris away from the trabecular meshwork. This helps to open up the obstruction to the flow of aqueous humour fluid.
  • Other types of eye drops are also used, including steroid eye drops.
  • Other fluid-reducing medication such as mannitol which is given into a vein (intravenously).

You may also be given painkillers and antisickness medication if needed.

Further treatment

When the pressure in your eye has gone down, further treatment is needed to prevent acute glaucoma from coming back. This involves using laser treatment or surgery to make a small hole in your iris. The hole allows fluid to flow freely around your iris and can stop the iris bulging forwards and blocking the trabecular meshwork in the future.

  • Laser treatment is called peripheral iridotomy. This is the usual treatment. Usually two small holes are made in your iris, using a laser. The holes are almost unnoticeable to other people. Laser treatment is done using local anaesthetic in an outpatient clinic.
  • Surgical treatment called surgical iridectomy is another option. A small, triangular hole is made in your iris. The hole is visible afterwards as a very small, black triangle at the edge of your iris.

Usually, laser or surgical treatment will be advised for the other eye, often at the same time. This is to prevent acute glaucoma in the other eye, which is otherwise quite likely. Sometimes eye drops are needed longer-term to help keep your eye pressure under control.

What is the outlook for acute angle-closure glaucoma?

The outlook (prognosis) is good if treatment is started quickly. Your eye can recover and laser treatment or surgery can prevent the problem coming back. If the attack is severe, or if treatment is delayed, the high pressure in your eye can damage the optic nerve and blood vessels. If this is the case, there is a risk that your vision will be permanently reduced in the affected eye.

Driving and glaucoma

Many people will be allowed to drive after recovering from acute angle-closure glaucoma. Even if vision is reduced in one eye, you may still be allowed to drive if your vision is good enough in the other eye. However, you will need advice from your eye specialist. If you are a driver in the UK and have glaucoma causing loss of vision in both eyes, you must by law inform the Driver and Vehicle Licensing Authority (DVLA). The DVLA will usually contact your eye specialist (ophthalmologist) and ask them for a report about your eye problems. They may also arrange an examination of your eyesight with an optician.

Can acute angle-closure glaucoma be prevented?

As mentioned above, some people have an increased risk of developing acute glaucoma because they have a shallow anterior chamber or narrow drainage angle. Sometimes this is noticed at a routine eye examination. You may be told about this and advised to be careful with certain medicines and eye drops (see above). If you are at very high risk of acute glaucoma, you may be advised to have preventative treatment such as laser iridotomy (see above).

Be aware of the symptoms of acute glaucoma. You should seek medical advice immediately if you develop a red eye with any of the following:

  • Pain
  • Being sick (vomiting)
  • Reduced vision

If you take a new medication or have eye drops to enlarge (dilate) your pupil and then you develop symptoms of acute glaucoma, seek medical advice straightaway. Tell your doctor about the medication and symptoms. This makes it easier for the problem to be recognised early.

What are the signs and symptoms of acute angle-closure glaucoma (AACG)?

Author

Albert P Lin, MD Assistant Professor, Department of Ophthalmology, Baylor College of Medicine; Staff Physician, Michael E DeBakey Veterans Affairs Medical Center; Ophthalmologist, Ophthalmology Consultants of Houston

Albert P Lin, MD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, Harris County Medical Society, Texas Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Kristin Schmid Biggerstaff, MD, MS Associate Professor, Department of Ophthalmology, Baylor College of Medicine; Glaucoma Staff Physician, Michael E DeBakey Veterans Affairs Medical Center

Kristin Schmid Biggerstaff, MD, MS is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, American Society of Cataract and Refractive Surgery

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Martin B Wax, MD Professor, Department of Ophthalmology, University of Texas Southwestern Medical School; Vice President, Research and Development, Head, Ophthalmology Discovery Research and Preclinical Sciences, Alcon Laboratories, Inc

Martin B Wax, MD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, Society for Neuroscience

Disclosure: Nothing to disclose.

Chief Editor

Inci Irak Dersu, MD, MPH Associate Professor of Clinical Ophthalmology, State University of New York Downstate College of Medicine; Attending Physician, SUNY Downstate Medical Center, Kings County Hospital, and VA Harbor Health Care System

Inci Irak Dersu, MD, MPH is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society

Disclosure: Nothing to disclose.

Additional Contributors

Kilbourn Gordon, III, MD, FACEP Urgent Care Physician

Kilbourn Gordon, III, MD, FACEP is a member of the following medical societies: American Academy of Ophthalmology, Wilderness Medical Society

Disclosure: Nothing to disclose.

Robert J Noecker, MD, MBA Associate Professor, Department of Ophthalmology, University of Pittsburgh School of Medicine; Director, Glaucoma Service, Vice Chair, Department of Ophthalmology, University of Pittsburgh Medical Center Eye Center

Robert J Noecker, MD, MBA is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, American Glaucoma Society, American Medical Association, American Society of Cataract and Refractive Surgery

Disclosure: Received consulting fee from Allergan for consulting; Received grant/research funds from Allergan, Zeiss, Lumenis for other; Received honoraria from Allergan, Alcon, Lumenis, Endo-optics for speaking and teaching.

Malik Y Kahook, MD Clinical Instructor of Ophthalmology, Fellow in Glaucoma, Department of Ophthalmology, University of Pittsburgh Medical Center

Malik Y Kahook, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, Association for Research in Vision and Ophthalmology, Colorado Medical Society

Disclosure: Received consulting fee from Alcon for consulting.

Acute angle closure crisis

” type=”text/css” href=”/sebin/l/d/custom-html.css”/>” type=”text/css” href=”/sebin/l/d/custom-html.css”/>” type=”text/css” href=”custom-html.css”/>

Take Home Points

  • Acute crisis needs attention
    immediately

  • You or your doctor may have caused the crisis by doing something
    to dilate the pupil

  • Symptoms: eye pain (headache), bad vision in one eye, red eye,
    pupils different sizes, nausea

  • Immediate treatment = a laser iris hole in
    both eyes

  • Some are cured forever, but others need continued treatment
    after laser iridotomy

  • Two special conditions need particular therapy: plateau iris
    syndrome, malignant glaucoma

Acute angle closure crisis deserves its own special mention, as it
is one of the few true emergencies in the glaucoma world. Of all of the
forms of glaucoma, angle closure has a much greater chance to cause
permanent vision loss than open angle glaucoma, and the acute crisis
(frequently called an acute attack) probably accounts for a lot of this
damage. The mechanism by which it happens was described in the preceding
section (Why isn’t glaucoma either there or not there—what makes you an
angle closure suspect?)see section Why isn’t glaucoma either there or not there?. It happens to those with angle closure under the
situation where aqueous humor movement from behind to in front of the iris
is so blocked that the pressure behind the iris pushes it against the
meshwork and stops all aqueous outflow (Figure 7). Eye pressure can rise to numbers like 70
millimeters of mercury (compared to the normal 15). This is so high that
permanent damage to ganglion cells in the optic nerve happens in days to
weeks rather than the much longer, slower process of typical
glaucoma.

It is the sudden increase in pressure that causes the severe
symptoms of the attack. A link between the stomach and the eye causes an
attack to be not only the worst pain that people ever remember having, but
also it causes nausea and vomiting. Sometimes the stomach problem is so
prominent that people go to an emergency room and the staff pays attention
to that, thinking it is appendicitis, before realizing that the eye is the
cause. Acute attacks also get misdiagnosed as migraine headaches.

The eye symptoms of acute crisis are pain, poor vision in the
involved eye, redness of the white part, and a bigger and irregular pupil
shape. More than 90% of acute crises are in one eye only, but for one in
10 persons it happens in both eyes. In order to see if an eye problem is
in one eye or the other, one should cover one eye then cover
the other with a hand. In the excitement of being in pain, we often forget to do such
simple things.

One thing that sets off the crisis is having the pupil half-way dilated. This occurs with
stress, excitement, spending time in a dark place (such as a dimly lit
restaurant), or being exposed to medications that dilate the pupil.
This sometimes happens during general anesthesia, since a drug that
dilates the pupil (atropine) is given by anesthesiologists. If you have
bad eye pain after surgery under general anesthesia, have an exam by an
eye doctor immediately. Acute attacks can also be caused by the many pills
that are given that can dilate the pupil while helping you with things
like incontinence, sinus troubles, and upper respiratory colds. The Food
and Drug Administration doesn’t distinguish the various kinds of glaucoma
in its warnings on drugs about “glaucoma”, so if you are an angle closure
suspect who has not had iridotomy, call your eye doctor before taking any
of these drugs. Most of the time, you’ll hear that it’s fine to take them.
After you have iridotomy, you can take any of these drugs safely. The
final types of drugs that can cause acute crisis are those used in the eye
doctor’s office to dilate the pupil for examination of the inside of the
eye. We’ve seen this a number of times over the years, and patients who
have had dilating drops and have pain the night of the exam and especially
into the next morning should go right back immediately to be checked.
There are a group of medicines that can cause a very unusual form of acute
angle closure in people who otherwise weren’t at risk for it (they don’t
have small eyes or other risk factors for angle closure). One such drug is
topiramate, a headache pill which is also used in epilepsy. Another group
of drugs that can do this are some antibiotics and some anti-anxiety medications(see section Can the treatments be worse than the disease?).

If you think you are having an acute angle closure crisis, go to the
office of an ophthalmologist (a medical doctor who does surgery and laser
surgery) or to an emergency room that you are sure has an ophthalmologist
on call. Most metropolitan areas have an “eye
trauma” center designated where immediate, appropriate care would be
available. Don’t drive yourself there, get a ride or take a cab.

The immediate treatment for acute crisis will most often fix it in
the first hour. The pressure is lowered by either eyedrops or by letting a
small amount of aqueous out of the eye. This sounds gruesome, but you
won’t feel it and it immediately relieves the pain. Sometimes, in order to
begin the lowering of pressure, a laser is used to treat the outer part of
the iris to move it away from the meshwork to let aqueous out faster
(laser iridoplasty). The vast majority of crises are relieved as soon as a
hole is placed in the iris with a laser (Figure 17). The laser most often used is called a neodymium-YAG
laser. It can be focused inside the eye to make the iris hole, without making
any incision or hole in the eye wall (cornea). There is a slight feeling
that something is happening, but typically only eye drop anesthesia is
needed. Several deliveries of the laser may be needed to make a hole less than 1 millimeter in diameter. That’s all it takes to relieve most crises.
Occasionally, a second type of laser is used in very thick irises (called
a continuous wave laser or diode) to thin things down before penetrating
with the neodymium-YAG. High quality centers have both available to use.
The opening is usually small enough that others can’t see it from normal
social distances. Those who get within 6 inches of your face for long
enough to see the iris hole are people who know you well enough that
they’re concentrating on other things. Sometimes a small hole is made
initially and it is made bigger a month later.

The other eye should have a hole made, too, though most persons want
to wait a day or so to try to get back vision in the first eye. Putting it
off for a long time is a really bad idea.

If the crisis has been going on for longer than a day (and you may
not have been aware of it during that time) or if there have been
preceding little attacks in the past that led up to this one, the laser
iridotomy alone is not going to cure everything. There can be scars in the
angle that won’t go away, leading eye pressure to stay high. There may
already be damage to optic nerve structure and visual field function, so
that vision is never fully normal again. Haziness in the lens of the eye
(cataract) may be already present or develop quite quickly after iridotomy
due to the prior high pressure.

Some have suggested that removing the lens (cataract surgery) would
be a good treatment for acute crisis. Since the reason for the crisis is
severe blockage of fluid movement between the iris and lens, that is a
correct statement, but removing the lens and replacing it with an
artificial intraocular lens by surgery in the middle of an acute crisis is
very difficult. Only the most experienced cataract surgeons, working at a
center with extensive equipment to operate on the retina and vitreous
inside the eye should even attempt this. On occasion, the acute crisis is
not broken by laser iris hole and by medication—this then calls for forms
of glaucoma surgery (see section Operations for glaucoma).

An uncommon type of glaucoma happens in some eyes that seem to have
a typical acute crisis, but do not respond to standard laser iridotomy,
with pressure remaining high. The doctor will see some special clues that
this condition, called malignant glaucoma has happened. Malignant glaucoma
got its name because it was difficult to deal with; it has nothing to do
with cancer. It even happens sometimes in persons who are not at risk for
typical angle closure. The mechanism involves a collapse forward within
the eye of the gel called the vitreous that fills the back two thirds of
the eye cavity. The best explanation at present is that the process
starts, like typical angle closure, with choroidal expansion, and in these
folks the vitreous collapses forward due to pressure behind it. The
treatments start with laser iridotomy, but then additional types of eye
drops, oral and intravenous medication, and often surgery to make a
channel through the vitreous gel are needed to cure the problem.

Figure 18: Malignant glaucoma. Drawings to illustrate the process that causes malignant
glaucoma. starts with expansion of the choroid (shaded in grey, and
thicker than the choroid in the normal eye (Figure 1). The higher pressure causes aqueous to
leave the front of the eye, causing a pressure that is higher in the
back of the eye and lower in the front. Normal eyes can make the
pressures equal by having water pass through the vitreous gel that
fills the eye. Eyes with malignant glaucoma have poor water flow
through the vitreous and it collapses forward, carrying the lens and
iris with it until the angle is closed (lower drawing).

Angle-Closure Glaucoma – Eye Disorders

Narrow angles are not present in young people. As people age, the lens of the eye continues to grow. In some but not all people, this growth pushes the iris forward, narrowing the angle. Risk factors for developing narrow angles include family history, advanced age, and ethnicity; risk is higher among people of Asian and Inuit ethnicity and lower among people of European and African ethnicities.

In people with narrow angles, the distance between the iris at the pupil and the lens is also very narrow. When the iris dilates, forces pull the iris centripetally and posteriorly causing increasing iris–lens contact, which prevents aqueous from passing between the lens and iris, through the pupil, and into the anterior chamber (this mechanism is termed pupillary block). Pressure from the continued secretion of aqueous into the posterior chamber by the ciliary body pushes the peripheral iris anteriorly (causing a forward-bowing iris called iris bombe), closing the angle. This closure blocks aqueous outflow, resulting in rapid (within hours) and severe (> 40 mm Hg) elevation of intraocular pressure (IOP).

Because of the rapid onset, this condition is called primary acute angle-closure glaucoma and is an ophthalmic emergency requiring immediate treatment. Non-pupillary block mechanisms include plateau iris syndrome in which the central anterior chamber is deep, but the peripheral anterior chamber is made shallow by a ciliary body that is displaced forward.

Intermittent angle-closure glaucoma occurs if the episode of pupillary block resolves spontaneously after several hours, usually after sleeping supine.

Chronic angle-closure glaucoma occurs if the angle narrows slowly, allowing scarring between the peripheral iris and trabecular meshwork; IOP elevation is slow.

Pupillary dilation (mydriasis) can push the iris into the angle and precipitate acute angle-closure glaucoma in any person with narrow angles. This development is of particular concern when applying topical agents to dilate the eye for examination (eg, cyclopentolate, phenylephrine) or for treatment (eg, homatropine) or when giving systemic drugs that have the potential to dilate the pupils (eg, scopolamine, alpha-adrenergic agonists commonly used to treat urinary incontinence, drugs with anticholinergic effects).

Primary Angle Closure / Primary Angle Closure Glaucoma (PAC / PACG)

Aetiology

Primary angle closure (PAC) is defined as appositional or synechial closure of the anterior chamber angle which can lead to aqueous outflow obstruction and raised IOP, in the absence of glaucomatous optic neuropathy. PAC is generally bilateral

Optic nerve damage resulting from PAC is described as primary angle closure glaucoma (PACG). The pooled prevalence of PACG among Caucasians of European ancestry aged 40 and over is 0.4%

PACG is caused by a variety of mechanisms although pupil block, in which aqueous is impeded on its passage between the lens and posterior surface of the iris, is considered to be a key element in its pathogenesis

Patients with angle closure disease may be categorized as follows:





Feature PAC Suspect PAC PACG
≥180 degrees ITC Present Present Present
Elevated IOP and/or PAS Absent Present Present
Optic nerve damage Absent Absent Present

(ITC = irido-trabecular contact, PAS = peripheral anterior synechiae) 

Acute angle closure (AAC) crisis: typically PAC and PACG develop chronically without symptoms, however an acute rise in IOP (unilateral in 90% of cases) can present as a clinical emergency

Predisposing factors

Anatomical

Associated with:

  • sex (F:M ratio 3:1)
  • ethnicity (e.g. Chinese, Vietnamese, Inuit). PACG is recognized as a leading cause of blindness in East Asia
  • family history
  • short axial length (hypermetropia)
  • shallow AC (F>M)
  • increasing age (AC becomes shallower as lens thickness increases)
  • small corneal diameter

Iatrogenic (secondary angle closure)

  • Drug induced (topical and systemic, see Evidence Base)

Adrenergic agents e.g. phenylephrine

Drugs with anticholinergic effects e.g. tricyclic antidepressants

Drugs that may cause ciliary body oedema, e.g. topiramate, sulphonamides

Angle closure may follow a number of surgical procedures, for example vitreo-retinal surgery with intraocular gas, especially in aphakic eyes

Symptoms primary angle closure

Patients with PAC can be asymptomatic or mildly symptomatic (ocular discomfort, headache). AAC is associated with sudden onset of symptoms and signs:

  • rapid progressive impairment of vision of one or both eyes
  • ocular and periocular pain which can be severe
  • nausea and vomiting
  • ocular redness

50% of patients with an acute angle closure attack give history of previous intermittent attacks, e.g. episodes of blurring of vision lasting 1- 2 hours, associated with haloes around lights, eye ache or frontal headache

Signs of primary angle closure

In a PAC suspect the eye may appear normal (with the exception of a narrow angle, as judged by the van Herick technique or by gonioscopy)

In cases with a narrow van Herick angle (≤ 25% [Grade 1 or 2]) with a normal anterior chamber depth, plateau iris should be suspected

In AAC the following signs may be present:

  • limbal and conjunctival vessels dilated, producing ciliary flush
  • pupil fixed, semi-dilated, vertically elliptical, iris whorling
  • corneal oedema
  • shallow AC with peripheral irido-corneal contact (if angle can be visualised)
  • high intraocular pressure (40-80mmHg)
  • AC flare and cells
  • optic disc oedematous and hyperaemic
  • grey/white anterior sub-capsular lenticular opacities (Glaukomflecken): diagnostic of previous attacks

Differential diagnosis

Neovascular glaucoma

Phakolytic glaucoma

Phakomorphic glaucoma

Acute anterior uveitis

Uveitis with raised IOP

Malignant glaucoma (cilio-lenticular block or aqueous misdirection glaucoma)

Management of primary angle closure by optometrist

Practitioners should recognise their limitations and where necessary seek further advice or refer the patient elsewhere

GRADE* Level of evidence and strength of recommendation always relates to the statement(s) immediately above

Non-pharmacological

Potentially occludable angle as judged by van Herick test

NICE does not provide guidance on referral for angle closure; however SIGN recommends that patients with peripheral anterior chamber width of ≤25% of the corneal thickness (van Herick Grade 1 or 2) should be referred to secondary eyecare services
(GRADE*: Level of evidence=low, Strength of recommendation=strong)

PAC Suspect

Can only be diagnosed by gonioscopy. The decision to refer for further treatment should be based on the risk of developing PAC/PACG or AAC. If not referring for further investigation, patients with PACS require close monitoring and serial gonioscopy. Patients should be aware that they are at risk of occlusion and that certain medications could induce angle closure
(GRADE*: Level of evidence=low, Strength of recommendation=strong)

PAC

The current clinical consensus is that patients with PAC/PACG should be treated surgically (peripheral iridotomy or cataract extraction) to relieve pupillary block together with pharmacological therapy to reduce elevated IOP
(GRADE*: Level of evidence=low, Strength of recommendation=strong)

Pharmacological

AAC

Prior to referral, commence first aid treatment with a drop of pilocarpine 2% eye drops in blue eyes and 4% eye drops in brown eyes (although this is likely to be ineffective when IOP is over 40mmHg and paradoxically pilocarpine can exacerbate angle closure by inducing anterior lens movement)
(GRADE*: Level of evidence=low, Strength of recommendation=weak)

Where the IOP is 40mmHg or higher and the patient is not vomiting, give a single dose of oral acetazolamide (Diamox) 500mg (not slow release formulation). (NB: Diamox may be hazardous in an elderly frail patient.) Then refer as an emergency to ophthalmologist. (In view of potential unwanted effects of this treatment, patient should be accompanied by a carer or relative)
(GRADE*: Level of evidence=low, Strength of recommendation=strong)

 

Management category

AAC
A2: first aid measures and emergency (same day) referral to ophthalmologist

PAC/PACG

A3: urgent (within one week) referral to ophthalmologist; no intervention

PAC Suspect

A3 (modified): routine referral to ophthalmologist; no intervention

Possible management by ophthalmologist

AAC: treatment directed to breaking the pupil block and reducing IOP

Medical

  • miotics (e.g. gutt. pilocarpine 2-4%)
  • systemic agents (e.g. acetazolamide, glycerol)
  • topical antihypertensives (e.g. gutt. timolol, gutt. dorzolamide, gutt. brimonidine)

Urgent interventions

  • anterior chamber paracentesis (occasionally used in advance of peripheral iridotomy)
  • argon laser peripheral iridoplasty (occasionally used in advance of YAG laser peripheral iridotomy [LPI])
  • LPI

Less urgent interventions

  • cataract surgery
  • clear lens extraction
  • selective laser trabeculoplasty, post LPI

PAC / PACG: first line treatment options include:

  • topical medical therapy
  • LPI (for patients with PACG)
  • early (clear) lens extraction (a recent RCT found that clear lens extraction showed greater efficacy and was more cost-effective than LPI)

Evidence base

*GRADE: Grading of Recommendations Assessment, Development and Evaluation (www.gradeworkinggroup.org)

Sources of evidence

American Academy of Ophthalmology Glaucoma Panel. Preferred Practice Pattern Guidelines: Primary Angle Closure. San Francisco, CA: American Academy of Ophthalmology; 2015. Available at: http://www.aaojournal.org/article/S0161-6420%2815%2901271-3/pdf

Azuara-Blanco A, Burr J, Ramsay C, Cooper D, Foster PJ, Friedman DS, Scotland G, Javanbakht M, Cochrane C, Norrie J; EAGLE study group. Effectiveness of early lens extraction for the treatment of primary angle-closure glaucoma (EAGLE): a randomised controlled trial. Lancet. 2016;388(10052):1389-1397

Dabasia PL, Edgar DF, Murdoch IE, Lawrenson JG. Non-contact screening methods for the detection of narrow anterior chamber angles. Invest Ophthalmol Vis Sci. 2015;56:3929-35

Day AC, Baio G, Gazzard G, Bunce C, Azuara-Blanco A, Munoz B, Friedman DS, Foster PJ. The prevalence of primary angle closure glaucoma in European derived populations: a systematic review. Br J Ophthalmol. 2012;96(9):1162-7

Hui X, Michelessi M. Medical interventions for treating primary angle-closure glaucoma. Cochrane Database of Systematic Reviews 2015;12:CD012001

Lachkar Y, Bouassida W. Drug-induced acute angle closure glaucoma Curr Opin Ophthalmol 2007;18:129-33

Napier ML, Azuara-Blanco A. Changing patterns in treatment of angle closure glaucoma. Curr Opin Ophthalmol. 2018;29(2):130-4

Rich R. The pilocarpine paradox. Journal of Glaucoma. 1996;5:225-7

Lay summary

Primary Angle Closure Glaucoma (PACG) is rarer in this country than Primary Open Angle Glaucoma, and in its acute form differs in that the drainage route for the fluid inside the eye is closed off, rather than gradually blocked. It affects women more often than men, is commoner in long-sighted people and people of East Asian ancestry, and becomes more likely to occur as people age. Certain drugs and eye operations can also cause the drainage angle to close.

A sudden complete closure of the drainage route (known as acute angle closure crisis), which usually affects just one eye, causes rapidly progressing impairment of vision, redness of the eye, and pain in and around the eye which may be so severe as to cause nausea and vomiting. The eye pressure may be very high, because the fluid continues to be formed within the eye but cannot drain away. Various other changes will be seen in the eye by the examining optometrist.

An acute attack of angle closure is an emergency which needs same-day referral to the ophthalmologist. There are drugs that the optometrist can use as first aid. The ophthalmologist will also prescribe drugs and may advise laser treatment to create a tiny hole in the iris (the coloured part of the eye) through which the fluid can drain.

If at a routine eye examination there are signs that there have been earlier, milder attacks of angle closure, or if it appears that a patient could develop PACG, the referral can be urgent, or may be made with less urgency.

Glaucoma (primary angle closure) (PACG)

Version 15

Date of search 15.12.17

Date of revision 19.04.18

Date of publication 09.05.18

Date for review 14.12.19

© College of Optometrists 

View more Clinical Management Guidelines

90,000 Acute attack of glaucoma – what is it, symptoms, diagnosis and treatment in the clinic

What is an acute attack of glaucoma?

Acute glaucoma is a dangerous condition that can result in permanent loss of vision and blindness. Such an attack develops due to a sudden and sharp increase in intraocular pressure, which is characteristic of angle-closure glaucoma – a disease caused by blocking access to the natural drainage system of the eye.

The risk of an acute attack is highest for the older generation – those who have crossed the 60-year mark. Although it can be diagnosed in people of any age, starting from infancy.

What factors can trigger an attack?

The following factors can provoke an acute attack of glaucoma:

  • increased physical activity;
  • long-term work requiring head tilt;
  • strong negative emotions, excitement, stress;
  • increase in blood pressure;
  • 90,013 eye injuries;

  • the use of certain medications – certain types of antidepressants, eye drops to dilate the pupil, nasal drops with a vasoconstrictor effect, etc.;
  • Consumption of alcohol, salted or pickled food;
  • one-time use of a large amount of liquid.

However, an acute attack of glaucoma can begin for no apparent reason, the specific triggers of this condition are not fully understood to date.

Symptoms of an acute attack of glaucoma

In view of the risk of serious complications, it is extremely important to recognize an acute attack of glaucoma in time – and to take measures to stop it as soon as possible.

Differences between an attack of glaucoma and other dangerous conditions

Symptoms of an acute attack of glaucoma are often misinterpreted. A person experiencing such a condition, or his relatives, may regard what is happening as an exacerbation of migraine, which really affects the eye area and is often accompanied by vomiting and temporary deterioration of vision, or, for example, as heart problems, due to which the necessary ophthalmological assistance is not provided in time. Treatment for other diseases begins, which only aggravates the situation.

However, it is still possible to distinguish a migraine or heart problem from a glaucoma attack. The fact that ophthalmological care is urgently needed is indicated by the following signs:

  • corneal opacity;
  • Immobility of the pupil and hardening of the eye;
  • Pupil immobility and eye hardening;
  • Marked redness of the eyes.

Instead of black in an acute attack of glaucoma, the pupil acquires a greenish tint.There may also be a decrease in the corneal reflex, manifested by the rapid closure of the eyelids as a reaction to mechanical stress on the cornea.

How to behave in an acute attack of glaucoma?

Intraocular pressure in patients with an acute attack of glaucoma is increased (up to 70-100 mm Hg), the eye is hardened, gives the impression of “stone”.

The main goal of treatment for an acute attack of glaucoma is to reduce intraocular pressure and normalize blood circulation in the eye to restore nutrition to the retina and optic nerve.

If symptoms of an acute attack appear, calm down and seek emergency medical help. Before the arrival of specialists, you can make foot baths or apply mustard plasters to the calf muscles, this will help reduce blood flow to the head and eyes.

If it is not possible to remove the attack within 24 hours, the question of urgent surgical treatment may be raised.

Remember, self-medication in a situation of development of an acute attack of glaucoma is by no means worth it.If the help of qualified specialists is not provided on time, vision may be lost forever!

Clinic licenses

Article rating:
4.7 / 5 (53 ratings)

Rate the article

Assessment recording…

thank you for rating

90,000 Modern approach to the treatment of angle-closure glaucoma

– What are the symptoms of this disease?

The classic symptoms of angle-closure glaucoma appear only in the subacute and acute stages of the disease. An acute attack of glaucoma is manifested by pain in the eye and around the eye, accompanied by a sharp headache, reddening of the eye, the appearance of rainbow circles in front of the sore eye and a sharp deterioration in visual acuity.Sometimes the attack is accompanied by nausea, vomiting, and general weakness. In rare cases, after the first acute attack, complete blindness occurs. An acute attack can be triggered by a prolonged stay in the dark, overwork or nervous strain, a change in the pupil under the influence of drugs, or being in an inclined position.

– What treatments are available for angle-closure glaucoma?

There are three ways to reduce intraocular pressure: medication, laser and surgical.It is important to note that in case of an acute attack of glaucoma, it is necessary to provide emergency care in an ophthalmological hospital. Urgent measures during an attack of glaucoma are to improve the outflow of intraocular fluid to reduce intraocular pressure (using eye drops, diuretics and systemic drugs).

Surgical techniques are also used for the treatment of angle-closure glaucoma, in particular, with the help of laser surgery. Laser iridectomy is the formation of a small hole in the iris to equalize intraocular pressure.In our clinic, using the available modern laser, such a laser operation can be performed on an outpatient basis for prophylactic purposes, in order to prevent the occurrence of the following seizures. In some cases, we resort to replacing the lens with a thin intraocular lens.

– Are there methods to prevent angle-closure glaucoma and is it possible to cure it?

Glaucoma cannot be cured, it is a chronic disease. Currently, there are no drugs or eye exercises that would guarantee the prevention of glaucoma.The only thing that is recommended for its prevention is early detection. It is necessary to periodically visit an ophthalmologist and monitor the health of your eyes, especially if your heredity for this disease is burdened.

I would like to note that in our center we use modern equipment and all our professional knowledge in the diagnosis and treatment of glaucoma in order to maintain a high level of vision and a high level of quality of life of our patients.

90,000 causes, symptoms, diagnosis and treatment of glaucoma

The term glaucoma refers to a broad group of diseases that are characterized by:

  • increased intraocular pressure (IOP)
  • damage to the optic nerve head, as well as retinal ganglion cells
  • narrowing of the field of view

Glaucoma can occur regardless of age, but is most common in the elderly or senile….

Glaukoma is considered one of the main causes of irreversible blindness in the world according to the World Health Organization (WHO).

Intraocular fluid and ways of its outflow

Intraocular fluid (hereinafter IVF) plays a huge role in maintaining the level of intraocular pressure. It is one of the sources of nutrition for intraocular structures (lens, cornea, trabecular apparatus, vitreous body).

It is produced by the IHF by the processes of the ciliary body located behind the iris, and is collected in the posterior chamber of the eye.Further, most of the fluid, washing the lens, flows through the pupil, enters the anterior chamber and passes through the ocular drainage system (trabecula and Schlemm’s canal), which is located in the corner of the anterior gully chamber. From the drainage system of the eye, VHF enters the excretory collectors (graduates), and then into the superficial veins of the sclera.

In this way, about 85% of the intraocular fluid flows out, but there is another outflow path, which flows out about 15%.

VHF can leave the eye, seeping through the stroma of the ciliary body and sclera into the veins of the choroid and sclera.This outflow pathway is called uveoscleral.

There is a certain balance between the production of VHF and its outflow. When this balance is disturbed, the level of intraocular pressure changes, which is a prerequisite for the development of glaucoma.

Causes and mechanisms of development of glaucoma

Glaucoma is a multifactorial disease, the development of which requires a number of reasons (risk factors):

  • heredity
  • Individual anatomical features or abnormal structure of the eye
  • pathology of the cardiovascular, nervous and endocrine systems.

Various combinations of these risk factors trigger the mechanism for the development of glaucoma , which can be represented as stages:

  • Increase in the production of intraocular fluid and / or deterioration of its outflow from the cavity of the eyeball;
  • increase in intraocular pressure (IOP) above the tolerant (tolerated) for the optic nerve;
  • ischemia (impaired blood supply) and hypoxia (lack of oxygen) of the optic nerve head;
  • development of glaucomatous optic neuropathy followed by
  • atrophy (death) of the optic nerve.

Forms of glaucoma

The following main types (forms) of glaucoma are distinguished:

  • congenital glaucoma:
  • primary early congenital glaucoma,
  • infantile congenital glaucoma,
  • juvenile glaucoma,
  • combined congenital glaucoma
  • primary adult glaucoma:
  • primary open-angle glaucoma (POAG)

    multifactorial disease associated with involutional and age-related changes in the eye)

  • primary angle-closure glaucoma (PZUG)

    (the main cause of the disease is the closure of the corner of the anterior chamber, where the drainage system of the eye is located, by the root of the iris)

  • secondary glaucoma in adults:

    (a consequence of other ocular or somatic diseases, in which the involvement of structures involved in the production or outflow of OHF occurs)

Glaucoma symptoms

Mostly glaucoma is asymptomatic, and the patient notes a decrease in vision, when already 50% of the optic nerve fibers are damaged irreversibly.

Nonspecific symptoms of glaucoma are:

  • blurred vision
  • pain
  • thread
  • a feeling of heaviness in the eyes
  • narrowing of the field of view
  • Visual impairment at night
  • “rainbow circles” before the eyes when looking at a light source

These symptoms are called nonspecific because they can be characteristic of other ophthalmic diseases.
In case of angle-closure glaucoma and the occurrence of an acute attack, the symptoms are pronounced: sharp pain in the eye, headache, reddening of the eye, nausea, vomiting.

But if any of the above symptoms appear, you should immediately consult a doctor.

Diagnostics of glaucoma

To diagnose glaucoma and determine the method of treating glaucoma, it is necessary to conduct a thorough diagnostic examination, which should include:

  • Visometry (determination of visual acuity)
  • refractometry (determination of the optical power of the eye – refraction)
  • perimetry (definition of peripheral vision)
  • tonometry (determination of intraocular pressure)
  • biometrics (determination of anterior chamber depth, lens thickness, eye length)
  • biomicroscopy (examination of tissues and environments of the eye using a slit lamp)
  • gonioscopy (study of the structure of the anterior chamber angle)
  • ophthalmoscopy (fundus examination with assessment of the state of the optic nerve and retina)

Glaucoma treatment

Conservative treatment of glaucoma includes drugs that reduce the production of intraocular fluid and / or improve its outflow, hemodynamic (improving blood supply) and neuroprotective (protecting nerve fibers) drugs.

These drugs are prescribed only after a diagnostic examination by an ophthalmologist.

In case of insufficient effectiveness of conservative therapy (increased IOP, narrowing of the visual field, progression of optic neuropathy), surgical treatment is indicated.

Surgical treatment of glaucoma is aimed at removing intraocular blocks (obstructions) in the path of intraocular fluid movement or creating a new outflow pathway.

There are many types of glaucoma surgeries, but the most successful are:

non-penetrating deep sclerectomy

– with drainage of the anterior chamber angle

– without drainage of the anterior chamber angle

After the incision of the conjunctiva and the formation of superficial and deep scleral flaps, the outer wall of the Schlemm’s canal is removed, thus increasing the outflow of intraocular fluid through the drainage system of the eye.Sometimes in the area of ​​excision of the outer wall of the Schlemm’s canal, a drain is implanted to enhance the effectiveness of the operation.

Benefits of this operation:

  • painlessness
  • local drip anesthesia
  • atrauma
  • is carried out without penetration into the eye cavity, which avoids a number of complications (a sharp decrease in IOP, bleeding, detachment of the choroid, etc.)

Non-penetrating deep sclerectomy is a highly effective method of surgical treatment of open-angle glaucoma.

Penetrating deep sclerectomy

– with drainage of the anterior chamber angle

– without drainage of the anterior chamber angle

– with valve implantation

After the incision of the conjunctiva and the formation of the superficial scleral flap, the deep layers of the sclera are excised, then the anterior chamber is opened and part of the iris is excised, which allows the intraocular fluid to circulate freely in the anterior and posterior chambers of the eye. To enhance the efficiency of the outflow of the IHF from the eye, a drain or valve is implanted in the area of ​​the operation.

Penetrating deep sclerectomy is a more traumatic operation, but its effectiveness is indisputable in the form of angle-closure glaucoma and with the ineffectiveness of a previously performed non-penetrating operation.

It is worth remembering that timely diagnosis and the appointment of adequate conservative or surgical treatment allows you to maintain high vision in patients with glaucoma for a long period.

In our ophthalmology department, all the necessary preoperative examinations for the treatment of glaucoma are performed, and the department’s specialists own the entire arsenal of surgical interventions.

Phone for making an appointment: 8 (499) 968-69-12 or 8 (926) 465-16-76

90,000 Glaucoma: causes, prevention and treatment

Strictly speaking, glaucoma is not one disease, but a whole group of diseases with similar symptoms. They are characterized by:

  • Increase in intraocular pressure – it can be either constant or episodic;
  • defeat and subsequent atrophy of the optic nerve;
  • decreased visual acuity, visual impairment.

Sign up for a free vision test

According to statistics, in 2019 more than 70 million people suffered from this disease. In Russia, the number of cases is estimated at about a million. Moreover, glaucoma is the second most common cause of blindness, second only to cataracts. It is very important to be examined regularly by a specialist!

The purpose of this article is to give a general idea of ​​glaucoma, tell about the causes of this disease, symptoms, treatment and prevention.

Contents

  1. Types of glaucoma
  2. Causes of glaucoma
  3. Stages of the disease
  4. Glaucoma symptoms
  5. Prevention
  6. Glaucoma Treatment

Types of glaucoma

The space of the eye, filled with a transparent liquid and bounded on one side by the cornea, and on the other by the iris, is called the anterior chamber. It has an area called the anterior chamber angle, or CPC.In the outer wall of the CPC there is a drainage system of the eye, which provides a controlled outflow of intraocular fluid. The circulation of the fluid maintains the intraocular pressure (IOP) at a constant level, and the violation of its function entails an increase in pressure.

Accordingly, there are two main types of glaucoma:

  • closed-angle;
  • open-angle.

The first type, that is, angle-closure glaucoma, is less common; according to various estimates, from 10 to 20% of the total number of cases suffer from it.It is most often encountered by people over the age of 30, who also have hyperopia.

The specificity of this type is that the iris overlaps the angle of the anterior chamber (APC) of the eye. For this reason, the work of the natural drainage system is disrupted, and pressure builds up in the visual organ. This may be accompanied by:

  • severe headache;
  • redness of the eye;
  • blurred vision and other visual impairments, including complete blindness.

Open-angle glaucoma is detected in about 80-90% of those who are faced with an increase in IOP. In this case, access to the natural drainage system remains open, but it works with disruptions. As a consequence, the pressure inside the eye gradually increases. Such a disease can be asymptomatic, which is especially dangerous, since a person can suddenly, without any intelligible reason, feel that the quality of his vision has noticeably decreased.

Causes of glaucoma

The balance of the inflow and outflow of intraocular fluid maintains the pressure inside the healthy eye at a level between about 10 and 20 mm Hg.Art. If the normal circulation of the fluid is disturbed, the pressure begins to rise. There are problems with blood circulation in the structures of the eye, the fibers of the optic nerve die off, the field of vision gradually narrows, and then the optic nerve can atrophy, and then complete blindness sets in.

Currently, experts cannot say for sure for what reasons glaucoma occurs. The appearance of this disease is influenced by factors such as:

  • heredity;
  • Individual anatomical features, specificity of the structure of the visual organs in a particular person;
  • various pathologies of the cardiovascular, nervous and endocrine systems.

The risk factors for the development of glaucoma include a small volume of the anterior chamber of the eye. This feature of the structure of the organ of vision is present in some peoples – the Eskimos and the inhabitants of East Asia. In women, this anatomical feature is more common than in men, so for them the risk of developing glaucoma is slightly higher.

The presence of age and genetic risk factors is the reason why many people should undergo an examination at least once a year for suspected glaucoma.This primarily applies to those who:

  • over 40 years old – with age, the likelihood of the disease increases;
  • suffers from other eye diseases such as cataracts, tumors, acute inflammations;
  • has diseases of the cardiovascular, endocrine and nervous systems;
  • has been taking or has been taking hormonal drugs for a long time;
  • has relatives who have been diagnosed with glaucoma.

Stages of glaucoma

The disease in its development goes through several stages. The transition to a more serious stage is usually expressed in the appearance of defects in the visual field. The field of vision is the space that a person sees around him, when looking at a fixed point.

At the initial stage of the disease, loss of small central areas of the visual field most often occurs. The patient may either not notice this at all, or pay attention to small dark spots in front of the eyes.

Further, peripheral vision gradually deteriorates. A person with glaucoma sees more or less well only what is directly in front of him. But over time, the central field of view narrows – experts often use the term “tunnel vision” because it seems to a person that he is looking at the world through a long narrow tube. A veil appears before the eyes, it may seem that dark dots are running in front of them.

At the last stage of glaucoma, which is called terminal glaucoma, there is a complete loss of vision.

Glaucoma symptoms

Obviously, the sooner ophthalmologists make an appropriate diagnosis, the more likely it is that the problem will be influenced. However, the signs of glaucoma, as mentioned above, often do not appear. Therefore, a person can find out about the presence of serious complications, for example, by visiting a specialist for a completely different reason.

Glaucoma is often discovered by accident, during a routine visit to an ophthalmologist.

However, there are a number of symptoms that clearly indicate that it is necessary to see a doctor .It:

  • blurred vision;
  • the onset of a sharp headache, including only in one half of the head;
  • pain in the eye area;
  • The appearance of rainbow halos around light sources;
  • redness of the eye;
  • Visual impairment in low light, primarily in the evening and at night;
  • loss of peripheral vision.

Prevention

Glaucoma prevention is especially important for people over the age of 45.They should follow the simple recommendations of doctors – this reduces the likelihood of the development and progression of the disease:

  • do not lift weights over 12 kg;
  • it is necessary to ensure that the night’s sleep is regular, sound and lasts at least 8 hours;
  • 90,013 people with a hereditary predisposition to glaucoma should not be in a position for a long time in which the head is tilted forward – to wash the floors, weed the garden or pick berries;

  • it is necessary to control blood pressure, monitor the amount of fluid and salt consumed, drink less coffee and eat more plant foods;
  • should avoid overwork, stress and nervous strain;
  • it is undesirable to be in rooms with sudden changes in lighting;
  • it is necessary to protect the eyes from sudden flashes;
  • it is better to refuse to visit cinemas or to keep such visits to a minimum;
  • stop drinking alcohol and tobacco.

Glaucoma treatment

Damage to the optic nerve and, moreover, loss of vision in glaucoma is irreversible. However, there are ways to normalize intraocular pressure and thereby prevent or halt the progression of the disease.

Conservative, that is, drug treatment involves the use of various drugs, primarily eye drops. At the same time, it is necessary to understand that they do not “cure” in the literal sense of the word, that is, they do not change the structure of the eye in such a way that the natural system of fluid outflow works again without disturbances.They artificially maintain the fluid balance in the eye. It is worth giving up the use of drops, and after a while the disease will begin to progress.

Glaucoma surgery is used when medication does not help. The main goal of the operation is to remove obstacles to the outflow of intraocular fluid or create new pathways. This can be achieved in several ways. Most often, specialists:

  • use modern laser techniques to, for example, expand existing or create new channels for IOP outflow;
  • special devices are implanted through which intraocular fluid is removed: tubes, drains, valves.

Glaucoma: causes, symptoms, prevention – GBUZ Vyselkovskaya CRH

Glaucoma is a chronic eye disease in which intraocular pressure (IOP) increases

and the optic nerve is affected. Translated from the Greek language means – “blue clouding of the eye”, “the color of sea water.” Other names for the disease are “green water”, “green cataract”. At the same time, vision decreases, up to the onset of blindness. One of the main external signs is a change in the color of the pupil – its repainting in a greenish or azure shade.According to statistics, about 70 million people worldwide suffer from glaucoma. According to experts, in 2020, 80 million people will be affected by this disease.

Causes

The main cause of glaucoma is high intraocular pressure. It increases due to an imbalance between the production and outflow of aqueous humor – a special liquid substance necessary for the normal functioning of the eye.

The most common primary glaucoma, the symptoms of which are mild.The factors provoking its development include age, myopia, heredity, diseases of the nervous system, thyroid gland, diabetes mellitus, hypotension.

Secondary glaucoma develops as a result of a previous eye disease. Its causes are: lens shift; inflammatory processes of the eyes, such as scleritis, uveitis, keratitis; cataract; dystrophic eye diseases, for example, progressive iris atrophy; wounds, eye burns; swelling of the eye; surgical operations on the eyes.

Glaucoma symptoms

In the case of glaucoma, visual field defects are an important symptom. The field of view is the space that we see around us. At the initial stage of glaucoma, most often, there are subtle drops of small central areas of the visual field, which the patient may not notice at all or notices in the form of dark spots with uneven outlines (if he tries to look with one eye).

With the further development of glaucoma symptoms, the patient notes a steady narrowing of the peripheral boundaries of the visual field (the patient clearly sees only the space located directly in front of him, but does not see what is happening on the sides of him).In the later stages of the disease, only tubular vision is preserved, in the form of a small picture (as if the patient was looking at the world through a long tube). In the terminal stage of glaucoma, vision disappears completely (complete blindness develops).

Characteristic signs of glaucoma:

  • visual impairment: slight blurred vision, the appearance of a film in front of the eyes and the so-called running dots at the moment of fatigue;
  • pain in the eyes and in the area of ​​the temples;
  • Rapid eye fatigue when reading, working at a computer.

The most common form of glaucoma is open-angle. Very often it proceeds almost imperceptibly for the patient. The eye looks normal, but watery moisture, not having a normal outflow, accumulates in the eye, which leads to an increase in intraocular pressure. And this is perhaps the most unpleasant feature of the open-angle form – the disease progresses imperceptibly, and without treatment, glaucoma sooner or later leads to complete loss of vision.

Angle-closure glaucoma occurs in about 10% of cases.This form is characterized by acute attacks in which the intraocular pressure rises significantly – it can reach 60-80 mm Hg. pillar. There are severe pains in the eye, often accompanied by headaches, nausea, vomiting, and general weakness. There is a sharp decrease in the vision of the diseased eye. Acute angle-closure glaucoma is difficult to diagnose: it is often mistaken for toothache, migraine, flu, meningitis, stomach disease, since patients complain of nausea, headaches, etc.and the eyes are not mentioned.

Principles of diagnosis and treatment

To understand how to treat glaucoma, it is necessary to undergo timely diagnostics. To diagnose the disease, the following methods are used: perimetry, measurement of intraocular pressure, ophthalmoscopy, ultrasound examination, checking the condition of the fundus, electrophysiological and some other studies.

As a preventive diagnosis of glaucoma, regular measurement of intraocular pressure is recommended: at the age of 35-40 – at least once a year, at the age of 55-60 and older – at least 1-2 times a year.If abnormalities are detected, a complete examination should be completed immediately.

It is quite difficult to diagnose a disease in a child due to the impossibility of carrying out some procedures. The main reasons provoking the development of glaucoma in children have not been identified by doctors. Experts are inclined to believe that the disease can manifest itself due to a hereditary predisposition or due to the influence of other factors during the period of the child’s stay in the womb.

It is highly recommended to contact a specialist if the following symptoms appear: the appearance of a “veil” on aiming at the light source; deterioration of vision; severe headaches; redness of the eyeballs; loss of peripheral and then central vision.

Glaucoma can be treated with eye drops, medication, laser surgery, conventional surgery, or a combination of these. The goal of any treatment is to prevent vision loss, as vision loss is irreversible. It is important to remember that eye drops for the treatment of glaucoma should be used only on the recommendation of the attending physician, with regular monitoring of the level of intraocular pressure. It should also be understood that glaucoma cannot be cured with folk remedies. The good news is that glaucoma can be controlled if it is detected early and that with medication and / or surgery, most people will retain their vision.

Nutrition for eye glaucoma plays an important role in the fight against this disease. Thanks to a properly formulated diet, it is quite possible to improve the result of drug treatment and reduce the risk of complications. People suffering from glaucoma, in order to successfully fight the disease, should receive daily in sufficient quantities of vitamins of group B, as well as A, C and E. They help to improve the functioning of the optic organ and prevent further progression of the disease.

The diet should be aimed mainly at protecting nerve cells and fibers from damage under the influence of high intraocular pressure.To do this, you need to pay special attention to antioxidant substances and foods that are rich in them. However, there are also products that are not recommended for use during glaucoma, as they can weaken the effectiveness of medications and aggravate the patient’s condition. Such products include fatty, smoked, spicy foods, as well as preservation. Alcoholic drinks, strong tea or coffee are completely excluded. Smoking should also become one of the prohibitions in order to exclude a negative effect on the vessels of the visual organ.

If untreated, the disease leads to complete blindness. And even the treatment and prevention of complications carried out for glaucoma do not always lead to improvement. Approximately 15% of patients completely lose sight within 20 years, at least in one eye.

Prevention

The disease may result in disability, but the prognosis is favorable, provided treatment is at an initial degree. Prevention of glaucoma should consist in regular examination by an ophthalmologist, if a person has a bad heredity, there are somatic factors.Patients suffering from glaucoma should be registered with an ophthalmologist, visit a specialist regularly every 2-3 months, and receive the recommended treatment for life.

Methods of prevention:

  • Watch TV in good lighting;
  • Take breaks when reading after 15 minutes;
  • Eat according to age characteristics with restriction of sugar, animal fats. Eat natural vegetables and fruits;
  • Test before drinking coffee.Measure the intraocular pressure 1 hour after drinking coffee. If it does not rise, you can drink a drink;
  • Nicotine is harmful to the eyes, so you should get rid of the habit to cure the disease;
  • Good sleep, taking 2-3 teaspoons of honey at night, warm foot baths – relieve pressure inside the eyes;
  • Physical activity is essential to prevent glaucoma and simply to maintain good or sufficient vision.

The only way to preserve vision in glaucoma is to identify it very quickly, monitor it regularly and treat it correctly.

GBUZ “Center for Medical Prevention” of the Ministry of Health of the Krasnodar Territory.

Signs of Glaucoma – Eye Surgery Center

In most cases, open-angle glaucoma occurs and progresses imperceptibly for a patient who does not experience any discomfort and see a doctor at a late stage of the disease, when he notices a deterioration in visual acuity.Complaints about the appearance of rainbow circles around light sources, periodic blurred vision are noted only by 15-20% of patients. It is these symptoms that appear with an increase in intraocular pressure (IOP) and may be accompanied by pain in the brow region and head.

Open-angle glaucoma usually affects both eyes, in most cases asymmetrically.

Intraocular pressure in open-angle glaucoma rises slowly and gradually as the resistance to the outflow of intraocular fluid (IVF) increases.In the initial period, it is fickle, then it becomes persistent.

The course of angle-closure glaucoma in most patients is characterized by periodic, at first short-term, and then more and more prolonged periods of increased intraocular pressure (IOP). In the initial stage, this is due to the mechanical closure of the trabecular zone by the root of the iris, which is due to the anatomical predispositions of the eye. In this case, the outflow of intraocular fluid (IVF) decreases.When the angle of the anterior chamber is completely closed, a condition called an acute attack of angle-closure glaucoma occurs. In the intervals between attacks, the corner opens.

During such attacks, adhesions are gradually formed between the iris and the wall of the anterior chamber angle, the disease gradually acquires a chronic course with a constant increase in intraocular pressure (IOP).

During the closed-angle form of glaucoma, the following phases can be distinguished:

  • preglaucoma;
  • acute attack of glaucoma;
  • chronic course of glaucoma.

Preglaucoma occurs in individuals who do not have clinical manifestations of the disease, but when examining the angle of the anterior chamber, it is found that it is either narrow or closed. In the period between preglaucoma and an acute attack of glaucoma, transient symptoms of visual discomfort, the appearance of rainbow circles when looking at a light source, and short-term loss of vision are possible. Most often, these phenomena occur with prolonged stay in the dark or emotional arousal (these conditions contribute to the dilation of the pupil, which completely or partially reduces the outflow of intraocular fluid) and usually disappear on their own, without causing much anxiety in patients.

An acute attack of glaucoma occurs under the influence of provoking factors, such as nervous tension, overwork, prolonged stay in the dark, drug-induced dilation of the pupil, prolonged work in a tilted head position, intake of large amounts of fluid. Sometimes an attack appears for no apparent reason. The patient complains of pain in the eye and in the head, blurred vision, the appearance of rainbow circles when looking at a light source. Painful sensations are caused by compression of nerve elements at the root of the iris and ciliary body.Visual discomfort is associated with corneal edema. With a pronounced attack, nausea and vomiting may appear, sometimes pain that radiates to the region of the heart and abdomen, sometimes imitating manifestations of cardiovascular pathology, is disturbing.

When visually examining such an eye without special devices, one can notice only a sharp expansion of the vessels on the anterior surface of the eyeball, the eye becomes “red”, somewhat with a bluish tint. The cornea becomes cloudy due to the development of edema.Noteworthy is the dilated pupil that does not react to light. At the height of the seizure, visual acuity can sharply decrease. Intraocular pressure can rise to 60 – 80 mm Hg. Art., the outflow of fluid from the eye stops almost completely. The eye is as dense as a stone to the touch.

If within the next few hours after the development of the attack, the pressure is not reduced with the help of medications or by surgery, the eye is threatened with irreversible loss of vision !!! An acute attack of glaucoma is an urgent situation and requires emergency medical care !!!

Prices:

Diagnostics for glaucoma 5500
Surgical treatment of glaucoma The cost
Antiglaucomatous surgery with hydrogel or collagen drainage from 40,000


All prices

Make an application on the website, we will contact you as soon as possible and answer all your questions.

Appointment

Glaucoma: treatment of the disease | Clinic Rassvet

Fast passage

What is glaucoma

Glaucoma is a severe, progressive eye disease caused by the death of nerve fibers and cells in the retina, leading to irreversible blindness of the eye.

According to the WHO (World Health Organization), the total number of glaucoma patients worldwide is about 105 million.people, and in the next 10 years an even greater increase is predicted, about 10 million people. There are over 1 million registered cases of glaucoma in the Russian Federation. But it is assumed that the real indicators of the number of glaucoma patients are much higher.

Glaucoma occupies one of the leading positions among the causes of disability and vision disability, which determines its most important socio-economic importance.

What types of glaucoma exist

Speaking about the types of glaucoma, first you need to understand how fluid normally circulates inside the eye.

Intraocular fluid is secreted by the processes of the ciliary body, then the fluid penetrates through the pupil into the anterior chamber of the eye and is directed to the corner of the anterior chamber. This angle is formed by the posterior surface of the cornea and the anterior surface of the iris. At the apex of this corner there is a drainage system consisting of a trabecular network (a kind of filter that facilitates one-way movement of moisture) and a Helmet canal. The fluid, filtering through the trabecular network, enters the Shlemov canal, then through the collector vessels connected to it – into the external veins, in which it flows out of the eye.

The described outflow pathway is the main one; about 80-90% of the intraocular fluid flows out of the eye along it.

Depending on the anatomy of the structure of the angle of the anterior chamber of the eye, the following types of glaucoma are distinguished:

  • Primary open-angle glaucoma (POAG) is the most common type of glaucoma, which is characterized by increased intraocular pressure (IOP), optic nerve atrophy due to progressive death of nerve fibers. In this case, the angle of the anterior chamber is open.
  • Narrow-angle (and angle-closure) glaucoma – occurs when there is an anatomically narrow angle of the anterior chamber of the eye, which impedes the outflow of intraocular fluid to the drainage system of the eye. In some circumstances (for example, natural dilation of the pupil in the dark, or drug-induced dilation of the pupil during a diagnostic examination), the drainage system may be completely blocked by the root of the iris. An acute attack of glaucoma develops, accompanied by a sharp critical increase in IOP, severe pain in the eye, headache on the affected side, sudden deterioration of vision (blurred image, the appearance of iridescent halos before the eyes), redness of the eye.This condition threatens with rapid loss of vision and requires urgent assistance.

There are also the following types of glaucoma:

  • Secondary glaucoma – develops as a result of eye trauma, inflammation in the eye, cataracts, tumors, caused by prolonged use of drugs (corticosteroids), in rare cases, eye surgery for another disease can trigger the development of glaucoma.
  • Glaucoma of normal or low pressure – this form of glaucoma is characterized by progressive atrophy of the optic nerve with IOP numbers within the normal range (the reason for the development of this type of glaucoma is unknown, the theory of impaired circulation of the optic nerve is being considered).

There are other types of glaucoma, depending on the age and course of the disease.

Risk factors for the development of glaucoma

Currently, unified concepts have not been formulated, the causes of the onset and mechanisms of development of glaucoma have not been determined. It is believed that the onset of glaucoma is facilitated by a whole range of causes, which together can provoke its development.

Among the reasons are heredity, features or abnormalities of the structure of the eye, cardiovascular, nervous and endocrine systemic disorders.

Let’s list the risk factors for the development of glaucoma:

  • Age – people over 55-60 years old are at high risk of glaucoma, and this risk increases with each subsequent year.
  • Heredity, family predisposition.
  • Race (in people of African descent, glaucoma is much more common, in Europeans, pseudoexfoliative glaucoma is more common, in Asians – angle-closure glaucoma, in the Japanese – normal pressure glaucoma).
  • Refractive errors (with farsightedness – the risk of angle-closure glaucoma, with myopia – low-pressure glaucoma, pigmentary glaucoma are more common, optic nerve lesions develop faster).
  • Circulatory disorders (presence of concomitant arterial hyper- and hypotension, vasospastic syndrome, diabetes mellitus).
  • Long-term use of corticosteroids (may provoke an increase in IOP).

Glaucoma symptoms

In the overwhelming majority of cases, at the initial stages, glaucoma does not manifest itself in any way and is absolutely asymptomatic!

Many people are unaware that they are suffering from glaucoma, and they notice the first signs of its manifestation, when a significant part of their vision has already been irretrievably lost.That’s why she was nicknamed “the silent killer of sight.”

As already mentioned, with glaucoma, nerve fibers and retinal cells die, which leads to the formation of optic nerve atrophy. There is a gradual narrowing of the field of vision from the periphery, and a person can feel “something was wrong” when only a small part of the entire field of vision remains. Ophthalmologists call this field of view “tubular” (to roughly represent such vision, you can roll a dark sheet of paper into a tube and look through it like a telescope; the overview presented to your gaze is the vision of a patient with advanced stage of glaucoma).Visual acuity in the remaining “island” of the field of view can be quite high.

Since we look with two eyes at the same time, and visual acuity does not suffer at first, a person may not notice a gradual narrowing of his field of vision. This disease is insidious. In rare cases, the glaucomatous process can begin with an acute attack of glaucoma, which is characterized by a sharp pain in the eye, in the head, a sharp deterioration in vision, the appearance of iridescent halos before the eyes, blurred images, reddening of the eye.

In the event of these complaints, it is necessary to urgently contact an ophthalmologist! Failure to provide timely assistance can lead to significant loss of vision in a short time.

Stages of glaucoma

Depending on the degree of narrowing of the visual field and damage to the optic nerve, the following stages of glaucoma are distinguished:

I – Initial stage – the boundaries of the visual field are within normal limits, however, there are small scotomas (blind spots) in the paracentral regions + changes in the optic nerve head (optic nerve disc) in the form of extended excavation (fossa on the optic disc, which progressively expands due to the death of nerve fibers).

II – Developed stage – narrowing of the boundaries of the visual field by 10 ° or more in the upper and / or in the lower nasal parts, changes in the paracentral parts of the visual field are more pronounced + excavation of the optic nerve disc is wider than in stage I, in some parts of the optic disc it can reach it the edges.

III – Far-reaching stage – concentric narrowing of the field of view, up to “tubular” vision + almost complete excavation of the optic nerve disc.

IV – Terminal stage – only light perception remained from vision, up to blindness and complete loss of visual fields + total excavation of the optic nerve disc.

Diagnostics of glaucoma

As already mentioned, in the vast majority of cases, glaucoma in the early stages is completely asymptomatic. Therefore, periodic preventive examinations by an ophthalmologist are important, especially for people at risk for glaucoma. Given the irreversible nature of glaucoma lesions, early diagnosis and timely treatment of glaucoma are extremely important.

Examination for glaucoma includes:

  • Interviewing a patient to identify risk factors for glaucoma.
  • Study of visual acuity.
  • IOP measurement (but don’t forget about normal and low pressure glaucoma!).
  • Biomicroscopy – examination of the anterior segment of the eye.
  • Ophthalmoscopy (fundus examination) – assessment of the optic nerve disc, its excavation, and the retina as a whole.
  • Pachymetry – examination of the thickness of the cornea (important for the correct interpretation of the measured IOP figures).
  • Gonioscopy – examination of the angle of the anterior chamber of the eye using a special goniolens.
  • Computer perimetry – examination of visual fields.
  • OCT (optical coherence tomography) – computer analysis of the optic disc, excavation, study of the thickness of nerve fibers, retinal layers at the “cellular level” (in microns).

Glaucoma treatment

The mainstay of glaucoma treatment is to reduce intraocular pressure (IOP) and stabilize it at the target value. It is possible to reduce IOP by medication, with the help of laser surgery and microsurgery (“knife” surgery).

The main goal of glaucoma treatment is to reduce intraocular pressure (IOP) to values ​​at which there will be no progression in narrowing of the visual fields, atrophy of the optic nerve and decrease in visual functions.

Today, there are 3 methods to reduce IOP:

  • Drug therapy
  • Laser surgery
  • Microsurgery (“knife”)

Drug treatment

In most cases, glaucoma treatment begins with conservative methods, by prescribing drugs that lower IOP.

There are several pharmacological groups of drugs for lowering IOP: some reduce the production of intraocular fluid, others improve the outflow of this fluid from the eye. For the convenience of treatment (reducing the number of instilled drugs, the frequency of their instillation during the day), combined forms of drugs have been developed containing two pharmacological groups of drugs in one. The adequacy of the achieved hypotensive regimen is determined by dynamic control examinations.In order to avoid the development of tachyphylaxis (addiction) to drugs, they should be routinely replaced with drugs from another pharmacological group.

Surgical treatment

In the absence of the desired effect from the ongoing drug therapy, non-observance of the prescribed instillation regimen, poor tolerance or an allergic reaction to drugs, they resort to surgical methods of treating glaucoma (laser and “knife” surgery).

Laser surgery

Laser surgery for glaucoma is considered to be less invasive surgery than knife surgery.There are the following types of laser surgery for glaucoma:

  • Laser trabeculoplasty – with the help of laser “burns”, the trabecular network is scarred, thereby improving the outflow of intraocular fluid into the Shlemov canal. However, this type of laser intervention is ineffective in advanced stages of glaucoma.
  • Laser iridectomy – is used in cases of an acute attack of glaucoma (to eliminate pupillary block) or as a prophylaxis of its occurrence.The bottom line is the formation of a through hole in the iris, through which moisture in the eye will circulate.
  • Laser descemetogoniopuncture – creating a hole in the surgically thinned posterior border plate – the trabeculodescemet membrane – in the area of ​​a previously performed surgical operation (non-penetrating deep sclerectomy), thereby facilitating a better outflow of fluid from the eye through the surgically created additional pathways.
  • Laser transscleral cyclocoagulation – sectoral coagulation of the ciliary body in order to reduce the secretion of intraocular fluid in the eye.

“Knife” surgery

In the absence of an effect from the medication and laser treatment carried out, a decision is made on a surgical operation.

Glaucoma surgery is performed with the aim of:

  1. Creation of new pathways for the outflow of intraocular fluid
  2. Decrease in the production of intraocular fluid

Operations to create additional pathways for the outflow of intraocular fluid are divided into:

  • Penetrating (sinustrabeculectomy and its modifications)
  • Non-penetrating (non-penetrating deep sclerectomy)

Operations that reduce the production of intraocular fluid are called cyclodestructive, i.e.e during the operation, the ciliary body is damaged by various methods (cyclokryodestruction, cyclodiathermy), the processes of which secrete intraocular fluid, due to this, the IOP decreases.

In order to prolong the hypotensive effect of the operation and achieve a relatively controlled level of IOP, it is possible to additionally use various drains and valves during surgery.

The purpose of glaucoma surgery is not to restore vision (unfortunately, lost visual functions cannot be restored).The main task is to achieve the target IOP value with the help of surgery.

Dispensary supervision

Glaucoma patients require dispensary observation. Routine dynamic examinations are the key to long-term stabilization of glaucoma and preservation of vision.

How do ophthalmologists treat glaucoma at the Rassvet clinic?

Ophthalmologists of the Rassvet clinic will carry out the necessary diagnostic examinations using modern expert-class equipment.

If the diagnosis of glaucoma is confirmed, recommendations will be given on the choice of the method of treatment and the terms of the subsequent dispensary observation will be determined.