Open-angle glaucoma is a chronic pathology of the eyes, accompanied by increased intraocular pressure and a gradual atrophy of the optic nerve, threatening complete blindness. How to recognize this disease, which is increasingly found in young people, and also how to treat it, we will consider further.
Closed-angle and open-angle glaucoma - differences
Two forms of pathology are known: open-angle glaucoma and closed-angle glaucoma. In both cases, the result of pathological processes in the tissues of the eye is the loss of the optic nerve, leading to blindness. In our eyes, watery liquid is continuously formed, the outflow of which occurs through the hole located between the cornea and the iris (the filtering angle).
Due to the balance of the inflow and exit of moisture inside the eyes, a special constant pressure is maintained. If due to various reasons the outflow of the intraocular fluid becomes more difficult, it begins to accumulate, which leads to an increase in pressure. As a result, the optic nerve and other nearby tissues begin to experience a constant load, blood supply is disturbed, hypoxia arises, and the person loses sight.
With open-angle glaucoma, the filtering angle remains as wide and open as it should be, and an obstacle to the release of moisture occurs in the deep layers of the eye. This form of the disease develops slowly, gradually. With the angle-closure glaucoma, there is a sharp blockage of the discharge channel, i.e. the angle of the front chamber becomes closed. In this case, intraocular pressure increases rapidly, an acute attack may occur, requiring immediate assistance.
Open angle glaucoma - causes
Depending on the mechanism of development of pathology, primary open-angle glaucoma and secondary are isolated. The first species develops independently and is associated with genetic factors. It was established that the propensity to develop pathology determines the features of the structure of the angle of the anterior chamber of the eyes. Along with this, changes in the drainage system are in some dependence on violations in the endocrine system, the nervous system, in the vessels. Therefore, the disease can be associated with such pathologies:
- atherosclerosis ;
- hypertonic disease;
- migraine ;
- diabetes;
- myopia of an extreme degree, etc.
Secondary glaucoma is formed against the background of other destructive or infectious-inflammatory diseases of the eyes, the consequences of injuries, burns, tumor processes, intoxications. According to recent studies, the development of the disease is influenced by factors such as a sedentary lifestyle, the lack of regular physical activity, bad habits, excessive body weight.
Open angle glaucoma - degree
Given the gradual pathological changes in the eye tissues, often sequentially developing processes, open-angle glaucoma is divided into several degrees (stages). At the same time, the level of intraocular pressure may be normal (less than 27 mm Hg), moderate (from 28 to 32 mm Hg) or high (more than 33 mm Hg). We characterize all the stages of open-angle glaucoma.
Open angle first degree glaucoma
At this stage, which is the initial stage, no pronounced pathological changes are observed. There may be increased intraocular pressure, an insignificant change in the field of vision. With a special ophthalmological examination, changes in the fundus are revealed - the appearance of a depression in the center of the optic nerve disk (excavation). If open-angle glaucoma is detected at this stage, the prognosis of the pathology is favorable for the working capacity and life of patients.
Open angle glaucoma 2 degrees
The second stage of pathology is called developed. Patients who are diagnosed with advanced open-angle glaucoma, complaints are specific, and they are associated with a narrowing of the peripheral field of vision at more than 10 degrees from the side of the nose. In addition, at this stage, a concentric narrowing of the field of view, which does not reach 15 degrees, can already be noted. Upon examination, it is revealed that the excavation of the optic nerve disc reaches its edge.
Open angle angle glaucoma 3 degrees
Pathological processes at this stage are considered far gone. Secondary open-angle glaucoma, detected at this stage, is considered very dangerous. The visual defect is increasing. There is a concentric decrease in the field of view in one or more segments, exceeding 15 degrees. Excavation of the disc of the optic nerve is aggravated. Often, in patients with a third degree of glaucoma, there remains a pipe vision, in which they look as though through a narrow tube.
Open angle angle glaucoma 4 degrees
Diagnosed glaucoma 4 degrees - terminal stage of the disease. In most cases, a person already completely loses sight on one or both eyes. Some patients are still able to see poorly due to the small "island" of the visual field. In addition, it is possible to maintain a light sensation, however, if the projection of the light rays is incorrectly determined. With the possibility of viewing the fundus, atrophy of the optic nerve is established.
Open angle glaucoma - symptoms
In the early stages, the primary open-angle glaucoma symptoms are so undefined that few of the patients are worried and are turning to the ophthalmologist. The following signs that appear regularly or from time to time should be cautious:
- a feeling of discomfort in the eyes, tension, stiffness;
- minor pain in the area of the orbit;
- pain in the eyes ;
- lacrimation ;
- redness of the eyes;
- deterioration of vision in twilight and darkness;
- the appearance of rainbow halos when looking at the light source;
- blurred vision, the appearance of a "grid" before the eyes.
Open angle glaucoma - diagnosis
Often, the diagnosis of "open-angle glaucoma" is established accidentally during planned professional examinations, examination in the office of optics. A complex of diagnostic measures, when open-angle glaucoma is suspected, includes such studies:
- measurement of pressure inside the eyeball (especially informative daily diagnostics, in which it is possible to detect significant fluctuations in the indices);
- the size of the lens of the eye and the anterior chamber;
- examination of the structure of the fundus for pathological changes by biomicroscopy;
- perimetry - definition of narrowing of fields of vision;
- evaluation of refraction (the ability of the optical system to refract light rays);
- gonioscopy - visualization of the open angle of the anterior chamber of the eye, the definition of enhanced pigmentation, increased density and sclerosis in the area of the cornea scleral trabeculae,
How to treat open-angle glaucoma?
Since the moment when open-angle glaucoma is discovered, treatment must be carried out constantly. It is not yet possible to fully heal the organs of vision, but the disease can be controlled, and its progress can be stopped. Treatment for open-angle glaucoma is based on conservative and operational techniques, depending on the nature of the pathology. The main medical task in this case is the prevention or reduction of damage to the optic nerve. This requires:
- decrease intraocular pressure;
- reduce or eliminate hypoxia of the eye tissues (especially the optic disc);
- restore the disturbed metabolism in the eyeball;
- correct the associated pathologies.
In the early stages, conservative therapy is often effective, involving different drugs with open-angle glaucoma, both local and systemic. In addition to them, physiotherapy techniques are sometimes used, among which - electrostimulation of the optic disc. If such treatment achieves good results, then the patient continues it, periodically, at least two times a year being examined by an ophthalmologist. Correction of treatment may be necessary if a deterioration of the eye nerve is detected.
Preparations for the treatment of open-angle glaucoma
As a local therapy, eye drops are used with open-angle glaucoma, which should be used regularly, strictly in time. These drugs have a different direction of action. Consider what droplets can be prescribed with open-angle glaucoma (list):
- to reduce the production of intraocular fluid :
- Proxodolol;
- Timolola maleate;
- Arutimol;
- Dorzolamide hydrochloride;
- Betaxolol;
- Asopt;
- Trusopt;
- Brinzolamide;
- to improve the outflow of moisture:
- Pilocarpine;
- Xalatan;
- Travatane;
- Armin;
- Tosmilen;
- Phosphacol;
- Latanoprost;
- Carbachol;
- drops of combined action:
- Kosopt;
- Fotil;
- Proxopheline;
- Azarga;
- Xalacom;
- Fotil forte.
If eye drops do not sufficiently control the pressure inside the vowel, additionally prescribe the drugs of systemic action:
- Clopheline;
- Anaprilin;
- Proserin;
- Hypothiazide.
In addition, to improve blood flow to the optic nerve and protect the nerve cells prescribed vascular drugs, antioxidants, vitamins:
- Cavinton;
- Gliatilin;
- Milgamma.
Surgical treatment of open-angle glaucoma
In severe cases, conservative therapy does not produce the proper effect, and surgical techniques are recommended to reduce intraocular pressure. In this case, regardless of the type of operation, vision can not be improved and completely cured. In cases where open-angle glaucoma of the 4th degree is diagnosed, the operation may be useless, and if the residual vision is preserved, even lead to its complete loss.
Operations are divided into two types:
- Laser (argon and selective trabeculoplasty, cycloablation, etc.);
- traditional surgical (trabeculectomy, drainage system implantation, canaloplasty, etc.).