signs of glaucoma:

signs of glaucoma:

signs of glaucoma

What is today called "glaucoma"? Glaucoma (from the Greek -. Sea watercolor azure) - a serious disease of the organ of vision, called by a greenish color, which becomes the enlarged and fixed pupil in the highest stage of development of the disease process - an acute attack of glaucoma. It happens, and the second name of the disease - "green water" or "green cataract" (from the German «Grun Star».).

There is currently no uniform presentation of the causes and mechanisms of this disease, there are certain difficulties even in the attempt to define the term "glaucoma".

Today glaucoma called chronic eye disease characterized by continuous or periodic increase in intraocular pressure (IOP) with the development of trophic disorders in the ways of outflow of intraocular fluid (IOF, aqueous humor) in the retina and in the optic nerve, causing the appearance of typical defects in the field of view and the development of the edge of excavation (groove punching) of the optic nerve.

Thus, the term "glaucoma" combines a large group of diseases of the eye (60) having the following general features:

Intraocular pressure (IOP) continuously or intermittently exceeds individually transferable (tolerable) level;
Develops characteristic damage of the optic nerve fibers - glaucomatous optic neuropathy, resulting in its final stage to its atrophy;
There are typical for glaucoma disorders visual functions.
Glaucoma can occur at any age from birth, but the prevalence of the disease is greatly increased in the elderly, and in old age. Thus, the frequency of congenital glaucoma is 1 in 10-20 thousand newborns, aged 40-45 years, primary glaucoma occurs in about 0.1% of the population. In the age group, 50-60 years have glaucoma occurs in 1.5% of cases and in persons over 75 years in more than 3%. This disease is one of the first places among the causes incurable blindness and is the most important social value.

Anatomy and physiology of the outflow tract IOF
The cavity includes a light guide eye protection: the aqueous humor that fills its front and rear camera, lens and vitreous body. metabolic regulation of intraocular structures, in particular, in optical media, and maintaining an eyeball tone intraocular fluid circulation is provided in the chamber of the eye.


Intraocular fluid (IOF) - an important source of supply of internal structures of the eye. Aqueous humor circulates mainly in the anterior segment of the eye. It participates in the exchange lens materials cornea, trabecular apparatus, vitreous body and plays an important role in maintaining a certain level of intraocular pressure (IOP).

Intraocular fluid produced continuously processes the ciliary body accumulates in the rear chamber, which represents the slit of complex configuration space located posterior to the iris. Then, most of the water flows away through the pupil, washing the lens, and then enters into the anterior chamber and flows through the drainage system of the eye, located in the zone of the anterior chamber angle - trabecula and Schlemm's canal (venous sinus of the sclera). From it flows off intraocular fluid by putting out collectors (graduates) in the superficial veins of the sclera.

The front wall of the anterior chamber angle formed at the junction of the cornea into the sclera, the rear - is formed by the iris, the apex angle is the anterior part of the ciliary body.

Trabeculae is a reticular ring formed the connective plate having a plurality of holes and cracks. Aqueous humor seeps through the trabecular meshwork and Schlemm's canal is going in, which is a circular slot with about 0.3-0.5 mm lumen diameter and then flows off through the thin tubules 25-30 (graduates) flowing into the episcleral (outer) eye veins, which are the final destination of the outflow of aqueous humor.

Trabecular apparatus is a multi-layered, self-cleaning filter, which provides a one-way movement of fluid from the anterior chamber to the scleral sinus.

The above path is the main and it flows off on average 85-95% of aqueous humor. In addition to the front outflow tract of intraocular fluid and secrete extra: approximately 5-15% of aqueous humor out of the eye, sweeping through the ciliary body and sclera in the veins of the choroid and sclera veins, forming a so-called use scleral outflow pathway.

Status eye drainage system can be estimated by using a special method of research - gonioscopy. Gonioscopy to determine the width of the anterior chamber angle, as well as the state of the trabecular tissue and Schlemm's canal. The angle of the anterior chamber can be wide, medium and narrow. On the basis of data, gonioscopy emits different clinical forms of glaucoma. In open-angle glaucoma gonioskopicheski visible from all parts of the anterior chamber angle, with angle-closure form parts are hidden from observation.

Between the inflow and outflow of intraocular fluid (IOF), there is a certain balance. If it for some reason is broken, this leads to a change in intraocular pressure (IOP). When the persistent and prolonged increase in intraocular pressure occur obstacles (blocks) that lead to the disruption of communications between the cavities of the eyeball or the closure of drainage canals. These blocks can be transient (temporary) or organic (constant).

The causes and mechanisms of development of glaucoma
Glaucoma refers to a multifactorial disease with a threshold effect. This means that the development of the disease requires a number of reasons, all of which lead to its occurrence. Especially important are heredity, individual features or abnormalities of the eye, the pathology of the cardiovascular, nervous and endocrine systems. Now scientists believe that the development and progression of glaucoma - a sequential chain of risk factors, which are summed up in its operation, with the result that triggered the mechanism that leads to the emergence of the disease. However, the mechanisms of disturbance of visual function in glaucoma pathogenesis still remain insufficiently studied.

The main stages of development of the pathological process in glaucoma can be represented as follows:

violation and the deterioration of the outflow of aqueous humor from the cavity of the eyeball, which can be caused by a mass of all sorts of reasons;
increased intraocular pressure (IOP) above the level of tolerance (portable, tolerance) for the eyes;
the deterioration of blood circulation in the tissues of the eye;
hypoxia (lack of oxygen) and ischemia (blood disorder) tissues in the exit of the optic nerve;
compression (compression) of nerve fibers in the area of ??their exit from the eyeball, leading to disruption of their function, and death;
dystrophy (malnutrition), destruction (destruction) and atrophy of the optic fiber, the collapse of their parent retinal ganglion cells;
the development of so-called glaucomatous optic neuropathy and subsequent atrophy (destruction) of the optic nerve.
Depending on the development of the glaucomatous process of the nerve fibers of the optic nerve atrophy, and the part is in a state of parabiosis (a sort of "sleep"), which makes it possible to restore their function under the influence of treatment (medical or surgical).

From the foregoing, it follows another important postulate. Glaucoma Treatment is directed primarily to normalize the level of intraocular pressure (IOP) and bring it up to the individual level of tolerance - that is, values ??carried by the optic nerve of the individual patient (usually 16-18 mm Hg. v. the measurement of standard tonometer of Maklakov). This so-called target pressure - the level of IOP, which seeks an ophthalmologist, appointing drops and surgeon performing surgery antiglaukomatoznyh. The treatment effect is primarily dependent upon the integrity of nerve tissue and thus usually can objectively be said that the visual features that "climb" glaucoma are not returned back.

Sign of glaucoma Species

There are congenital glaucoma, juvenile glaucoma (juvenile glaucoma, glaucoma or younger), adult primary glaucoma and secondary glaucoma.

Congenital glaucoma can be genetically determined (predetermined) or caused by disease and injury of the fetus during embryonic development or during childbirth. This type of glaucoma appears in the first weeks and months of life, and sometimes several years after birth. This is a fairly rare disease (1 in 10-20 thousand births).

Congenital glaucoma develops as a result of anomalies (mainly in the anterior chamber angle), often resulting mother various pathological conditions (particularly, to VII month of pregnancy). By the development of congenital glaucoma cause infectious diseases (measles, mumps (mumps), poliomyelitis, typhoid, syphilis, and others.) A deficiency disease, thyrotoxicosis, mechanical trauma during pregnancy, poisoning, alcoholism, exposure to ionizing radiation and others.

In 60% of cases of congenital glaucoma is diagnosed in the newborn. This condition in the medical literature is sometimes called the terms "gid oft ALM" (dropsy of the eye) or "buphthalmos" (bull's eye). The cardinal signs of congenital glaucoma are high intraocular pressure (IOP), bilateral enlargement of the cornea, and sometimes all of the eyeball.

Juvenile (Youth) glaucoma occurs in children older than three years. The age limit for this type of glaucoma - 35 years.

Adult Primary glaucoma - the most common type of glaucoma, age-related changes in the eye. This site focuses on is of primary glaucoma adults as most extended illness.

Secondary glaucoma is a consequence of other ocular or general diseases involving lesions of the ocular structures are involved in the circulation of intraocular moisture or outflow from the eye.

Primary glaucoma adults

Primary glaucoma is divided into four main clinical forms: open-angle glaucoma, angle-closure glaucoma, mixed glaucoma and glaucoma with normal intraocular pressure. For each form of glaucoma more it will be discussed in the relevant section.

The classification allocated 4 stage glaucoma: the initial stage of glaucoma, glaucoma development stage, advanced stage of glaucoma stage and end-stage glaucoma. Each stage is designated by Roman numerals I - IV for a brief record of the diagnosis. Stages of glaucoma determined by the state of the field of vision and the optic nerve.

Normal IOP is not more than 26 mm Hg. Art., A moderately increased - from 27 to 32 mm Hg. Art., High - 33 mm Hg. Art. or more (measurement data standard tonometer Maklakova 10 grams in weight).

** Dynamics of visual function assessed by the field of view. If it is for a long time (6 months) did not change, consider stabilized visual functions. In the absence of the stabilization process is also indicated by visual changes in the optic nerve, which can be evaluated by a doctor, an ophthalmologist at the fundus examination in dynamics.

I-initial (boundaries of the visual field are normal, but there are small changes in the paracentral parts of the visual field). The picture changes in fields of vision in glaucoma will see clinical picture of primary glaucoma;

II-developed (pronounced changes in the field of view in the paracentral department in conjunction with its narrowing);

III-advanced stage (the boundaries of the field of vision narrowed concentrically or there is severe narrowing in one of the segments);

IV-terminal (complete loss of vision or color perception saving with the wrong projection. Sometimes retained a small island in the temporal field of view of the sector).

For glaucoma, the low intraocular pressure is characterized by all the typical primary glaucoma symptoms: change the field of view and partial atrophy of the optic nerve. However, the level of intraocular pressure is maintained within the normal range. This type of glaucoma is often associated with vascular dystonia hypotonic type flows.

The clinical picture of primary glaucoma:
Open-angle glaucoma is a genetic disease. There are risk factors that can contribute to its development. These include heredity (the disease can be transmitted from generation to generation), myopia, advanced age, systemic diseases (diabetes mellitus, arterial hypotension or hypertension, atherosclerosis, cervical osteochondrosis, etc.). It is assumed that these factors lead to the deterioration of the brain and the eyes of the blood supply, disturbances of normal metabolic processes in the eye.

In most cases, open-angle glaucoma occurs and progresses silently for a patient who does not experience any unpleasant sensations and goes to the doctor already at an advanced stage of the disease when she notices the deterioration of visual acuity. Complaints about the appearance of bright circles around lights, intermittent blurred vision note only 15-20% of patients. These symptoms appear with an increase in intraocular pressure (IOP) and may be accompanied by pain in the head region and the brow.

Open-angle glaucoma affects, as a rule, both eyes, in most cases flowing asymmetrically.

Leading symptom of the disease - an increase in intraocular pressure (IOP). The intraocular pressure in open angle glaucoma is increased slowly and gradually with the growth of resistance to the outflow of intraocular fluid (IOF). In the initial period it is intermittent, then it becomes persistent.

The most important diagnostic feature of open-angle glaucoma is a change in the field of view. Previously, all these defects are determined in the central departments and manifest extension of the blind spot boundaries, the emergence of the arcuate fallout. These abnormalities are detected in the early stages of glaucoma, with special research field of view. As a rule, patients do not notice these changes in everyday life.

With further development of glaucomatous process identified defects of the peripheral field of view. The narrowing of the field of view comes mainly from the nasal side, in a further narrowing of the field of view concentric covering peripheral parts up to complete its loss. Deteriorating dark adaptation. These symptoms appear on the background of a persistent increase in intraocular pressure (IOP). The drop in visual acuity to mention the heavy, the advanced stage of the disease, followed by almost complete atrophy of the optic nerve.

Angle-closure glaucoma is 20-25% of cases of primary glaucoma. Women suffer more than men. Contributing factors to the development of this form of glaucoma are:

anatomic predisposition;

functional factors closing the anterior chamber angle;
age-related changes in the eye.
Anatomical features of the eyeball structure predisposing to the development of angle-closure glaucoma are the small size of the eye, shallow anterior chamber, a large lens, narrow anterior chamber angle, farsightedness. The functional factors include increased production of intraocular fluid (IOF), the increase in blood filling of intraocular vessels, pupil dilation.


The current angle-closure glaucoma in most patients is characterized by periodic, short-term first, and then increasingly long periods of elevated intraocular pressure (IOP). In the initial stage, it is caused by a mechanical closure trabeculae root zone of the iris, which is due to anatomic predispositions eyes. In this case, the outflow of intraocular fluid (IOF) is reduced. At the full closure of the anterior chamber angle, there is a condition called an acute attack of angle-closure glaucoma. In the intervals between bouts, corner opens.

During such episodes gradually forming adhesions between the iris and the wall of the anterior chamber angle, the disease gradually becomes chronic course with the constant increase in intraocular pressure (IOP).

During the closure forms of glaucoma can be identified such phases as:

pre-glaucoma;
an acute attack of glaucoma;
chronic glaucoma.
Preglaukoma occurs in persons who have no clinical manifestations of the disease, but the study of the anterior chamber angle is found that it is either a narrow or closed. Between preg auk, Moy and acute attack of glaucoma may be transient symptoms of visual discomfort, the appearance of bright circles when looking at the light source, a short-term loss of vision. Most often, these phenomena occur with prolonged stay in the dark or emotional arousal (these conditions contribute to the expansion of the pupil, which is fully or partially reduce the outflow of intraocular fluid) and usually disappear on their own, without causing great anxiety in patients.

Acute glaucoma attack occurs under the influence of provoking factors, such as nervous tension, fatigue, long stay in the dark, medical mydriasis, a prolonged work in a position with an inclination of the head, drinking large amounts of fluids. Sometimes an attack occurs for no apparent reason. The patient complains of pain in the eye and in the head, blurred vision, the appearance of bright circles when looking at the light source. Pain is caused by compression of the nerve cells in the root of the iris and ciliary body. Visual discomfort associated with corneal edema. With a pronounced attack may be nausea and vomiting, and sometimes disturb pains, extending to the region of the heart and abdomen, sometimes mimic the symptoms of cardiovascular disease.

Visual inspection of the eye without special equipment can be seen only dramatic expansion vessels on the anterior surface of the eyeball, the eye becomes "red", with a few bluish shade (congestive vascular injection). The cornea due to the development of edema cloudy. Attention is drawn to advanced and responsive to light the pupil. At the height enacted attack can dramatically decrease visual acuity. Intraocular pressure can increase up to 60 to 80 mm Hg. Art., the outflow of fluid from the eye is stopped almost completely. In the eyes feel tight as a rock.