Glaucoma
Summary/Definition
Glaucoma is a disease that occurs in the optic nerve, which transmits optical information received by the eyes to the brain, and causes characteristic morphological and functional changes that lead to deterioration of the visual field. It is defined as progressive neuropathy of the optic nerve.
Primary open-angle glaucoma
Primary open-angle glaucoma is the most common type of glaucoma in which watery moisture is drained openly. It is characterized by normal or increased intraocular pressure. In most cases, this condition is not accompanied by symptoms and remains unnoticed until the damage to the visual field reaches a more serious stage. Primary open-angle glaucoma is divided into two subtypes: glaucoma with high intraocular pressure, which develops due to increased resistance to drainage of watery moisture, and glaucoma with normal intraocular pressure, in which glaucoma is detected, despite the normal pressure inside the eye, which is 21 mm Hg.
Closed-angle glaucoma
Angle-closure glaucoma occurs in cases where the drainage of watery moisture is limited, which leads to an increase in intraocular pressure. This condition is divided into acute and chronic forms. Acute angle-closure glaucoma is more often accompanied by pronounced symptoms, while the chronic form develops gradually and often manifests itself without symptoms. Chronic angle-closure glaucoma can occur as a result of anatomical changes that occur after acute angle-closure glaucoma.
Congenital glaucoma
Congenital glaucoma is associated with abnormalities of the eye structure that differ from the normal. Intraocular pressure increases due to these structural abnormalities. In most cases, surgical treatment is required.
Other forms
This includes secondary glaucoma associated with cataracts, retinal diseases, uveitis, ocular hypertension and glaucoma that develops as a result of drug treatment, for example, steroids.
Symptoms
The symptoms of primary open-angle glaucoma and normal pressure glaucoma, which make up the majority of all cases of glaucoma, develop gradually with an increase in damage to the optic nerve. First of all, peripheral vision suffers, while central vision usually remains relatively normal until the late stages of glaucoma. Therefore, early detection of primary open-angle glaucoma is a difficult task. Since intraocular pressure can increase in one or both eyes early in the morning or late at night, patients often experience temporary visual disturbances, headaches and eye discomfort. With the progression of damage to the optic nerve, the visual fields are significantly narrowed, which reduces the ability to distinguish between surrounding objects and react to unexpected situations. As a result, the patient may fall down the stairs or get injured when hitting his head on low obstacles or signs. If glaucoma is accidentally detected, symptoms may occur after diagnosis.
Diagnostics
Early detection of glaucoma presents certain difficulties for a number of reasons, including the absence of pronounced symptoms in the early stages of the disease and the inability to establish a diagnosis solely based on data on intraocular pressure. Various methods are used to diagnose glaucoma, including measurement of intraocular pressure, gonioscopy, visual field testing and assessment of the condition of the optic nerve.
When conducting an oral consultation, anamnesis, drug use, family history, main symptoms and lifestyle are taken into account. In the presence of glaucoma symptoms, their time of manifestation, frequency, severity is assessed, and a connection with glaucoma is established. The intraocular pressure of the patient is measured by special methods, and the condition of the eye is checked using a microscope with a slit lamp.
Treatment and course of the disease
Treatment methods vary depending on the type of glaucoma. These include drug therapy, including instilling medication directly into the eye or oral medication once or several times a day. Laser therapy is also used, which is aimed at changing the structure of the eye by irradiating internal structures with a laser. In some patients who are difficult to treat or who do not have a reaction to eye drops, surgery may be performed. Laser treatment is used in cases of angle-closure glaucoma or open glaucoma, which cannot be controlled with medication and is accompanied by side effects such as mild pain or a foreign body sensation after the procedure. Surgical methods of treatment include trabeculectomy and installation of antiglaucomatous drainage.
