Introduction to glaucoma

Introduction Glaucoma refers to an eye disease in which intraocular pressure is intermittent or continuously elevated. Continuous high intraocular pressure can cause damage to various parts of the eye tissue and visual function. If not treated in time, the visual field can be completely lost to blindness. Glaucoma is one of the three most common blind eye diseases that cause blindness in humans. The overall population incidence rate is 1%, and after 45 years old, it is 2%. Causes Normal intraocular pressure and factors affecting intraocular pressure: The pressure exerted by the contents of the eyeball on the wall of the eyeball is called intraocular pressure (referred to as intraocular pressure). The intraocular pressure that maintains the normal visual function is called normal intraocular pressure. Under normal circumstances, the rate of aqueous humor production, the rate of aqueous humor discharge, and the volume of the contents of the eye are in dynamic equilibrium, which is an important factor in maintaining normal intraocular pressure. If the dynamic balance of these three disorders is imbalanced, pathological intraocular pressure will occur. The normal intraocular pressure value of Chinese people is mostly between 1.33 and 2.79 kPa (10-20 mmHg), and the pathological phenomenon is more than 3.19 kPa (24 mmHg). The suspected pathological intraocular pressure is between 2.79 and 3.192 kPa (21-24 mmHg). . However, 4.55% of normal people have an intraocular pressure of more than 3.192 kPa (mean ± 3 standard deviations) without glaucoma. In other words, although the intraocular pressure of these people exceeds the upper limit of normal people, the optic nerve is not damaged. Therefore, it is not possible to simply use a numerical value as a criterion for dividing pathological intraocular pressure. It is appropriate to divide the intraocular pressure into normal, suspicious pathology and pathology. Range of pathological intraocular pressure: If any part of the aqueous channel is blocked, it will cause an increase in intraocular pressure. Normal people have slight fluctuations in intraocular pressure within 24 hours a day, generally the lowest in the evening. After nighttime rest, the intraocular pressure gradually rises to the highest in the morning before waking up, and then slowly declines after getting up, and the intraocular pressure fluctuation range does not exceed 0.665 kPa ( 5mmHg), the intraocular pressure of both eyes is also basically equal, or the difference is not big. If the 24-hour intraocular pressure difference exceeds 1.064 kPa (8 mmHg), the maximum intraocular pressure exceeds 2.793 kPa (21 mmHg) or the intraocular pressure difference is greater than 0.665 kPa (5 mmHg), it should be regarded as abnormal and further examination is required. High intraocular pressure and optic disc microcirculation disturbance are the main causes of glaucomatous optic disc depression and visual field damage. Although high intraocular pressure is an important factor in glaucoma damage, it is not absolute. In clinical practice, although some patients have exceeded the normal high limit of intraocular pressure, long-term observation does not cause optic disc and visual field damage, which is called ocular hypertension. There are also a small number of patients with intraocular pressure in the normal range or critical value, and the optic disc and visual field damage are already very obvious, this type of glaucoma. It is called low-tension glaucoma or low-critical glaucoma. Symptoms There are four main types of glaucoma: congenital glaucoma, primary glaucoma, secondary glaucoma, and mixed glaucoma. The clinical manifestations and characteristics of various types of glaucoma vary. Here, I will use Baidu Encyclopedia to explain the clinical symptoms of various glaucoma. I hope that everyone can have a deeper understanding of glaucoma and achieve early detection and early treatment. First, congenital glaucoma: according to the age of onset can be infantile glaucoma and adolescent glaucoma. Glaucoma under the age of 30 falls into this category. The reason for the formation of congenital glaucoma is that during the development of the embryo, the anterior chamber angle is abnormally developed, causing the drainage of the aqueous humor to be blocked, causing an increase in intraocular pressure. 25-80% of patients show up within half a year, and 90% of children can be diagnosed by the age of one. 10% of patients develop symptoms at the age of 1-6. 1. Infant glaucoma: Children with glaucoma from 0-3 years old are generally classified as such. This type is the most common in congenital glaucoma. The mother is sick, and symptoms appear immediately or slowly after birth. It is usually a binocular disease, but it does not necessarily start at the same time. There are also 25-30% of children with monocular disease. The clinical manifestation is that the eyeball is prominent after birth, which is quite similar to the cow's eye. It is called "bull's eye". It is afraid of light, tears, eyes, eyelids, corneal opacity, irritability, crying, poor diet or vomiting. Wait until the systemic symptoms. The key to the prognosis of this type is timely and correct diagnosis. Because the eye wall of children is in the development stage, the eye pressure is checked, it may be normal, and the fundus examination is not good, so there is a lack of glaucoma enrichment. 2. Adolescent glaucoma: The age of onset is between 3 and 30 years old. This type of clinical manifestations are similar to open-angle glaucoma, and the incidence is concealed and extremely harmful. In recent years, this type has occurred mostly in myopia patients and has a trend of increasing incidence. More than 90% of patients do not show typical glaucoma symptoms, but come to "myopia, visual fatigue, headache, insomnia", and even unconsciously blinded to see a doctor, detailed examination to know is glaucoma. Some patients have found glaucoma, but they mistakenly believe that I don't feel anything now, my vision is OK, it can't be as serious as the doctor said, I am really blind, then I regret it too late, I can only suffer in the dark. Have spent the rest of your life. Second, primary glaucoma: according to the shape of the anterior chamber anterior horn and rapid onset, divided into acute, chronic angle-closure glaucoma, open-angle glaucoma, etc.: 1. Acute angle-closure glaucoma: the occurrence of acute angle-closure glaucoma Because the room angle in the eye is suddenly narrowed or closed, the aqueous humor can not be discharged in time, causing the water to rise and the eye pressure to rise sharply. More common in middle-aged and older people, 90% of those over 40 years old. The incidence of women is higher, with a male to female ratio of 1:4. The situation is fierce, the symptoms are mild, the anterior chamber is narrow or completely closed, the sudden onset of intense eye swelling headache, sharp vision loss, eyeball hard as stone, conjunctival hyperemia, nausea and vomiting, constipation, blood pressure, at this time Systemic symptoms are more likely to be misdiagnosed as gastroenteritis, encephalitis, neuropathic headache and other diseases. If you do not get timely diagnosis and treatment for 24-48 hours, you can completely lose sight and have no light. At this time, it is called "violent glaucoma", but some patients in the clinic are less tolerant of pain, only manifested as eyelids and eye discomfort. The eye has no symptoms and is transferred to the forehead, ears, maxillary sinus, teeth and other pain. Acute angle-closure glaucoma is actually due to the repeated delay of chronic angle-closure glaucoma. 2. Chronic angle-closure glaucoma: This type accounts for more than 50% of patients with primary glaucoma. The age of onset is over 30 years old. In recent years, with the accelerated pace of life, social competition has become increasingly fierce, and mental workers have risen sharply. Trends, this type of seizures have obvious incentives, such as emotional agitation, visual fatigue, excessive use of the brain, long-term insomnia, habitual constipation, women during menstruation, or local or systemic medication, can be induced, expressed as an eye Department dry, fatigue discomfort, pain, blurred vision or decreased vision, rainbow vision, dizziness, insomnia, elevated blood pressure. After rest, it can be relieved. Some patients have blindness without any symptoms. When checking, the intraocular pressure can be normal or fluctuating, or not too high 20-30mmhg, and the fundus can be normal at an early stage. This type is most easily misdiagnosed. Such repeated episodes of anterior chamber angle can form fulminant glaucoma once the adhesion is closed (see: acute angle-closure glaucoma). There are four early symptoms: First, often feel eye fatigue and discomfort; Second, the eyes often sore, will relieve after rest; Third, blurred vision, myopia or presbyopia suddenly deepened; Fourth, the eyes often feel dry. 3. Primary open angle glaucoma: more than 40 people. 25% of patients have a family history. Most patients have no obvious symptoms, and some have no discomfort until the ground is blind. The anterior chamber angle is open at the time of the attack. This type of diagnosis is the most critical. At present, once the diagnosis of Western medicine has obvious fundus changes, it is necessary to comprehensively and conscientiously exclude every patient with glaucoma. Early diagnosis and early treatment should not wait until the diagnosis is glaucoma. The best treatment opportunity has been lost. Third, secondary glaucoma: glaucoma caused by eye and systemic diseases are of this type, the cause is quite complicated, a wide variety, only the most common types of secondary glaucoma are briefly described: 1. Refractive error (ie, myopia) , hyperopia) secondary glaucoma: due to refractive system adjustment disorders, ciliary muscle dysfunction, aqueous humor secretion, coupled with the iris root compression anterior chamber angle, aqueous drainage is blocked, so cause elevated intraocular pressure, such patients The clinical features are conscious fatigue symptoms or no obvious discomfort. Wearing glasses can not correct vision and is easily misdiagnosed. Therefore, patients with a history of refractive error should seek timely glaucoma-rich clinical experience if they have unexplained eye abnormalities. an examination. 2. Angle, conjunctiva, uveitis secondary to glaucoma: intraocular inflammation caused by aqueous humor, ciliary muscle, iris, corneal edema, shallow angle of the anterior chamber, or adhesion of the pupil, trabecular mesh obstruction, abnormal water discharge Increased intraocular pressure. At present, Western medicine generally treats the disease with antibiotics and hormones, and artificially interferes with the autoimmune function, causing the disease to recur and prolong the recovery. 3. Cataract secondary to glaucoma: crystal opacity in the development process, edema enlargement, or translocation leading to relatively narrow anterior chamber, blocked drainage of water, causing elevated intraocular pressure, once cataract surgery, rapid optic atrophy and blindness. 4. Traumatic glaucoma: tearing of the anterior chamber, detachment of the iris root, or anterior chamber hemorrhage, vitreous hemorrhage, retinal shock, so that the secretion of the aqueous humor, the discharge pathway is blocked, and the glaucoma optic nerve atrophy is followed. Surgery can only repair the damaged intraocular tissue, but the fundus damage caused by it can not be corrected. Therefore, this type of patient is generally treated by Western medicine at that time, and it is considered to be good. It is no longer treated. Once the optic nerve atrophy is found, it is serious. Vision damage. 4. Mixed glaucoma: Two or more primary glaucoma exist at the same time, and the clinical symptoms are the same as those of the various types. Diagnosis of chronic simple glaucoma, if it can be diagnosed early, is extremely important for the protection of visual function. The following points are helpful for early detection and early diagnosis: Family history: Family members have a history of glaucoma, and they are conscious of headache, eye swelling, visual fatigue, especially those with presbyopia, or elderly people who frequently change glasses. Timely to the eye examination and regular review. Check the intraocular pressure: In the early stage of glaucoma, the intraocular pressure is often unstable, and the intraocular pressure rises only a few hours in a day. Therefore, measuring the 24-hour intraocular pressure curve is helpful for diagnosis. Fundus changes: Increased optic disc depression is one of the common signs of glaucoma. There is no obvious change in the early optic disc. As the disease progresses, the physiological depression of the optic disc gradually enlarges and deepens, and finally reaches the edge to form a typical glaucoma cup-shaped depression. Retinal nerve fiber layer damage in the vicinity of the optic disc is the basis of visual field defects, which occurs before the optic disc or visual field changes. Therefore, it can be used as one of the early diagnostic indicators of open angle glaucoma. Vision: Vision is an important test for the diagnosis of open-angle glaucoma. Open-angle glaucoma occurs when there is a pathological change in the optic disc. For glaucoma, it is best to use medication first. If you can't control intraocular pressure under the maximum dose, you can consider surgery. You should first use a low concentration of the drug solution, then use a high concentration of drug droplets, and according to the effective antihypertensive effect time of different drugs, determine the number of times of drug per day, the most important thing is to ensure that it can remain effective within 24 hours. Dosage, apply eye ointment before going to bed. Follow-up after open-angle glaucoma treatment is also very important. Even if the intraocular pressure has been controlled, it should be reviewed every 4 to 6 weeks, including intraocular pressure, fundus and vision. The visual field should be checked once a year to ensure the continuity and stability of the treatment. Sex. In acute exacerbation of acute angle-closure glaucoma, accompanied by severe headache, nausea, vomiting, etc., sometimes overlooking the eye symptoms, and misdiagnosed as acute gastroenteritis or nervous system diseases. The acute episode is easily confused with acute iridocyclitis or acute conjunctivitis and needs to be identified. complication Read more...