Primary glaucoma in adults usually occurs after age 40. The diagnosis of glaucoma set in the measurement of intraocular pressure. To investigate the intraocular pressure may be at palpation of the eyeball, and you can suspect the increase or decrease in intraocular pressure. For the objective measurement of intraocular pressure using special ustoroystva tonometers.
There are two ways to measure intraocular pressure: applanatsiya (flattening), and the crushing burden on the cornea with a broad platform Impression (indentation) - in the sclera pin is pushed under a certain pressure.
In Russia, for the measurement of intraocular pressure method and Maklakov tonometer Maklakov. Maklakov tonometer is a hollow cylinder. Inside the cylinder is a piece of lead, which can move freely. At the ends of the tonometer attached to a smooth polished ground glass plate with a diameter of 1 cm Before examining these areas should be wiped with alcohol, then they smeared a layer of special ink.
To measure the pressure in the eye instilled local anesthetic solution (dicaine), twice with an interval of 1 min. The patient is on a couch, lying down, face up. He must raise his arm up and look at the index finger. Shall ensure that the cornea was positioned horizontally. Eyelids are pushing the patient. Tonometer is lowered vertically to the center of the cornea, the holder is impaired. Under the influence of load, the sphericity of normal cornea, bends and flattens. Paint with moves from the area of cargo on the cornea, the site of contact with the cornea of the goods.
The lower the intraocular pressure, the greater the cornea flattens and the greater the contact area of cargo with the cornea, which means more ink is transferred from the cargo on the cornea, and after the imprinting of cargo on a sheet of paper is a thin strip of color, and vice versa.
The smaller the cornea flattens, less contact with the cornea of the goods, less paint goes on the cornea and in the print load paper with a higher intraocular pressure have greater impression. Tonometer flip the other side and measured intraocular pressure again. Then measure the pressure in the other eye.
After this, hold the prints on paper pads tonometer and in accordance with the scale, carried out the calculation of intraocular pressure.
A single detection of increased intraocular pressure can not yet be cause for the diagnosis of glaucoma, as the transient increase in intraocular pressure may be accidental, in the excessive consumption of water, etc. If you suspect that glaucoma is carried out daily measurement of intraocular pressure 4-5 times a day for a week.
If you find repeatedly elevated intraocular pressure is carried out further examination of the patient. Form of glaucoma is established by Gonioscopy.
Gonioscopy - a method of inspection of the angle of the anterior chamber with gonoskopa, a special instrument with a system of mirrors. With open-angle glaucoma can be seen all the anterior chamber angle, and angle-closure at the root of the iris is covered.
Allocate preglaucoma and four-stage course of glaucoma.
Preglaukomoy is a condition in which reduced rates of intraocular fluid, but no complaints and the intraocular pressure remains within normal limits. This condition requires constant monitoring by an ophthalmologist.
Four stages of the flow of glaucoma:
The initial stage of glaucoma. At this stage, the observed increase in intraocular pressure may be the only symptom. The patient may not be complaints or recurrent pains in his eyes mist.
The advanced stage of glaucoma. There narrowing of visual fields with the nasal side, arcuate scotoma Bjerrum. The patient complains of pain in his eyes mist before his eyes, headaches, colored circles before my eyes.
In advanced stages of glaucoma. Field of vision narrowed to 15 degrees. There is a glaucomatous optic disc atrophy. With increased intraocular pressure is a violation of the blood supply to the optic nerve fails him food. The optic disc becomes pale and flattened. For the occurrence of optic atrophy usually takes several years. But if the numbers are high intraocular pressure, the patient receives no treatment optic atrophy can develop very quickly.
End-stage glaucoma. The function of sharply reduced to light perception (the patient distinguish only light and dark), or lost altogether (blindness).
Treatment of primary glaucoma in adults.
The goal of treatment to preserve visual function as long as possible. Without treatment, vision can be lost very quickly. To preserve the visual functions necessary to keep the intraocular pressure within normal limits. To do this, prescribers reduce intraocular pressure.
This drug narrowing pupil and improve outflow of intraocular fluid miotikami two groups:
drugs blocking the beta-adrenergic receptors (timolol, arutimol, optimol).
Applied drugs that reduce the production of intraocular fluid and improve its flight:
adrenaline
Clonidine
Phethanolum
prostaglandins (latanoprost, uniproston).
To fight the progression of degenerative processes in the structures of the eyeball are assigned courses antidistroficheskogo treatment 2 times a year. The patient is contraindicated in night work, in conditions of high temperatures, prolonged stay in position with bowed head. It is recommended to reduce the number of one-time intake of fluid.
In the absence of or insufficient effect of conservative therapy is applied laser surgical methods. Various reconstructive operations - filtering operation - trabekulotomiya and sinusotomy, diathermocoagulation or laser coagulation of the ciliary body, viskokanakulostomii. Glaucoma patients should be under constant surveillance by an ophthalmologist.
