Glaucoma is a common eye disease that causes damage to the optic nerve and visual impairment in the affected eye due to an increase in intraocular pressure above normal levels, of which closed-angle glaucoma, which occurs in elderly women between the ages of 50 and 70, is one of the major blinding eye diseases among the elderly in China. The acute onset of the disease is fierce and, if left untreated, will lead to a dramatic loss of vision and even blindness. Therefore, elderly people should be alert to the occurrence of closed-angle glaucoma.
There are two clinical types of closed-angle glaucoma: acute and chronic. Acute closed-angle glaucoma is a serious blinding eye disease with rapid onset and is an ophthalmic emergency. Clinical manifestations are characterized by head and eye distension, nausea and vomiting, sudden loss of vision or iridescence (seven-colored rainbow-like bands of light visible around a lamp-like luminous object), and a sharp increase in intraocular pressure and rigidly dilated pupils. It is often triggered by mood swings, fatigue, sudden climatic changes and prolonged stay in dark environments.
Clinical manifestations: acute angle-closure glaucoma is clinically divided into five phases.
1, preclinical: because closed-angle glaucoma has genetic characteristics and is a bilateral disease, so where an acute attack is diagnosed in one eye, or where there is a family history of closed-angle glaucoma, the other eye or the healthy eye can be diagnosed as preclinical even without any symptoms. The preclinical stage does not always turn into glaucoma, but it can develop at any time if there are triggers present.
2, prodromal phase: refers to a period of disease before the acute attack of acute closed-angle glaucoma, manifested as a transient or repeated small attacks, the attack mostly occurs in the evening, sudden foggy vision (as if there is a fog in front of the eyes or as if looking through the hairy glass), rainbow vision, may be accompanied by the affected side of the frontal pain and nasal root soreness. IOP is often above 40 mmHg at the time of attack. The above symptoms last for a short period of time and resolve or disappear on their own after rest, so they are often mistaken for a general fatigue headache or cold and are not taken seriously. In fact, if the diagnosis can be confirmed at this time, the treatment effect is the best, and more than leave no permanent damage.
3.Acute attack period: It is characterized by severe headache, eye pain, photophobia, lacrimation, eye redness, serious loss of vision or even loss of vision, and often accompanied by nausea, vomiting and other systemic symptoms. Sometimes, the symptoms of headache, nausea and vomiting are more obvious than the eye symptoms, leading to misdiagnosis and wrong admission to neurology or gastroenterology, which delays the treatment and prevents patients from relieving their pain in time. The eye pressure is more than 50 mmHg. After the high eye pressure is relieved, the symptoms are reduced or disappear, and the vision can often be partially improved, but permanent eye tissue damage is often left in the anterior segment. This period is an ophthalmic emergency, need to be sent to the hospital in time to actively rescue, can not be delayed, because sometimes an acute attack, can lead to irreversible blindness.
4, intermittent period: refers to the small attack after the self-remission, or acute attack after drug treatment or self-remission, clinical symptoms disappeared, IOP returned to normal. The length of the intermittent period varies, and after a period of time, there will be another acute attack. In this period, no medication is needed or only a small amount of pupil constrictor alone is needed to stabilize IOP to normal level.
5. Chronic phase: After acute grand mal or repeated petit mal attacks, the eye tissue structure is severely damaged and various clinical manifestations still exist, but they are much milder than in acute attacks and need to be maintained by medication; once the medication is stopped, the symptoms will worsen again. The chronic phase mostly evolves from acute attacks.
6. Absolute stage: late stage, vision completely disappears. At this time, due to the long-term high intraocular pressure, the patient has adapted to, in addition to blindness, often no other clinical symptoms, there is no hope of treatment.
Treatment methods.
1. Drug treatment.
(1) Pupil constrictor: 1% to 2% of maurobranchedrine (Zhenrui, pilocarpine) eye drops. In the case of small seizures during the aura period, the eye drops should be given once every half hour, and after 2 to 3 times, the pupil can generally be narrowed, the anterior chamber angle opened, and the intraocular pressure reduced. In acute grand mal seizures, 1 drop every 5 minutes, 4 drops, then 1 drop every 30 minutes, 4 drops, then 1 drop every hour, if the pupillary sphincter is not damaged, the pupil can be reduced. Each drop should be compressed for several minutes in the lacrimal sac to avoid systemic toxic symptoms caused by the absorption of the drug through the nasal mucosa after it flows into the nasal cavity.
(2) Carbonic anhydrase inhibitors: can reduce atrial fluid production to reduce intraocular pressure, commonly used acetazolamide (acetazolamide) oral, 2-3 times a day, each time 0.125g, the first dose doubled. Long-term use may lead to side effects such as numbness of the mouth, lips, face and toes, general discomfort, renal colic, hematuria, etc. Therefore, long-term use is not recommended.
(3) β-adrenergic receptor blockers: The main function is to inhibit atrial aqueous production and thus reduce intraocular pressure, commonly used 0.25% to 0.5% timolol (timolol) eye drops or betaxolol hydrochloride (Betaser, Betagen) eye drops or carteolol (Mechelon) eye drops, twice a day. These drugs mostly do not affect pupil size and eye regulation, but the effect of lowering intraocular pressure is limited, and the effect diminishes after long-term application. Timolol eye drops are contraindicated in patients with bronchial asthma, atrioventricular block, and sinus node insufficiency, while betaxolol eye drops can be used in patients with a history of bronchospasm.
(4) Adrenergic agonists: The main effect is to promote atrial fluid discharge, commonly used are 0.2% brimonidine tartrate (Alfagen) eye drops, which does not cause pupil dilation and has no significant effect on cardiopulmonary function.
(5) Hypertonic dehydrating agents: Hypertonic agents are mainly used to reduce intraocular pressure by reducing intraocular volume, commonly used 50% glycerol and 20% mannitol. The former is for oral administration, 2-3 ml/kg body weight, and the latter is for rapid intravenous infusion, 1-1.5 g/kg body weight. Individual patients may have side effects such as headache and nausea, mostly caused by the reduction of intracranial pressure.
(6) prostaglandin preparations: mainly to increase the atrial fluid discharge, commonly used 0.005% Latanoprost (Siliquant), Travoprost (Suvoprost), Bimatoprost (Lumigan), etc. The main side effects of these drugs are local transient burning sensation, tingling, itching and conjunctival congestion, long-term use of drugs can increase the iris pigment, eyelashes become longer and thicker, etc. The drugs are antagonistic to the brassinosteroids, and they should not be used in combination.
(7) Sedatives: For those with severe eye pain and irritability, appropriate amount of sedative can be applied, commonly used luminal sodium 0.1g intramuscular injection, or luminal 0.03-0.06g orally, contraindicated the use of Valium, because Valium can make the intraocular pressure rise.
2.Surgical treatment.
If the atrial angle is largely open and the extent of adhesions is less than l/3 of a week, peripheral iridectomy or laser iridotomy can be performed. If the atrial angle has extensive adhesions, apply filtration surgery, usually by cautery filtration, scleral occlusion, trabeculectomy, etc.
Prevention and home care.
(1) Avoid reading in poorly lit areas or working in a dark environment. Because working in a dark environment, the pupil is dilated, which affects the drainage of atrial fluid in the eye, thus causing an increase in intraocular pressure and causing or aggravating the disease.
(2) Avoid great sadness and anger: when you are very sad and angry, your blood pressure will rise, which will cause or aggravate the disease.
(3) Avoid atropine and other drugs: Some drugs, such as atropine, 654-2, belladonna, etc. have the effect of spreading the pupil and raising the intraocular pressure, so they are contraindicated for patients with glaucoma.
(4) In the event of an attack, you can immediately apply 1% to 2% of maurozanthine (Zhenrui, Pirocarpine) eye drops, using the same method as described above. But at the same time, you should go to the hospital as soon as possible.