Glaucoma is a difficult disease in ophthalmology, and there are many types of glaucoma, including acute and chronic, among which acute congestive glaucoma is more common in women. It is a common disease that endangers visual function greatly. This disease must be treated urgently and surgery is preferable.
Types of disease
There are four main types of glaucoma: congenital glaucoma, primary glaucoma, secondary glaucoma, and mixed glaucoma. The clinical manifestations and characteristics of each type of glaucoma are different. We would like to take advantage of Baidu.com to explain the clinical symptoms of various types of glaucoma. We hope that everyone can have a better understanding of glaucoma and achieve early detection and treatment.
1, congenital glaucoma: according to the age of onset, it can be infantile glaucoma and juvenile glaucoma. 30 years old or younger belong to this category. The reason for the formation of congenital glaucoma is the abnormal development of the anterior chamber angle during embryonic development, resulting in the obstruction of atrial aqueous drainage, causing an increase in intraocular pressure. 25-80% of patients show up within six months, and 90% of children can be diagnosed by the age of one year. 10% of patients develop symptoms at the age of one to six years.
(1) Infantile glaucoma: Children aged 0-3 years with glaucoma are generally classified in this category. This type is the most common form of congenital glaucoma. The disease is present in the mother, and symptoms appear immediately or slowly after birth. The lesions are usually bilateral, but not always simultaneous, and 25-30% of children have monocular disease. The clinical manifestations are protrusion of the eyeballs after birth, resembling the eyes of a cow, fear of light, lacrimation, rubbing of the eyes, eyelid spasms, cloudy cornea, agitation and crying, poor diet or vomiting, sweating and other systemic symptoms. The key to the prognosis of this type is timely and correct diagnosis, because the eye wall of children is in the developmental stage, the intraocular pressure may be normal, and the fundus examination is not good, so there is a lack of glaucoma-rich book.
(2) Juvenile glaucoma: The age of onset is between 3 and 30 years old. The clinical manifestations of this type are similar to those of open-angle glaucoma, with insidious onset and great danger. More than 90% of patients do not show typical glaucoma symptoms, but come to the clinic with “myopia, visual fatigue, headache, insomnia”, or even unconscious blindness, and only after detailed examination do they know it is glaucoma. Some patients find out glaucoma, but they mistakenly think, “I don’t feel anything now, and my vision is fine, so it can’t be as serious as the doctor said, but when they really lose their eyesight, it’s too late to regret, and they can only spend their life in darkness and pain.
2, primary glaucoma: according to the morphology of the anterior chamber anterior angle and the onset of urgency, it is divided into acute and chronic closed-angle glaucoma, open-angle glaucoma, etc.
(1) Acute closed-angle glaucoma: Acute closed-angle glaucoma occurs when the atrial angle in the eye is suddenly narrowed or closed, and the atrial fluid cannot be discharged in time, causing the atrial fluid to fill up and the intraocular pressure to rise sharply. It mostly occurs in middle-aged and elderly people, accounting for 90% of those over 40 years old. The incidence is higher in women, with a male to female ratio of 1:4. The onset of the disease is fierce, the symptoms are mild and dramatic, and the anterior chamber is narrowed or completely closed at the onset, showing sudden onset of severe eye swelling and headache, sharp loss of vision, hard eyes like stones, conjunctival congestion, nausea and vomiting, constipation, elevated blood pressure, and the systemic symptoms are easily misdiagnosed as gastroenteritis, encephalitis, neurological headache and other pathologies. If not treated in time, the patient can be completely blind and lightless in 24-48 hours, which is called “fulminant glaucoma”, but clinically, some patients have strong pain tolerance, only orbital and ocular discomfort, or even no symptoms in the eye, but the pain is transferred to the forehead, ear, maxillary sinus, teeth, etc. Acute closed-angle glaucoma is actually the result of repeated extension of chronic closed-angle glaucoma.
(2) chronic closed-angle glaucoma: this type accounts for more than 50% of primary glaucoma patients, the age of onset of more than 30 years old, in recent years, with the pace of life continues to accelerate, social competition is increasingly fierce, the trend of a sharp increase in brain workers, this type of attack generally have obvious triggers, such as emotional excitement, visual fatigue, eye and brain overuse, long-term insomnia, habitual constipation, women in menstruation, or local, systemic medication, can be a cause of the pain. This type of attack can be triggered by emotional excitement, visual fatigue, overuse of the eyes and brain, chronic insomnia, constipation, women during menstruation, or improper local or systemic medication. Some patients can be relieved after rest, some patients without any symptoms that blindness, examination, intraocular pressure can be normal or fluctuate, or not too high about 20-30mmhg, the fundus early can be normal, this type is most likely to be misdiagnosed. This type is most likely to be misdiagnosed. Such repeated attacks of anterior chamber angle can form fulminant glaucoma once the adhesions are closed.
There are four kinds of early symptoms
1. Frequent eye fatigue and discomfort;
2. The eyes are often sore and swollen, which will be relieved after rest;
3, blurred vision, myopia or presbyopia suddenly deepen;
4.The eyes often feel dry.
(3) Primary open-angle glaucoma: mostly occurs in people over 40. 25% of patients have a family history. The vast majority of patients have no obvious symptoms, and some have no discomfort even when they are blind. The anterior chamber angle is open at the onset. The diagnosis of this type is the most critical, once the western medical diagnosis has been confirmed have obvious fundus changes, so we must fully and carefully exclude every patient with the first signs of glaucoma, early diagnosis, early treatment, do not wait until the diagnosis of glaucoma before treatment, then the best time to treat has been lost.
3, secondary glaucoma: glaucoma caused by ocular and systemic diseases are all in this category, the cause is quite complex, a wide variety, now only briefly described the most common secondary glaucoma: (1) refractive error (refractive error), (2) refractive error (refractive error), (3) refractive error (refractive error), (4) refractive error (refractive error).
(1) refractive error (i.e. myopia, hyperopia) secondary glaucoma: due to refractive system derangement, ciliary muscle dysfunction, atrial aqueous secretion is not constant, coupled with the iris root compression of the anterior chamber angle, atrial aqueous drainage is obstructed, so causing an increase in intraocular pressure, the clinical characteristics of such patients is the symptoms of self-conscious visual fatigue or no obvious discomfort, wearing glasses can not correct vision, easy to misdiagnosis, so patients with a history of refractive error once the appearance of If patients with a history of refractive error have unexplained eye abnormalities, they should promptly seek a doctor with extensive clinical experience in glaucoma for detailed examination.
(2) Glaucoma secondary to angular, conjunctival and uveitis: Intraocular inflammation causes clouding of the atrial fluid, edema of the ciliary muscle, iris and cornea, shallowing of the atrial angle, or pupillary adhesions and obstruction of the trabecular meshwork, which prevents normal drainage of the atrial fluid and causes an increase in intraocular pressure. At present, Western medicine generally treats this disease with antibiotics and hormones symptomatically, which artificially interferes with the autoimmune function, making the disease recurrent and difficult to heal.
(3) Cataract secondary glaucoma: During the development of crystal clouding, the edema expands, or translocation leads to relative narrowing of the anterior chamber, and the atrial aqueous discharge is obstructed, causing the IOP to rise, and once the cataract is operated, soon the optic nerve atrophies and blindness.
4, traumatic glaucoma: atrial angle tear, iris root break, or anterior chamber blood, vitreous blood, retinal shock, so that atrial water secretion, discharge pathway is blocked secondary to glaucoma optic nerve atrophy, such as positive Chinese medicine treatment prognosis is good, surgery can only repair the damaged intraocular tissue, but the damage caused by the fundus can not be corrected, so this type of patients are generally treated by Western medicine at the time, think it’s okay, no longer Treatment, once found to have optic nerve atrophy, resulting in serious visual impairment.
The early manifestations of glaucoma are
1. Elevated intraocular pressure
When the IOP rises to 25-40 mmHg, the eye is as hard as a pumped-up ball when touched with a finger. When the pressure rises to 40-70 mm Hg, the eye is as hard as a stone when pressed with the finger.
2. Narrowing of visual field and reduced vision
Due to high intraocular pressure, the optic nerve is damaged, and vision loss and foggy vision appear at night in the early stage and disappear the next morning.
3.Headache and eye swelling
Due to the rapid rise of intraocular pressure, the end of the trigeminal nerve is stimulated, reflexively causing pain in the distribution area of the trigeminal nerve, and patients often feel migraine and eye distension.
4. Nausea and vomiting
Increased intraocular pressure can also reflexively cause excitation of the vagus nerve and the vomiting nerve center, resulting in severe nausea and vomiting.
5.Rainbow vision
Due to the elevated intraocular pressure, the corneal edema and refractive changes are caused by the impaired circulation of body fluids in the eye, and when looking at daylight, especially when looking at lights, the phenomenon of orange-red outer circle, violet inner circle, and green colored ring in the middle will appear. When the eye pressure returns to normal, the ring disappears. This phenomenon is medically known as iridopsia. In the case of physiological or cataractous iridopsia, there are no headaches or elevated intraocular pressure.
Glaucoma is common in middle-aged and older adults, especially in women, and most of the causes are psychologically related, such as significant mental stimulation, excitement, insomnia, and overexertion.
In addition, glaucoma in some patients is associated with genetic factors, so people with a family history of glaucoma should be more alert to the occurrence of the disease. Some patients with glaucoma may show no early signs until they have a small field of vision and difficulty moving, which is often difficult to treat. However, most people will have some of these symptoms in the early stages of the disease, so patients should be aware of them and seek early treatment.
The following four groups of people are most likely to get glaucoma.
1. People who have relatives with glaucoma in their family. Due to genetic factors, the chances of glaucoma are about 10 times higher in these people than in others.
2. People with nearsightedness and farsightedness.
3, Patients with endocrine diseases such as diabetes and thyroid disease.
4, people with high work pressure, irregular life, easy to lose temper, and high daily mood swings. Because, mental factors are also a major cause of glaucoma.