Auntie Liu from the street office was told by her doctor that she had cataracts in both eyes during a medical checkup five years ago. At that time, she thought she could read the newspaper without any problem, and her friends around her told her that she should have surgery only when she could not see, so she did not pay attention to it. One day ago, she suddenly experienced severe swelling and pain in her right eye, vision loss, redness in her eyes, headache, nausea and vomiting, and immediately came to the hospital.
Cataracts are manifested as clouding of the lens. The lens is like the lens of a camera, when it transmits light to take a picture. If the lens is cloudy and blocks light from entering the eye, the patient will experience blurred vision.
Glaucoma is a very serious type of blinding eye disease, usually characterized by high eye pressure, vision loss, and visual field defects. Acute attacks are accompanied by severe eye pain, headaches and even nausea and vomiting. The eye is somewhat like a balloon filled with water and has a certain amount of pressure. Unlike a balloon, the water inside it (called atrial fluid) is in constant circulation, constantly producing and discharging, maintaining a dynamic balance. As shown in Figure A below, atrial water is produced by the ciliary body, passes forward through the gap between the iris and the lens, reaches the open atrial angle (the angle formed by the iris and cornea), and is discharged from the trabecular meshwork, thus maintaining a stable pressure inside the eye week after week.
Diagram of atrial fluid circulation During the formation and development of cataract, the lens continuously absorbs water and expands in size, pushing the iris forward. When the angle between the iris and the cornea, a structure we call the atrial angle, is squeezed to a certain degree, atrial fluid discharge will be blocked and a sudden increase in intraocular pressure will occur, i.e., an acute attack of glaucoma (shown in Figure B on the right side of the above figure). The patient will then experience the symptoms described above for Aunt Liu: eye distention, vision loss, eye redness, headache, nausea and vomiting. This is medically diagnosed as: age-related cataract expansion stage, secondary to angle-closure glaucoma.
This condition requires emergency treatment and the patient should seek urgent medical attention. Medications are first used to lower the intraocular pressure and open the atrial angle as much as possible. If seen in a timely manner, the symptoms of high IOP can be relieved in most patients. However, the cause of glaucoma is still not removed, and if not treated properly, it can recur and cause irreversible damage to the eye. The most effective way is to perform cataract surgery to remove the cloudy and swollen lens from the eye and replace it with a thin artificial lens to eliminate the possibility of its occurrence at the source.
After the pressure in her right eye was controlled, she underwent cataract surgery, which restored her vision and reduced her pain. Subsequently, on the advice of her doctor, she also underwent cataract surgery on her left eye, eliminating the possibility of glaucoma attacks.
There is another kind of cataract-induced glaucoma. Cataracts go through the incipient, swelling and mature stages, and if they are not treated with surgery in time for various reasons, cataracts develop into the “overripe stage”, when the lens dissolves and the particles inside enter the atrial water and flow down to the trabecular network, blocking the trabecular network and causing glaucoma. Glaucoma.
This is what happened to an 85-year-old man who was seen a while ago. He had been unable to see out of his left eye for 10 years, so he relied on his right eye, which could still see, in order not to cause trouble for his children. The cataract was too old and he developed glaucoma, along with the symptoms of uveitis. In short, not only can you not see, but you are also in pain and suffering. This condition is medically diagnosed as age-related cataract overmaturity, lens dissolving glaucoma, and lens cortical allergic uveitis. The only way to resolve such problems is surgery. After surgery, the old man’s pain was relieved, but his vision was not restored satisfactorily.
What was originally a simple cataract, because of the secondary glaucoma, not only caused the patient’s pain, but more regrettably, due to the secondary damage caused by the glaucoma attack, the patient’s surgical results were also greatly reduced, and for those who seriously delayed the treatment, they could even only solve the pain but could not restore the dimming vision, which was a saddening result. It also makes the surgery more difficult, risky and costly.
From the above two cases, we have learned one thing: don’t wait until you can’t see before going to the doctor when you have cataract, that is, don’t wait until maturity to have surgery for cataract, let alone not treating it even after it has matured.