Glaucoma is a disease that causes damage to the optic nerve. The optic nerve is made up of many nerve fibers, and when intraocular pressure increases, it can cause damage to the nerve fibers, resulting in visual field defects. Early mild visual field defects are often difficult to detect, but if the optic nerve is severely damaged, it can lead to blindness. Early examination, diagnosis and treatment of glaucoma is the key to prevent optic nerve damage and blindness.
The anterior chamber of glaucoma DD is the space behind the cornea and before the iris and pupil, while the posterior chamber is behind the iris and pupil and before the lens. The anterior and posterior chamber are filled with a clear fluid that we call atrial fluid. Atrial fluid is constantly circulating in the anterior and posterior chambers and is constantly being produced and expelled to keep the intraocular pressure at a stable level.
The eye is a closed structure, if the atrial water discharge channel an atrial angle is blocked, the atrial water discharge is obstructed and the intraocular pressure rises, causing too much pressure in the wall of the eye, then it leads to optic nerve damage.
Glaucoma symptoms
The etiology and pathogenesis of glaucoma are very complex, so its clinical manifestations are also various.
1. Acute closed-angle type
The onset of the disease is rapid, showing the typical symptoms of severe pain in the head on the side of the affected eye, eye congestion and sudden loss of vision. The pain radiates along the trigeminal nerve distribution area around the orbit, sinuses, ear roots, teeth, etc.; the intraocular pressure rises rapidly, the eye is hard, often causing nausea, vomiting, sweating, etc.; the patient sees a colored halo around the incandescent light or like a rainbow after the rain, that is, the iris phenomenon.
2.Subacute angle closure type (including subclinical phase, prodromal phase and intermittent phase)
Patients have only mild discomfort, or even no symptoms, may have decreased vision, light eye congestion, often in the evening onset, relieved by sleep. If not treated in time, the interval between attacks will be shortened, the duration of each attack will be prolonged, and the attack will become acute or chronic.
3. Chronic closed-angle type
There are no obvious conscious symptoms, mild eye swelling, headache, difficulty in reading, and often iris vision. The attack can be relieved after the patient goes to a bright place or sleeps, and all symptoms disappear. This type of glaucoma has recurrent small attacks with long intervals between early attacks and short duration of symptoms, and after many attacks, the interval between attacks is shortened and the duration is prolonged. If improperly treated, the condition will gradually progress, with late visual acuity loss and severe visual field defects.
4.Primary open angle type
Open angle glaucoma
When the lesion develops to a certain degree, mild eye distention, visual fatigue and headache may appear, and vision is generally unaffected, while the visual field gradually shrinks. In the late stage, when the visual field shrinks to a tubular shape, mobility problems and night blindness appear. Some advanced cases may have blurred vision and iridescence. Therefore, early diagnosis of primary open-angle glaucoma is very important, and relevant investigations are emphasized in suspected cases.
Congenital glaucoma usually presents clinically in young children or in adolescents. If it develops before the age of 3 years, it may present with shyness, tearing, blepharospasm and large corneas; if it develops after the age of 3 years, it may present as juvenile progressive myopia.
Classification of glaucoma
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.
Congenital
Depending on the age of onset, there are two types of glaucoma: infantile glaucoma and juvenile glaucoma; all glaucoma under the age of 30 falls into this category. The cause 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 are diagnosed by the age of one year. 10% of patients develop symptoms at the age of one to six years.
1. Infantile glaucoma: Children with glaucoma aged 0-3 years are generally classified as this type. This type is the most common type of congenital glaucoma. The disease is present in the mother and symptoms appear immediately or slowly after birth. The lesion is 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 lies in the timely and correct diagnosis, because the pediatric eye wall is in the developmental stage, check the intraocular pressure, may be normal, and fundus examination is not good with, so the lack of glaucoma rich ornamental book.
2, adolescent glaucoma: the age of onset 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 are found to have 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 will be too late to regret, and they can only spend their life in darkness and pain.
Primary
According to the morphology of the anterior chamber anterior angle and the urgency of the onset, 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 suddenly narrows or closes, and the atrial fluid cannot be discharged in time, causing the atrial fluid to rise 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, neuropathic headache and other lesions. If not treated in time, 24-48 hours can be completely blind and lightless, 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, and the pain is transferred to the forehead, ear, maxillary sinus, teeth and other parts. Acute closed-angle glaucoma is actually due to the repeated extension of chronic closed-angle glaucoma.
2, chronic closed-angle glaucoma: this type accounts for more than 50% of primary glaucoma patients, the onset of age 30 years or older, in recent years, with the increasing pace of life, social competition is increasingly fierce, brain workers have a sharp increase in the trend, this type of attack generally have obvious causes, 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. This type of attack can be triggered by emotional excitement, visual fatigue, excessive use of the eyes and brain, chronic insomnia, constipation, women during menstruation, or improper use of 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. Once the anterior chamber angle is closed by adhesions in such repeated attacks, fulminant glaucoma can be formed.
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 until the ground is blind. The anterior chamber angle is open at the onset. The diagnosis of this type is the most critical, once the diagnosis is confirmed by Western medicine, there are already 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, by then the best time for treatment has been lost.
Secondary
Glaucoma caused by ocular and systemic diseases are all in this category, the cause is quite complex and there are many different kinds, now only briefly describe the most common secondary glaucoma: 1.
1, refractive error (i.e. myopia, farsightedness) 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 blocked, so caused by increased 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 there is an unexplained eye abnormality, you should find a doctor with rich clinical experience in glaucoma and have a detailed examination.
2, Angle, conjunctiva, uveitis secondary glaucoma: intraocular inflammation caused by atrial clouding, ciliary muscle, iris, corneal edema, shallow atrial angle, or pupil adhesion, trabecular network obstruction, atrial aqueous can not be normal drainage caused by the IOP rise. At present, western medicine generally treats this disease with antibiotics and hormones symptomatically, which artificially interferes with the autoimmune function and makes the disease recurrent and difficult to heal.
3, cataract secondary glaucoma: crystal clouding in the process of development, edema expansion, or translocation resulting in anterior chamber relative narrowing, atrial aqueous discharge obstruction, causing IOP elevation, once the cataract surgery, soon optic nerve atrophy 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 its cause of fundus damage can not be corrected, so this type of patients are generally treated by Western medicine at the time, think it is well, no longer treatment.
Neovascular glaucoma
Once found, the optic nerve atrophy has been detected, causing serious visual impairment.
Mixed type
Two or more types of primary glaucoma co-exist, and the clinical symptoms are the same as each combined type.
Due to vitreous and retinal detachment surgery
Glaucoma due to vitreous and retinal detachment surgery can occur on the first day after surgery, mostly as acute IOP elevation, but can also occur more than six months after surgery, manifesting as insidious or chronic IOP elevation.