For the diagnosis of glaucoma there are three conditions: intraocular pressure, visual field, and fundus.
1. IOP: It is difficult to simply use a value as a criterion to classify normal and abnormal (or pathological) IOP. It should be divided into only three ranges: normal physiological, suspected pathological and pathological is more reasonable. Normal values are just average statistics for most people. An IOP value is pathologic for A, but physiologic for B. A person with an IOP over 21 mmHg, a 24-hour IOP difference greater than 8 mmHg in the same eye, and a difference in pressure between the two eyes greater than 5 mmHg can be considered suspicious. Regular observation of IOP, visual field, fundus, etc. is then required.
It is important to note that the most important pathogenesis of glaucoma is the decrease in the difference between blood pressure and intraocular pressure, which results in insufficient intraocular blood perfusion and consequently glaucomatous damage.
Normal IOP fluctuations of 2-3 mmHg are closely related to fluctuations in blood pressure. Fluctuations in intraorbital pressure are also correlated with
Blood pressure fluctuations.
(1) temporally: human blood pressure is commonly high in the morning and low in the evening, with specific fluctuation times and fluctuation ranges varying from person to person.
(2) Position: in the standing position (systolic blood pressure is slightly lower, diastolic blood pressure is slightly higher);
(3) Exercise: blood pressure is slightly lower at rest and significantly higher after activity;
(4) Sleep: blood pressure is lowest when asleep and slightly higher when awake;
(5)Emotionally: blood pressure is low when in a good mood, when emotionally stable and mentally relaxed, and increases when emotionally volatile.
2, visual field: narrowing, nasal side step visual field damage, bowed dark spot ;
3, fundus: increased cup-to-disc ratio, late becoming pale, sharp edges; thinning of the optic nerve fiber layer on the superior and inferior temporal side (especially below) around the optic disc on OCT.
In addition to the above three conditions, before making a diagnosis of glaucoma, the following issues must first be clarified to clarify the type of glaucoma (because the treatment response is different for different types of glaucoma).
1, whether there is a history of eye trauma
2.History of frequent eye inflammation
3, whether there is a family history
4, the onset of the disease with or without eye redness, eye swelling, blurred vision, rainbow vision, headache, nausea and vomiting, afterglow (visual field) narrowing, etc.
5.The depth of the anterior chamber
6.The condition of the atrial angle
7.Lens condition
8.History of fundus disease
9.History of systemic diseases