Glaucoma is the most challenging of all ophthalmic diseases to diagnose and treat, and it is like a vicious and cunning enemy that requires constant vigilance in the fight against it. Glaucoma is a good time to develop in autumn when the weather changes from cold to warm and people’s moods fluctuate.
Glaucoma is an irreversible, blinding eye disease that causes damage to the optic nerve and loss of visual field due to an increase in intraocular pressure as a result of obstructed atrial fluid removal.
There are four main types of glaucoma: congenital glaucoma, primary glaucoma, secondary glaucoma, and mixed glaucoma. The one we are talking about today is primary glaucoma, which has a high incidence. China has the largest number of glaucoma patients in the world, and the current prevalence of glaucoma in China is 2% in people over 40 years old. In the hospital, the eye center is the main battlefield in the battle against glaucoma disease.
Knowing ourselves and our enemy, we can overcome the enemy. Primary glaucoma is divided into two categories: open-angle and closed-angle, which attack and destroy in a variety of complex forms, mainly in the tactics of sneak attack, fierce attack, feinting, and the combined use of a variety of tactics.
Sneak attack this is the open-angle glaucoma used to destroy the way, they make the eye pressure rise is gradual, so that the patient unknowingly visual field damage, starting from the periphery, gradually eat away at the range we see, until the tubular vision, we can still see 1.0 vision at this time, giving the illusion of no disease, and finally, the cruel enemy took away as the candle-like vision, the patient into darkness, at this time the patient to Hospital visits, doctors have returned to the dead.
This is the tactic used in acute closed-angle glaucoma, they take advantage of the elderly in the evening or gray light to watch TV with eyes to attack, overnight occupation of the position, the patient’s eye pressure rises, eye pain, hard as a rock, the patient mental pain, headache, nausea and vomiting, bedridden, and even overnight the patient’s vision down to only light perception.
Feinting acute angle-closure glaucoma is also often used as a form of attack, they launch several small attacks over a not too long period of time, several months, each time the firepower is not large, the patient only nasal pain and eye pain, after a little rest the condition improves, however, due to each attack, the atrial drainage system is damaged adhesions, until the last time, the enemy destroyed the atrial angle in one fell swoop, the patient experienced the above symptoms.
Also, the enemy applies the above tactics in combination, sneak attack, feint attack, and finally slam attack which is the offensive characteristic of chronic angle-closure glaucoma. Clinically, some patients have a light and strong tolerance for pain, showing only orbital and ocular discomfort, or even no symptoms in the eye, while shifting to pain in the forehead, ear, maxillary sinus, teeth, etc. Acute closed-angle glaucoma is actually due to the repeated extension of chronic closed-angle glaucoma.
The space in which the enemy wreaks havoc is vast, and the front line of our battle with it occurs in several departments of the hospital. In addition to the frontal ophthalmology center battlefield, the other is the emergency room, the neurology clinic, the gastroenterology clinic, the cardiovascular medicine clinic, and even the endocrinology clinic and other departments that apply to antispasmodics like atropine.
Acute glaucoma tends to occur in the evening.
Therefore, once a patient has symptoms of eye pain, headache, nausea and vomiting, he usually goes to the emergency medicine department at night. Due to the severe symptoms of headache, nausea and vomiting, the patient’s eyes are closed in mental pain and sent by his family, and the patient himself has no time or ability to describe the visual condition, so the enemy makes the emergency medicine doctor treat the headache, brain fever, nausea and vomiting of the common cold as this disease.
As the patient’s eye pain headache to neurology, neurologists encounter too many headache patients to be investigated, if the eye situation is ignored, check the head situation and then encounter some old infarct lesions, often fall into the headache diagnosis is unknown.
Gastroenterology, the patient nausea and vomiting do not think about tea and food, eat what vomit, the doctor will be mistaken for typical digestive system problems ……
Cardiovascular medicine encounter glaucoma patients, because the patient’s headache is unbearable, when the natural blood pressure rises, sometimes systolic blood pressure up to 200 mm Hg, quickly lower the pressure is the main.
In addition to the above enemy attack sites, in the case of the use of atropine antispasmodic drugs, latent glaucoma this enemy will also take the opportunity to come out to exert its power. As the patient is seriously ill in bed, he or she often cannot receive timely and effective treatment.
In addition, the cunning of glaucoma is that it seems to know the psychology of the patient, they often attack those who love to be angry, so glaucoma has a nickname “gas blindness”, in addition, glaucoma patients, by nature, are cautious and thoughtful, so many people are often hesitant after the disease, delaying the best opportunity for surgical treatment. The best opportunity for surgical treatment is often delayed. Because of the irreversible nature of glaucoma, the earlier the disease is detected and treated, the better the outcome
Because of the onset of glaucoma, including open-angle glaucoma and chronic closed-angle glaucoma, more than 90% of glaucoma patients are already in the mid- to late-stage when they arrive at the hospital. The awareness rate of the public and the diagnosis rate of doctors are relatively low. Therefore, it is crucial to increase health education and publicity in general.
There are four types of early early symptoms.
1.Frequent feeling of eye fatigue and discomfort.
2, eyes are often sore and swollen, which is relieved after rest.
3, blurred vision, sudden deepening of myopia or presbyopia.
4, eyes often feel dry.
Early symptoms
1.Increased eye pressure
The normal IOP range is 10-21 mm Hg. When the IOP rises to 25-40 mm Hg, 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 is no headache or elevated intraocular pressure.
Treatment of glaucoma.
Due to the advancement of medical instruments and drugs, glaucoma can be controlled for a long time and the vision can be maintained without loss of vision as long as it is checked early, once or twice a year for adults over 40 years old or in high risk groups; if glaucoma is present, it is treated with medication on time, supplemented by surgery if needed, and followed up regularly.
The IOP test is one of the three most important tests to detect glaucoma, and it is also the simplest test, especially the current pneumatic IOP test, which is quick and easy to perform without anesthesia.
Lowering IOP and protecting visual function are the main goals of glaucoma treatment.
Different types and periods of glaucoma are treated differently.
1. In the early stages of closed-angle glaucoma, the iris should be prevented from blocking the anterior chamber angle as much as possible. There are two ways to do this: one is to put pupil reduction drops to narrow the pupil, usually with 1% maurobronchioline; the other is to cut a small hole in the iris (perirhinal resection) to equalize the pressure between the anterior and posterior chambers. Pupil constrictors must be applied for a long period of time without interruption; blurred vision and darkened vision after pupil constriction can cause some inconvenience to work and life. Peripapillary iridotomy is safe and easy to perform, and the results are indeed worth promoting.
In the case of severe attacks of closed-angle glaucoma, patients are given frequent drops of maurozanthine and other antihypertensive drugs such as acetazolamide and mannitol, which often provide only temporary relief and require further decompression surgery, and treatment cannot be interrupted arbitrarily because of a reduction in self-perceived symptoms.
The purpose of open angle glaucoma treatment is to stop the progression of glaucoma as much as possible, and the treatment plan should be based on a comprehensive examination of the glaucoma patient, including the accurate grasp of the height and fluctuation of intraocular pressure, quantitative threshold changes in the visual field, detailed changes in the morphology of the optic nerve papillae, as well as the abnormalities of the blood supply to the optic nerve, and combined with the systemic cardiovascular system, respiratory system and other diseases to The selection of glaucoma is based on a comprehensive consideration.
In the past, the principle of treatment for open-angle glaucoma was generally to use medication first and then consider surgery when it was ineffective, mainly based on factors such as many complications and poor efficacy of surgery (non-microsurgery) (the patient is younger and prone to scarring of the filter tract). With the advancement of clinical development, the development of microsurgery, the continuous improvement of surgical instruments, and the improvement of surgical techniques and methods, the efficacy of glaucoma filtration surgery has been greatly improved, and some scholars advocate aggressive surgical treatment, especially in cases with existing optic nerve and visual field damage.
Precautions for patients with glaucoma
Vision protection is important for care.
If you have been diagnosed with glaucoma, you are more fortunate than the thousands of glaucoma patients who do not know they have glaucoma. That’s because you and your eye doctor can work together to protect your vision for years to come. 6 precautions for glaucoma.
1. Patients should receive systematic and regular treatment as soon as they are diagnosed, preferably with a fixed hospital and physician. The number of daily doses and the duration of each dose should be exactly as prescribed by the doctor. Regular check-ups of visual acuity, visual field, fundus changes and testing of 24-hour IOP changes are required.
2, the usual state of mind should be stable, excessive emotional fluctuations can often cause pupil dilatation, increased intraocular pressure, aggravating the disease. Therefore, it is important to avoid anger and anxiety, to treat people with optimism and broad-mindedness, and to maintain a good mental state.
3, the diet should be light, eat more vegetables and fruits, keep the bowel movement smooth. Avoid spicy, greasy food and wine, strong tea, coffee and other beverages that cause increased intraocular pressure. To control the total amount of daily water and the amount of water drunk at one time. In general, do not drink more than 250 ml of water at a time, and do not drink more than 2000 ml of water a day. Drinking too much water will cause an increase in intraocular pressure.
4, pay attention to living, to prevent colds. The collar should be loose. Sleep well. Sleep with a slightly higher pillow. It is not advisable to take a cold shower. This is good for preventing IOP from rising.
5, careful medication, prohibit atropine, scopolamine, belladonna, prudence, stomach, Valium and oral contraceptives, etc., these drugs can make the eye pressure rise.
6, do not stay in the dark for too long. Because in the dark environment, the pupil will dilate, making the eye pressure rise. When watching TV, you should light a small lamp in the room, so that the room is not too dark, and the viewing time should not be too long. Appropriate participation in some physical exercise, but should not do those excessive bending, head down, breath-holding, weight-bearing activities, so as not to increase the abdominal pressure and cause an increase in intraocular pressure, aggravating the condition.