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Stages of glaucoma by visual fields. Degrees of glaucoma and their treatment

10.03.2020 -
Allergy

2016-03-29 11:35:56

Aiza asks:

Diagnosis; Grade 3 open-angle glaucoma in both eyes can be cured?? Your answer is very important to us.

Responsible Molebnaya Oksana Vasilievna:

Glaucoma is a chronic disease, and, as you know, they are not treated. When glaucoma is detected in the early stages of the disease and proper treatment you can save your eyesight. When detected on late stages- you can only try to save what is left, the lost is not restored. Therefore, it is recommended to undergo preventive control of IOP after 35 years of age annually, especially for people in whose family there were close relatives who suffered from glaucoma.

2012-03-18 11:20:19

Zhuldyz asks:

My father is 61 years old. He has grade 3 glaucoma, currently one eye does not see, and the second is at the stage of blindness. Have been to many times eye institute in the Republic of Kazakhstan, Almaty. At the last appointment with the eye doctor, they answered that if they operated, he might go blind at all and there were no guarantees, only eye drops were prescribed. In this connection, I ask you to answer whether it is possible to operate at least one eye to prevent blindness and whether there is a guarantee. Or there are other options. Please indicate the address and the best clinic.

Responsible Kozina Ekaterina Nikolaevna:

At your stage of the disease, in order to maintain residual vision, it is very important to constantly maintain low intraocular pressure and systematically, two to three times a year, conduct courses of conservative and physiotherapeutic treatment. this is especially true in the case of preparation for surgery - to avoid oppression of the optic nerve. After all, it is the progressive atrophy of the optic nerve in glaucoma that leads to blindness. and the main thing here is not the search for a superclinic, but systematic treatment under the supervision of a competent doctor who is territorially and financially accessible to you. After all, the diagnosis of glaucoma is for life. By the way, the predisposition to this disease is inherited.

2015-06-29 16:22:50

Artyom asks:

Hello, my mother has a very serious disease, the second is absolutely painful glaucoma of the right eye, myopia of a weak degree of the left eye, my mother does not see anything with her right eye, as I understand it is impossible to return vision, is it possible to get rid of pain in the eye ??? moment very sore eye and went around it tumor what is this and how to deal with it???

Answers:

Hello Artem. Of course, there are ways to get rid of pain in the eye with glaucoma. It can be conservative and operational methods. Contact a specialized ophthalmological clinic - the Center for Eye Microsurgery in Kyiv or the Institute of Eye Diseases. V. P. Filatov in Odessa in the glaucoma department. After the examination, the specialist recommends the best treatment method specifically for your case. I wish your mom well!

2015-06-08 12:39:23

Oksana asks:

Hello!!! Tell me please, I am 28 years old, I have congenital myopia high degree on the left eye, which turned into glaucoma 1.5 years ago and strabismus begins, is it possible with the support of Travatan drops and eye exercises to prevent at least strabismus ?????? p.s I have Small child unfortunately, for many reasons, I can’t go for the operation yet. Thank you very much, human for the answer !!!

Responsible Molebnaya Oksana Vasilievna:

Dear Oksana, myopia does not turn into glaucoma, completely different diseases. Travatan or gymnastics do not prevent the development of strabismus. What kind of operation are we talking about?

2015-03-10 14:20:44

Vitaly asks:

Good afternoon, I myself am a hemodialysis patient, the problem was that my eyes began to fester strongly, just very sour with pus, many ophthalmologists did bakpasev with antibiotics, staphylococcus aures 10 ^ 6 was detected, they prescribed a lot of antibiotics, another ophthalmologist diagnosed dry eye syndrome , myopia of a weak degree in both eyes, secondary / steroid / open-angle 2C glaucoma in both eyes, and another optometrist began to inject gentamicin into the eyes, and nothing helped, as the discharge is as it is, I don’t know what to do, the eyes are very tired, what examinations to do to to determine what is really happening, what to treat, now there is already a problem with the skin of the face, the face of the skin, and especially around the eyes, is so dry, the skin is cracking, the dermatologist prescribed a talker on the face, nothing helps, the eyes in the morning are very dry, I moisturize half a bubble, nothing helps tell me what to do.

Responsible Gudarenko Vera Yurievna:

Hello Vitaly! From the condition you described, I can recommend taking a detailed general blood test, blood for sugar, glycosylated hemoglobin, to rule out diabetes. You can instill or wash your eyes with sodium sulfacyl 20% - these are eye drops (silver nitrate) an excellent antiseptic. With the results of the analysis and a high-quality photo with a problem, you can send it to the site telederm.com.ua, where you will register and get a more detailed consultation.

2014-12-17 14:06:53

Vitaly asks:

Thank you for your answer. I did an eye examination on your advice, they diagnosed dry eye syndrome, mild myopia in both eyes, secondary (steroid) open-angle 2C glaucoma in both eyes, Maklakov IOP examination TOD = 39mm Hg, TOS = 36mm. Hg, Johnson test OU=3mm, optic nerve OU pale pink, clear boundaries, glaucomatous excavation OD E/D=0.8, OS E/D=0.7 a chest of drawers in both eyes 4-5 times a day, timolol 0.5, 1 drop 2 times a day with an interval of 12 hours for a long time, please tell me, discharge from the eyes, detachable purulent threads appear, and the prescribed preparations are very expensive, maybe you will advise me some drugs are not very expensive and effective, I remember myself as a hemodialysis patient.

Responsible Prokhvachova Elena Stanislavovna:

Dear Vitaly. In this situation, the most dangerous is uncompensated intraocular pressure. You need effective drugs- prostaglandins, which, unfortunately, are not cheap - Lanotan, or Taflotan, or Xalatan. In addition - humidifiers, a sickly chest of drawers is a suitable preparation. I wish you health!

2014-01-10 12:59:38

Diana asks:

Can high myopia have glaucoma?

Responsible Prokhvachova Elena Stanislavovna:

Hello Diana. With a high degree of myopia, the development of glaucoma is possible due to the weakness of the sclera in the region of the optic nerve. You should regularly conduct an examination with an ophthalmologist, so as not to miss the development of complications of high myopia.

2013-07-30 05:50:11

Oleg asks:

I caught a cold in the outer ear (right) and went to the doctor, it was quickly cured, but there was a slight leak at night - this ear became wet! The doctor told me to wash my ears. I told her that I had washed it well earlier and I don't think there was anything left. Later, I found something black in my ear, and suddenly, (on the right), then after several days of treatment with hydrogen peroxide, I went to the doctor! I started washing my ears. left ear was injured by the very strong jet of the washing machine! More than 15 sec. I could barely bear the pain! Note on a perfectly healthy ear! Nothing washed out - the ear was clean. She also washed her right ear and washed out the particles of black residue and pieces like paper soaked in black. The doctor prescribed three antibiotic tablets and said to drink within three days! The next morning, I felt severe pain in my left ear (in a healthy earlier and injured with a strong jet when washing! I drank these pills and went to the doctor, who took swabs from both ears. A month later, I came to the clinic and I was pleased with the tests: left and, fungus growth in the right!!!Moreover, there were no manifestations of the disease in any ear!I again passed the tests for a smear and in the left the infection of Pseudomonas aeruginosa was confirmed in the 6th degree, and in the right ear - an intestinal infection!A month has passed and for this while both ears itch, the impression is that the ears are slightly swollen and burning!The doctor did not prescribe any treatment, but wrote dermatitis in the ears.
Tell the doctor your opinion. What happens if the infection is not treated? I can be beaten, bleeding, weakened, and then the infection will show up, meningitis will begin, etc. Moreover, I have glaucoma, will it not affect my eyes, which are now behaving very badly ..., at night I wake up and the visibility is very blurred, this has not happened before, of course I'm nervous. I am 62, but I do not fit, I have been cycling, hardening for 29 years, I feel not bad. This infection, and DIFFERENT in each ear, puzzled me. I've been in the water since childhood, every day in the shower and I know how to deal with the ears ... What do you think about what I have described? Thanks in advance!

Responsible Medical consultant of the portal "site":

Good afternoon, Oleg! Let's sort it out in order. So, for starters, about Pseudomonas aeruginosa and Escherichia coli - normally, these microorganisms can be in a small amount in the ear canal, as well as on the skin and in the intestines. However, under conditions of reduced immunity (stress, acute and chronic diseases, adverse physical effects, etc.), Pseudomonas aeruginosa and E. coli can begin their rapid growth and development, thereby leading to the development of a number of diseases, sometimes even very severe and life-threatening (pneumonia, endocarditis, sepsis). But, however, Pseudomonas aeruginosa and E. coli have nothing to do with glaucoma - make an appointment with an ophthalmologist and establish the true cause of vision loss. By the way, frequent visits to the pool can provoke the appearance of both Pseudomonas aeruginosa and Escherichia coli in the ear canal, as well as a fungal infection. Therefore, I would advise you to refuse to visit the pool for the period of treatment, and in the future to use special devices that close the ear canal (ear plugs). It would not be superfluous to examine the blood for sugar. And also sign up for a second consultation with an otolaryngologist and receive adequate recommendations regarding the existing external dermatitis ear canal(desensitizing, local anesthetic, antiseptic and other medications). All the best!

2010-06-17 22:02:06

Anastasia asks. :

Hello. I have retinopathy of prematurity grades 4 and 5. Astigmatism, nystagmus, cataract, glaucoma. There was a retinal detachment. And the LK operation was done. I work as a massage therapist. Can my work affect my eyesight?

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Hello dear readers. In the article I will talk about glaucoma of the 2nd degree, about the development of this disease and symptoms, which will allow the patient to monitor the condition of his eyes, timely apply for medical care and conduct preventive actions.

People often do not pay attention to deterioration central vision, color perception and distortion of the outlines of objects. And these are the first signs of deterioration of vision, which may result in its loss.

In the initial stage, the disease is quite difficult to diagnose, but grade 2 glaucoma gives itself out as clear manifestations, so it is easier to recognize it. At this stage, the disease responds well to treatment and there is a guarantee of restoration of vision.

Many people have heard about an eye disease - glaucoma, but they don’t know exactly what it is. Meanwhile, glaucoma is called one of the dangerous eye diseases from which you can lose your sight.

Ophthalmologists claim that almost 3% of the population is affected by the disease. The probability of getting sick increases after the age of 40, and by the age of 50-60, second-degree glaucoma develops.

The main causes of the disease

Medicine considers jumps in intraocular pressure to be the main cause of glaucoma. The change in pressure lies in the imbalance in the formation and outflow of intraocular fluid.

The contributing factors are age-related changes, heredity, the development of myopia, neurological diseases, thyroid dysfunction, low blood pressure and diabetes mellitus.


Important! Eye diseases such as cataracts, iridocyclitis, retinitis can also cause glaucoma.

Often the causes of the disease are associated with stress, addictions, eye injuries or certain medications.

Symptoms of second degree glaucoma

Clinical signs are:

  • tearing;
  • veil on the eyes when waking up;
  • vision becomes worse at night;
  • there is a heaviness in the eyes.

These signs are the first signal that you should immediately visit an ophthalmologist.

What is the treatment for second degree glaucoma?


Immediately it should be warned that glaucoma is not completely curable. But you can stop the course of the disease. It is important to remember that such serious problem self-medication is not solved. Only the ophthalmologist after the diagnosis decides how the treatment will be carried out.

With glaucoma of the 2nd degree, it can be prescribed:

  • local drug treatment;
  • the use of neuroprotectors;
  • physiotherapy;
  • surgical intervention.

Drug treatment includes drugs to increase the outflow of fluid. These are Travatan, Xalatan drops. It is necessary to bury them at night drop by drop. To reduce fluid production, funds from the group of adrenergic blockers are shown. They should be instilled twice a day. The most popular are Timolol and Betoptik. Medications such as Azopt or Trusopt also help reduce fluid production.

Preparations are prescribed by an eye doctor and are selected individually for each patient. The doctor monitors the condition of the patient's eyes and adjusts the course of treatment if necessary. In order to slow down the development of the disease, antihypertensive drops are prescribed.

Neuroprotectors promote the regeneration of nerve tissues. Injection courses are prescribed, special eye drops with vitamin complexes and nootropic drugs.

Physiotherapy includes methods of electrical stimulation of the optic nerves, magnetotherapy, laser therapy.

If the indicated treatment is ineffective, and the disease passes from stage 2 to stage 3, then surgical intervention is indicated.

What should a patient know about glaucoma treatment?

The video talks about what is essential in the treatment of glaucoma and how you can stop the progression of the disease. The doctor talks about the importance of measuring intraocular pressure and the tactics that doctors use when prescribing a course of treatment.

Conclusion

Dear patients! Don't put off your visits to the ophthalmologist. The sooner the disease is detected, the easier it is to stop the disease. Eyes need to be protected from childhood. Do not neglect the advice of doctors. Disease prevention is the key to maintaining acute vision to old age. Be healthy!

which develops over years. During this time, the glaucoma process undergoes several stages.

In the article, we will analyze the stages of glaucoma, their criteria and treatment: when will drops help, and in which case will only surgery save the situation?

What it is

The main criterion for the disease is high intraocular pressure. It is created by a transparent liquid - aqueous humor. In healthy eyes, moisture comes and goes regularly. Its excess is absorbed into the trabecular meshwork, which is located in the corner in front of the iris. This corner is called the front. Behind the iris there is a posterior angle, where fluid forms.

In angle-closure glaucoma, fluid remains in the rear camera and does not fall into the anterior chamber angle due to its closure. The open-angle form differs in the development mechanism - the angle is free, and moisture does not leave due to the pathology of the trabecular meshwork.

Both of these forms pass in their development through the same stages, from imperceptible changes to complete blindness. Based on these stages, a classification of the disease was created. But can glaucoma be cured and at what stage? We will try to answer this question in detail.

REFERENCE: Glaucoma is treated in specialized clinics by glaucomatologists. But the local therapist or doctor can suspect the disease. general practice during preventive examinations.

Initial

Symptoms

The earliest stage in the development of glaucoma flows almost imperceptibly. Only a few patients will talk about discomfort in the eye area, bursting. A small group of people report difficulties with the selection of glasses and the rapid onset of inconvenience when wearing them. In the case of angle-closure glaucoma, pain attacks are already possible at this stage.

How to determine

Diagnostic criteria are the same as for any form of glaucoma: damage to the optic nerve and visual field are assessed.


At grade 1, the boundaries of vision are absolutely normal, so classical perimetry cannot detect their change.

But when conducting computer perimetry, small scotomas are determined - areas of vision that “fell out”. In a healthy eye, when examining the bottom, the optic nerve head is always visible. In its center there is a recess - excavation.

It's absolutely normal condition nerve. In the initial stage of glaucoma, the excavation expands slightly, but never touches the edges.

Treatment

What to do when the disease has just arisen, is it necessary to be treated? Ophthalmologists unequivocally answer this question - treatment is mandatory. The therapy at this stage is very successful.. Apply blood pressure drops, often in monotherapy. In case of inefficiency, a combination of means is used.

As a rule, there are no indications for surgery at this time., except for the occurrence of an acute attack, which is not stopped by drops. Together with drugs to reduce pressure, drugs are used to improve the nutrition of the optic nerve, vitamins. This will delay the progression of the disease and preserve vision.

REFERENCE: The most effective drops: travatan, xalatan, arutimol. They are used 1, maximum 2 times a day.

Forecast

Developed

Symptoms


Signs of glaucoma in the second, advanced stage still small and invisible to humans. Intraocular pressure at the advanced stage can be consistently high, reaching 30-40 mm Hg. Art.

Sometimes there are attacks of angle-closure glaucoma, accompanied by pain syndrome.

Some people report bursting sensations inside the eye.

How to determine

Developed glaucoma of 2 degrees is established not by pressure inside the eye, but by visual fields and disk changes. There is a pronounced narrowing of the visual fields from the side of the nose by 10 degrees or more. Such a change can already be detected by conventional perimetry. The area of ​​livestock is increasing. When examining the bottom, an increase in disc excavation is determined, in some places up to its edge.

Treatment

At an advanced stage, treatment is using drops to reduce pressure, most often in combination. To overcome addiction to the drug, the drops are changed every 3 months. Additionally, be sure to use vitamin drops and antioxidants. These drugs slow down the death of the nerve. Surgical treatment according to indications with the ineffectiveness of drops, if it is impossible to stabilize the process.

IMPORTANT: If it is not possible to achieve low pressure with possible combinations of drops, then sclerectomy is used: the inner portion of the sclera is removed and the fluid will leave through the resulting window.

Forecast

Prospects at this stage are still good.. Changes in the optic nerve have not yet reached critical, and with regular treatment, the disease stabilizes and does not progress.

far gone

Symptoms

Stage III glaucoma develops after several years of stable high blood pressure.

Depending on the individual features eye progression process can affect several decades.

Due to the pronounced narrowing of the fields there is visual discomfort. Some people develop secondary myopia - myopia, distance vision becomes poor.

How to determine

The criterion for confirming grade 3 glaucoma is not by IOP, but by almost complete excavation of the optic nerve. His disk is damaged almost entirely, affecting most of the edge. The fields of view are narrowed strongly and pronouncedly: no more than 15 degrees are preserved. Such vision is considered to be tunnel vision.

Treatment

At this stage often recommended surgical intervention in the form of fistulization or laser iridectomy. This treatment restores the outflow of fluid and slows down the progression of glaucoma. If the pain syndrome is not pronounced, and the drops help, then you can do without surgery. Be sure to prescribe neuroprotectors to protect the nerve from lack of oxygen.

IMPORTANT: Laser interventions have a shorter recovery period. They can be performed on an outpatient basis, without mandatory hospitalization in a hospital.

Forecast

At an advanced stage doubtful. With a good response to treatment, a favorable outcome of the operation, it is possible to avoid blindness. But in some cases it inevitably comes.

Terminal

Symptoms

Manifestations of the fourth, most recent stage - blindness. It can be total or with the feeling of light from the flashlight. A painful form is also possible, with frequent pain syndrome. Patients experience great psychological discomfort from complete loss of vision.

How to determine


The main criterion for end-stage or grade 4 glaucoma is complete loss of visual acuity.

Only light perception is preserved, and with an incorrect projection.

That is, the light from the flashlight on the right for a person seems to be left-sided or located from above.

The optic disc is deepened entirely, the excavation is total.

Treatment

Often, relatives of elderly people affected by glaucoma are interested in the question: is blindness treated? Unfortunately, on this stage conservative treatment won't do any good. Even surgery will not restore visual acuity. Surgical treatment is carried out only in case of pain in order to eliminate seizures. Considering that glaucoma is often a two-sided process, one should carefully consider the medical treatment of the second eye in order to preserve at least his vision.

Forecast

Prospects are unfavorable blindness is irreversible. A completely dead optic nerve means that vision cannot be restored. Severe pain forms are possible, which are not eliminated by medicines and require surgery.

REFERENCE: The glaucoma process in the map is reflected by the ICD 10 code - from H40 to H42.

Disability

Progressive glaucoma is direct. People with visual field narrowing of less than 40 degrees, that is, with an advanced stage of glaucoma, are eligible for benefits.. In this case, it is possible to obtain the III group of disability.

People with an advanced form of the disease have the right to receive group II when the fields are narrowed by less than 20 degrees. The progression of the narrowing of less than 10 degrees allows you to qualify for group I. This includes people with end-stage glaucoma.

Useful video

In the video below, a practicing ophthalmologist talks in detail about the signs by which the stage of the disease can be determined:

Any glaucoma process goes through several stages. In the earliest stages, treatment will be simple and effective..But when the terminal stage is reached, it is impossible to help the eyes. The question involuntarily arises - how to preserve vision, if the diagnosis of "glaucoma" has already been made? Compliance simple recommendations doctor, mandatory medication and regular visits to the ophthalmologist - all that is necessary for clarity of vision.

The worst thing about illness is not that a person dies, at least for the person himself. For me, the worst thing has always been the consequences of illness. After all, you will agree that sometimes it is better to choose an easier path and die than to be in a coma for the rest of your life, for example.

Some cannot live without a sense of smell, some without a voice, and for others, life loses its meaning without movement. I thought for a long time what would be the worst thing for me, and came to the conclusion that blindness. Even if, God forbid, I was immobilized, or forgot how to speak, I would still have my sight. I would be glad that I can see my loved ones, that I am able to watch the sun rise and set in all its glory and enjoy this endless cycle, being able to see the riot of colors in autumn and the green grass shoots in spring. Yes, I can’t imagine my life in eternal pitch darkness, without smiles, light and the look of someone’s insanely dear eyes.

But, unfortunately, we are not in a position to choose our fate. And many people suffer from eye diseases. In this article, I would like to consider a group of diseases that are united under the common name glaucoma, and which can permanently deprive a person of the opportunity to live a full life.

Glaucoma and its causes

We found out that the term glaucoma hides a whole group of diseases, which are characterized by an increase in intraocular pressure. There are four degrees of glaucoma.

Among the reasons are the following:

  • ophthalmohypertension, or increased pressure inside the eye;
  • old age, people over fifty are more likely to suffer;
  • ethnic factor, people of the Negroid race are more likely to suffer from such diseases;
  • chronic diseases of the organs of vision;
  • injuries of the organs of vision;
  • severe diseases (diabetes, obesity, atherosclerosis);
  • frequent stressful situations;
  • long-term use of certain medications;
  • hereditary predisposition.

    • The disease can be congenital, or it can be acquired with age or due to any injuries and injuries.

    Glaucoma glaucoma is different, or the degree of the disease

    Of course, the division into degrees is mostly arbitrary, but thanks to such a classification, it is possible to most accurately assess the condition of the optic nerve head, as well as how wide the patient's field of vision is.

  • First-degree glaucoma is also called primary glaucoma. The boundaries of the visual field are normal, but slight changes are observed in the paracentral zone. escaping, or plain language the deepening of the optic nerve disc is slightly expanded, but does not reach the disc edge. There are also no significant pathological abnormalities. If the diagnosis is made at this stage of the development of the disease, then with careful and scrupulous observance of the recommendations prescribed by the doctor, you can preserve the visual functions of your organs of vision for a long time.
  • The second stage of the development of the disease, or the advanced stage, is characterized by pronounced changes in the size of peripheral vision, as well as its narrowing. At this time, clinical signs greatly simplify the diagnosis.
  • Advanced grade 3 glaucoma is characterized by a sharp concentric decrease in the peripheral visual field. Escaping reaches the edge of the disc. This result comes from long course diseases. It takes several years before the picture of the disease takes on this form. Decreased intraocular pressure. The patient himself notes that he began to see worse. Significant treatment must be applied here.
  • Complete blindness, in some cases the patient retains light perception, but the light projection is incorrect. Sometimes the patient is able to see poorly due to a small island of visual field. These factors characterize grade 4 glaucoma - terminal glaucoma. If a person loses vision due to glaucoma, then it is not possible to restore it. If the ophthalmologist has detected such changes, then it is necessary to try to save the vision in the second eye, that is, to begin immediate close observation of the remaining organ of vision.

    • The most common diagnosis of glaucoma is early stage development is possible only with a random examination by an ophthalmologist. In any case, this disease requires attentive attitude to the organs of vision and periodic inspection.

    Glaucoma

    Glaucoma is a group of diseases often characterized by an increase in intraocular pressure (IOP), but not always, changes in the visual field and pathology of the optic disc (excavation up to atrophy).

    This is how a person with glaucoma sees:

    Causes of glaucoma

    Risk factors for developing the disease:

    - increased IOP (ophthalmohypertension)

    - age over 50 years old

    - ethnicity (glaucoma is more common in the Negroid race)

    - chronic eye diseases (iridocyclitis, chorioretinitis, cataracts)

    - history of eye injury

    - general diseases (atherosclerosis, hypertension, obesity, diabetes mellitus)

    - stress

    — long-term use certain drugs (antidepressants, psychotropic substances, antihistamines, etc.)

    - heredity (in families where one of the relatives has glaucoma, there is a risk of developing the disease)

    Glaucoma is congenital and acquired. The first type is associated with developmental disorders of the eye in embryonic period development. Often these are intrauterine infections - rubella, influenza, toxoplasmosis, mumps, or maternal diseases and the influence of damaging factors (severe endocrine pathologies, exposure to high temperatures and radiation).

    The main types of acquired glaucoma are primary (open-angle, closed-angle, mixed) and secondary (inflammatory, phacogenous, vascular, traumatic, postoperative).

    Signs of open-angle glaucoma include ophthalmohypertension (periodic or constant increase in pressure), visual field loss (in this case, a person does not see part of the surrounding objects).

    Open angle glaucoma

    Open-angle glaucoma is divided into stages (according to the degree of development clinical signs) and the level of intraocular pressure.

    Stages of primary open-angle glaucoma:

    Stage I (initial) - there are no changes in peripheral vision, but there are small ones in the central one (paracentral scotomas, in the Bjerrum zone, expansion of the blind spot), excavation of the optic nerve papilla, not reaching its edge.

    Stage II (advanced) - narrowing of the peripheral visual field more than 10 degrees from the nasal side or concentric narrowing, not reaching 15 degrees from the point of fixation, excavation of the OD (marginal)

    Stage III (far advanced) - characterized by a concentric narrowing of the field of view and in one or more segments more than 15 degrees from the fixation point, excavation of the OD

    Stage IV (terminal) - complete absence of vision or light perception with incorrect projection, possibly residual vision in the temporal region. If the media of the eye are transparent and the fundus is visible, then there is atrophy of the optic nerve.

    Stages of glaucoma

    According to the level of intraocular pressure, 3 degrees are distinguished:

    A-normal IOP (up to 27 mm Hg)

    B-moderate IOP (28-32 mmHg)

    C-high IOP (more than 33 mmHg)

    Separately isolated glaucoma with normal intraocular pressure. At the same time, there are characteristic visual field loss, excavation develops, followed by atrophy of the optic nerve papilla, but IOP is normal.

    Angle-closure glaucoma

    Angle-closure glaucoma occurs in cases of complete or partial blockage of the iridocorneal angle, through which the outflow of aqueous humor occurs. Provoking factors: small eyes (farsightedness often develops), shallow anterior chamber, excessive aqueous humor production, large lens, narrow iridocorneal angle (ANC). There is a periodic increase in IOP, the extreme manifestation of which is an acute attack of glaucoma, which can be caused by prolonged exposure to a dark room or at dusk, a large number of drunk liquid, emotional stress. There are severe pains in the eye, radiating to the corresponding half of the head, redness, iridescent circles when looking at the light source.

    Acute attack of glaucoma

    This state requires immediate treatment.

    Stabilized and non-stabilized glaucoma is also distinguished depending on the degree of progression (by visual acuity and field of view).

    Depending on the degree of compensation, glaucoma can be compensated (no negative dynamics), subcompensated (there is a negative dynamics) and decompensated (acute attack of glaucoma with sharp deterioration visual functions).

    Glaucoma long time may have an asymptomatic course and patients seek help when some visual functions have already been irretrievably lost.

    Symptoms for which you should see a doctor to stop the development of the disease:

    - loss of field of view (some objects are not visible)

    - rainbow circles when looking at a light source

    - blurred vision

    - frequent change of glasses

    - pain in the brow area

    1. Ophthalmological examination:

    – visometry (even with tubular vision, visual acuity can be 100%)

    – perimetry, incl. computer. Reveal the slightest changes in the field of view.

    - campimetry - a study of the blind spot (the area in the field of view that a person normally does not see) - normally 10?12 cm

    - biomicroscopy (expansion of the vessels of the conjunctiva, a symptom of the emissary (deposition of pigment along the anterior ciliary vessels), a symptom of the cobra (expansion of the episcleral veins in the form of a funnel before their perforation of the sclera), dystrophy of the iris and pigmented precipitates)

    - gonioscopy-examination of the iridocorneal angle using a goniolens (determine the size of the angle of the anterior chamber)

    – tonometry according to Maklakov (norm 16-26 mm Hg), non-contact tonometry (not an accurate method, used for mass research)

    - tonography - tonometry for 4 minutes using an electronic tonograph. Normal indicators:

    P0=10-19 mmHg (true intraocular pressure)

    F=1.1-4.0 mm3/min (minute volume of intraocular fluid)

    С=0.14-0.56 mm3/min/mm Hg (outflow ease factor)

    KB= 30-100 (Becker's ratio= P0/S)

    - ophthalmoscopy (determine the excavation of the optic nerve head) and examination with a Goldman lens

    Excavation of the optic disc

    – optical coherence tomography of the retina (determine the slightest changes in the optic nerve head)

    – Heidelberg retinotomy

    - rheoophthalmography (determine the degree of ischemia or hypervolemia of each eye)

    - stress tests (help in the diagnosis of angle-closure glaucoma - dark, orthoclinostatic, with mydriatics). In this case, the pupil dilates, the angle of the anterior chamber closes, and symptoms of an acute attack occur.

    2. General examination- clinical blood and sugar tests, biochemical analysis blood, consultations of a therapist, cardiologist, neuropathologist, endocrinologist to identify concomitant pathology that can provoke the onset or development of complications in patients with glaucoma.

    There is no cure for glaucoma, it can only stop the progression of the disease. Treatment is prescribed only by a doctor.

    Types of treatment used for glaucoma:

    1. Local drug treatment:

    - derivatives of prostaglandins (increase the outflow of intraocular fluid) - Travatan, Xalatan - instill 1 drop in each eye at bedtime

    -?-blockers - reduce the production of aqueous humor - (non-selective (do not side effects on the heart and bronchi, contraindicated in people with bronchospasm) and selective) - Timolol (Arutimol, Kuzimolol 0.25% or 0.5%), Betoptik and Betoptik S. Instilled every 12 hours.

    - miotics - pilocarpine 1% - used for angle-closure glaucoma (narrow the pupil, the iris root moves away from the angle of the anterior chamber, thereby opening it) - 1 drop up to 3 times a day.

    - carbonic anhydrase inhibitors reduce the production of intraocular fluid (Azopt, Trusopt) - 1 drop 2 times a day.

    First, 1 drug is prescribed (more often these are prostaglandin derivatives). If there is no effect, add other drops, for example?-Adrenergic blockers. Treatment is selected only by a doctor, because. some drugs are toxic and have many contraindications.

    Antihypertensive drops are used constantly to slow down the development of glaucoma.

    2. Neuroprotectors are required because glaucoma strikes nervous tissue. There are direct and indirect (improve microcirculation and indirectly act on neurons). The direct ones include vitamins C, A, group B, emoxipin, mexidol, histochrome, neuropeptides (retinalamin, cortexin), indirect-theophylline, vinpocetine, pentoxifylline, nootropics, hypocholesterolemic drugs. The patient 1-2 times a year undergoes a course of drug therapy in a hospital.

    3. Physiotherapy treatment includes the use of methods such as electrical stimulation of the optic nerve, magnetotherapy, laser therapy.

    4. If drug therapy ineffective, surgical treatment (laser or traditional) is indicated.

    Glaucoma attack

    An acute attack of glaucoma requires immediate treatment. There are arching pains in the eye, radiating to nearby areas, nausea and vomiting, there may be an oculocardial syndrome. On examination, a mixed injection, edematous cornea, anterior chamber is small, dilated pupil, bombardment (bulging) of the iris, the fundus is not clearly visible, the optic nerve with hemorrhages. The eye acquires a stone density.

    The first step is to ask the patient when last time was stool and urination, measure blood pressure (BP). These conditions contribute to high blood pressure. When emptying the intestines, vasospasm is relieved, and there is a high probability that IOP will quickly decrease.

    Be sure to often instill pilocarpine 1% and timolol 2 times a day. Intramuscular anesthetics (promedol, analgin). Apply distraction therapy (for example, mustard plasters on the back of the head). They take diacarb with asparkam, intramuscularly lasix under the control of blood pressure. After stopping the attack, surgical treatment is recommended.

    Operative treatment of glaucoma

    Main types laser treatment: laser iridectomy(form a hole in the iris) trabeculoplasty(improve the permeability of the trabeculae).

    Iridectomy

    There are many ways of microsurgical treatment. The most widely used method is sinustrabeculectomy. at which they form new way outflow of aqueous humor under the conjunctiva, and from there the fluid is absorbed into the surrounding tissues. Other operations are also possible - iridocycloretraction(expand the angle of the anterior chamber), sinusotomy(improved outflow), cyclocoagulation(decreased production of aqueous humor).

    Folk remedies are ineffective. Patients are only wasting precious time treating them as the disease progresses.

    Complications of glaucoma

    Complications with untimely or irrational treatment: blindness, terminal painful glaucoma leads to the removal of the eye.

    Prevention of glaucoma

    Prevention is early detection diseases. In the presence of risk factors, it is necessary to visit an ophthalmologist regularly for examination and measurement of intraocular pressure.

    Patients with glaucoma must comply with the regime of work and rest, dosed physical activity is not contraindicated, excluded bad habits, you can not drink large amounts of liquid, wear clothes that can impede blood flow in the head area (tight ties, collars).

    Ophthalmologist Letyuk T.Z.

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    Glaucoma

    Glaucoma is one of the most formidable diseases of the eye, leading to loss of vision. According to available data, glaucoma affects about 3% of the population, and in 15% of blind people worldwide, glaucoma has caused blindness. At risk for the development of glaucoma are people over 40 years old, but in ophthalmology there are such forms of the disease as juvenile and congenital glaucoma. The frequency of the disease increases significantly with age: for example, congenital glaucoma is diagnosed in 1 out of 10-20 thousand newborns; in the group of 40-45-year-old people - in 0.1% of cases; in 50-60-year-olds - in 1.5% of observations; after 75 years - in more than 3% of cases.

    Glaucoma is a chronic eye disease that occurs with a periodic or constant increase in IOP (intraocular pressure), disorders of the outflow of intraocular fluid (intraocular fluid), trophic disorders in the retina and optic nerve, which is accompanied by the development of visual field defects and marginal excavation of the ONH (optic nerve head) . The concept of "glaucoma" today unites about 60 various diseases having the above features.

    Reasons for the development of glaucoma

    The study of the mechanisms of glaucoma development allows us to speak about the multifactorial nature of the disease and the role of the threshold effect in its occurrence. That is, for the occurrence of glaucoma, the presence of a number of factors that together cause the disease is necessary.

    The pathogenetic mechanism of glaucoma is associated with a violation of the outflow of intraocular fluid, which plays a key role in the metabolism of all structures of the eye and maintaining a normal level of IOP. Normally, the aqueous humor produced by the ciliary (ciliary) body accumulates in the posterior chamber of the eye - a slit-like space located behind the iris. 85-95% of the intraocular fluid flows through the pupil into the anterior chamber of the eye - the space between the iris and the cornea. The outflow of intraocular fluid is provided by a special drainage system of the eye, located in the corner of the anterior chamber and formed by the trabecula and Schlemm's canal (venous sinus of the sclera). VOG flows through these structures into the scleral veins. An insignificant part of the aqueous humor (5-15%) flows out by an additional uveoscleral route, seeping through ciliary body and sclera into the venous collectors of the choroid.

    To maintain normal IOP (18-26 mmHg), a balance is needed between the outflow and inflow of aqueous humor. In glaucoma, this balance is disturbed, as a result of which an excessive amount of intraocular fluid accumulates in the eye cavity, which is accompanied by an increase in intraocular pressure above the tolerant level. High IOP, in turn, leads to hypoxia and ischemia of the eye tissues; compression, gradual dystrophy and destruction of nerve fibers, disintegration of retinal ganglion cells and, ultimately, to the development of glaucomatous optic neuropathy and optic nerve atrophy.

    The development of congenital glaucoma is usually associated with eye abnormalities in the fetus (anterior chamber angle dysgenesis), trauma, and eye tumors. Predisposition to the development of acquired glaucoma is found in people with a burdened heredity according to this disease, persons suffering from atherosclerosis and diabetes. arterial hypertension. cervical osteochondrosis. In addition, secondary glaucoma can develop as a result of other eye diseases: farsightedness. occlusion of the central retinal vein. cataracts, scleritis. keratitis. uveitis. iridocyclitis. progressive atrophy of the iris, hemophthalmos. eye injuries and burns. tumors, surgical interventions on the eyes.

    Classification of glaucoma

    By origin, primary glaucoma is distinguished as an independent pathology of the anterior chamber of the eye, drainage system and ONH, and secondary glaucoma, which is a complication of extra- and intraocular disorders.

    In accordance with the mechanism underlying the increase in IOP, closed-angle and open-angle primary glaucoma are distinguished. In angle-closure glaucoma, there is an internal block in the drainage system of the eye; with an open-angle form - the angle of the anterior chamber is open, however, the outflow of intraocular fluid is impaired.

    Depending on the level of IOP, glaucoma can occur in a normotensive variant (with a tonometric pressure of up to 25 mm Hg) or a hypertensive variant with a moderate increase in tonometric pressure (26-32 mm Hg) or high tonometric pressure (33 mm Hg). article and above).

    Along the course, glaucoma can be stabilized (in the absence of negative dynamics within 6 months) and unstabilized (with a tendency to changes in the visual field and optic disc during repeated examinations).

    According to the severity of the glaucoma process, 4 stages are distinguished:

  • I(the initial stage of glaucoma) - paracentral scotomas are determined, there is an expansion of the optical disc, excavation of the optic disc does not reach its edge.
  • II(stage of advanced glaucoma) - the field of view is changed in the parcentral region, narrowed in the lower and / or upper temporal segment by 10 ° or more; excavation of the ONH is of a regional nature.
  • III(stage of advanced glaucoma) - there is a concentric narrowing of the boundaries of the field of view, the presence of marginal subtotal excavation of the optic disc is revealed.
  • IV(terminal stage of glaucoma) - there is a complete loss of central vision or the preservation of light perception. The condition of the ONH is characterized by total excavation, destruction of the neuroretinal rim, and shift of the vascular bundle.

    • Depending on the age of onset, glaucoma is classified into congenital (in children under 3 years old), infantile (in children from 3 to 10 years old), juvenile (in people aged 11 to 35 years old) and adult glaucoma (in persons over 35 years of age). In addition to congenital glaucoma, all other forms are acquired.

    Symptoms of glaucoma

    Clinical course of open-angle glaucoma. usually asymptomatic. The narrowing of the visual field develops gradually, sometimes progressing over several years, so often patients accidentally discover that they see with only one eye. Sometimes there are complaints of blurred vision, the presence of iridescent circles before the eyes, headache and aching in the superciliary region, decreased vision in the dark. Open glaucoma usually affects both eyes.

    During the closed-angle form of the disease, the phase of preglaucoma, acute attack of glaucoma and chronic glaucoma is distinguished.

    Preglaucoma is characterized by the absence of symptoms and is determined during an ophthalmological examination, when a narrow or closed angle of the anterior chamber of the eye is detected. With preglaucoma, patients can see rainbow circles in the light, feel visual discomfort, and short-term loss of vision.

    An acute attack of angle-closure glaucoma is caused by complete closure of the angle of the anterior chamber of the eye. IOP can reach 80 mm. rt. Art. and higher. Seizure can be provoked nervous tension, overwork, medical dilation of the pupil, long stay in the dark, long work with bowed head. With an attack of glaucoma, there is a sharp pain in the eye, a sudden drop in vision up to light perception, hyperemia of the eyes, tarnishing of the cornea, dilation of the pupil, which acquires a greenish tint. That is why the typical sign of the disease got its name: “glaucoma” is translated from Greek as “green water”. An attack of glaucoma can occur with nausea and vomiting, dizziness. pain in the heart, under the scapula, in the abdomen. To the touch, the eye acquires a stony density.

    An acute attack of angle-closure glaucoma is emergency and requires an early, within the next few hours, reduction of IOP by medication or surgically. Otherwise, the patient may face a complete irreversible loss of vision.

    Over time, glaucoma takes a chronic course and is characterized by a progressive increase in IOP, recurrent subacute attacks, and an increase in the blockade of the angle of the anterior chamber of the eye. The outcome of chronic glaucoma is glaucomatous optic nerve atrophy and loss of visual function.

    Diagnosis of glaucoma

    Early detection of glaucoma has an important prognostic value, which determines the effectiveness of treatment and the state of visual function. The leading value in the diagnosis of glaucoma is the determination of IOP. detailed study fundus and optic nerve disc examination, examination of the visual field, examination of the angle of the anterior chamber of the eye.

    Tonometry is the main method of measuring intraocular pressure. elastotonometry. daily tonometry. reflecting fluctuations in IOP during the day. Indicators of intraocular hydrodynamics are determined using electronic tonography of the eye.

    An integral part of the examination for glaucoma is perimetry - determination of the boundaries of the field of view using various techniques - isoptopperimetry, campimetry, computerized perimetry, etc. Perimetry allows you to detect even initial changes in visual fields that are not noticed by the patient himself.

    With the help of gonioscopy in glaucoma, the ophthalmologist has the opportunity to assess the structure of the angle of the anterior chamber of the eye and the condition of the trabecula, through which the outflow of intraocular fluid occurs. Informative data helps to obtain an ultrasound of the eye.

    The state of the ONH is the most important criterion assessment of the stage of glaucoma. Therefore, in the complex ophthalmological examination ophthalmoscopy is included - a procedure for examining the fundus of the eye. Glaucoma is characterized by deepening and expansion of the vascular funnel (excavation) of the optic disc. In the stage of advanced glaucoma, marginal excavation and discoloration of the optic disc are noted.

    More accurate quality and quantitative analysis structural changes of the optic disc and retina is performed using laser scanning ophthalmoscopy, laser polarimetry, optical coherence tomography or Heidelberg laser retinotomography.

    Glaucoma treatment

    There are three main approaches to the treatment of glaucoma: conservative (drug), surgical and laser. The choice of treatment tactics is determined by the type of glaucoma. The objectives of drug treatment of glaucoma are to reduce IOP, improve blood supply to the intraocular optic nerve, and normalize metabolism in the tissues of the eye. According to their action, antiglaucoma drops are divided into three large groups:

  1. Drugs that improve the outflow of intraocular fluid: miotics (pilocarpine, carbachol); sympathomimetics (dipivefrin); prostaglandins F2 alpha - latanoprost, travoprost).
  2. Means that inhibit the production of VGZh: selective and non-selective?-blockers (betaxolol, betaxolol, timolol, etc.); a- and?-blockers (proxodolol).
  3. Combined drugs.

With the development of an acute attack of angle-closure glaucoma, an immediate decrease in IOP is required. The relief of an acute attack of glaucoma begins with the instillation of miotic - 1% of the solution of pilocarpine according to the scheme and the solution of timolol, the appointment of diuretics (diacarb, furosemide). At the same time with drug therapy carry out distracting activities - setting cans, mustard plasters, leeches on the temporal region (hirudotherapy), hot foot baths. Laser iridectomy (iridotomy) or basal iridectomy by a surgical method is necessary to remove the developed block and restore the outflow of intraocular fluid.

Methods of laser surgery for glaucoma are quite numerous. They differ in the type of laser used (argon, neodymium, diode, etc.), the method of exposure (coagulation, destruction), the object of exposure (iris, trabecula), indications for performing, etc. In laser surgery for glaucoma, laser iridotomy and iridectomy, laser iridoplasty, laser trabeculoplasty. laser goniopuncture. In severe degrees of glaucoma, laser cyclocoagulation can be performed.

Have not lost their relevance in ophthalmology and antiglaucomatous surgery. Among the fistulizing (penetrating) operations for glaucoma, the most common are trabeculectomy and trabeculotomy. Non-fistulizing interventions include non-penetrating deep sclerectomy. Operations such as iridocycloretraction, iridectomy, etc. are aimed at normalizing the circulation of intraocular fluid. In order to reduce the production of intraocular fluid in glaucoma, cyclocryocoagulation is performed.

Prediction and prevention of glaucoma

It must be understood that it is impossible to completely recover from glaucoma, but this disease can be kept under control. At an early stage of the disease, when irreversible changes have not yet occurred, satisfactory functional results in the treatment of glaucoma can be achieved. The uncontrolled course of glaucoma leads to irreversible loss of vision.

Prevention of glaucoma consists in regular examinations by an ophthalmologist of persons at risk - with a burdened somatic and ophthalmological background, heredity, over 40 years old. Patients suffering from glaucoma should be registered with an ophthalmologist, regularly visit a specialist every 2-3 months, and receive recommended treatment for life.

Glaucoma chronic pathology eyes, which leads to irreversible loss of vision. In the modern classification, 4 stages of glaucoma are distinguished, which in the diagnosis are indicated by Roman numerals from I to IV. The division into stages is conditional, since the pathological process is continuous. The stage of glaucoma is assessed by the indicator the state of the optic nerve head (OND) and the state of the visual field.

Glaucoma leads to permanent vision loss

Initial (or I degree) glaucoma is characterized by unchanged, normal visual boundaries. However, there are separate areas of loss of vision (scotomas) in the 5-20 ° zone (paracentral zone located around the blind spot). At first, they are represented by small areas, which gradually turn into Bjerrum's arcuate scotoma, the appearance of which is characterized by early stage of glaucoma.

There is an expansion of the blind spot - a physiological scotoma, which is a projection of the optic nerve head that does not have photoreceptors. Another sign of the initial stage of glaucoma is the expansion of the physiological escaping of the center of the disc. ophthalmic nerve. This is a depression on the surface of the disk of various shapes and sizes, which, at stage I of the pathology, does not reach the edge of the ONH.

Normally, physiological escapation has the shape of a circle. At the initial stage, glaucoma escapation looks like a vertically located oval. At the same time, the areas located above and below the depression on the optic disc are narrower than the rim in the temporal and nasal parts. During the diagnosis, a shift in the vascular bundle of the eye is noticeable. But this symptom is not a diagnostic sign of glaucoma, as it can be present in a healthy eye.

The doctor evaluates intraocular pressure to determine the stage of glaucoma

Of great importance in the diagnosis of eye pathology is the assessment of intraocular pressure. At the initial stage of glaucoma, there is a periodic increase in intraocular pressure. diagnostic sign glaucoma are also daily fluctuations of ophthalmotonus. If a pre-disease is characterized by a gradual formation of a pathological process that lasts for years, then at the initial stage these processes have already formed. Violation of the outflow of intraocular fluid has reached such an extent that the tone of the eye periodically goes out of control of the mechanisms that maintain homeostasis. The combination of the results of tonography and daily tonometry, registering pathological abnormalities from the norm, are important sign development of glaucoma.

Manifestations of glaucoma at the initial stage

As a rule, the patient at the initial stage does not complain. Visual acuity remains the same. There is no discomfort and pain. Often the patient is unaware of the occurrence of his pathology. In some cases, the patient may complain of the appearance of iridescent circles before the eyes when looking at a light source.

The patient sees a dark space surrounded by iridescent circles, starting from purple, located directly around the source. Red color is marked on the border of light circles. This effect causes swelling of the cornea caused by an increase in pressure inside the organ of vision. Dispersion of light in glaucoma is noted in the morning and coincides with fogging, which disappears after normalization of pressure.

Haze, which looks like a light haze or a dense cloud, is also caused by swelling of the upper layer of the stoma of the cornea. Rapidly onset eye fatigue (asthenopenia) as a result of the work of the organ of vision is caused by a violation of the innervation of the muscles due to a decrease in blood flow. Such symptoms are noted only in 15-20% of patients. But due to the fact that these signs are not characteristic only for glaucoma, the condition is underestimated, and the time for diagnosing the pathological process may be missed.

There are also subjective symptoms in the form of pain on the side of the affected eye. The pain is felt in the temporal region, the superciliary arch and is distinguished by a dull, aching character. Although sometimes patients complain of severe pain. Pain coincide in time with the phenomena of "clouding" of vision.

In the initial stage, early signs of accommodation disturbance (weakening) that are uncharacteristic of age can also be noted. But such a symptom, along with "flickering flies", a feeling of lacrimation, is very rare. However, even in the absence of visible manifestations of the disease, changes occur in the optic nerve.

Pain in the temporal part on the side of the affected eye is a sign of glaucoma

At the initial stage of glaucoma, an examination of the anterior part of the eye is very informative, since changes in it occur earlier than an increase in intraocular pressure is noted. So, with ophthalmoscopy, changes in the stoma of the iris are visible, which are most pronounced in the pupil area. At the same time, the iris looks untidy, “sprinkled” with pigment grains. The features of the initial stage of glaucoma are:

  • multifactorial nature of occurrence;
  • heterogeneity or absence of severe symptoms;
  • lack of severity in the transition from norm to pathology;
  • the development of a pathological process with pseudonormal intraocular pressure and benign ocular hypertension.

If left untreated, the disease progresses and progresses to the next stage.

Stage II characteristics

Advanced (or II) stage of glaucoma also has characteristics, which are determined during the study of the field of view. In this case, there is a narrowing of more than 10 ° peripheral field of view. The process can develop from the nasal side or spread concentrically.

The patient may complain of a gradual limitation of the field of view, which moves from the area located from the side of the nose to the central part. This process is due to trophic disorders in the optic nerve, which occur as a result of an increase in intraocular pressure.

An increase in pressure interferes with the normal circulation of blood in the vessels of the eye. What is the primary cause of damage to the optic nerve? Cellular apoptosis increases due to disruption of cellular metabolism and lack of oxygen. Some of the cells die and are not restored.

In glaucoma, there is a 10° narrowing of the peripheral visual field.

Another recognized theory of the occurrence of glaucomatous optic neuropathy is the theory of mechanical action. As a result of intraocular fluid pressure, the cribriform plate deflects in the prelaminar section of the optic nerve head. A bundle of nerve fibers passes through the plate. Deflection of the plate causes deformation of the tubules of the lattice, mechanical compression of the axons of large M-cells of the ganglion and, as a result, a violation of their conductivity.

Stage II glaucoma is characterized by the onset of atrophy of nerve fibers at the level of the cribriform plate. When the transport of nutrients to axons decreases, and then completely stops nerve cells- from the terminals to the body - the mechanism of programmed death (apoptosis) is activated. As a result, toxic substances are released that affect an increasing number of nearby cells, expanding the scope of death.

With the progression of the central escapation, which tends to the edge of the optic disc, there is a gradual and uneven narrowing of the neural ring. Glaucomatous scotoma is noted - an increase and deformation of the border of the blind spot, with which arcuate scotomas gradually merge. At the II stage of development of glaucoma, the following processes continue to grow:

  • violations of the outflow of intraocular fluid;
  • intraocular pressure rises, reaching levels higher than tolerant for the optic nerve;
  • the processes of hypoxia and ischemia of the tissues of the head of the optic nerve progress;
  • glaucoma appears optic neuropathy;
  • apoptosis of retinal ganglion cells begins.

The division of the course of the pathological process into stages II and III is conditional, since their severity varies significantly, depending on the individual characteristics and form of the glaucoma process. However, stage II has a direct impact on the formation of stage III.

A healthy eye differs from a patient with glaucoma by pathological processes in it.

What is typical for stage III?

The advanced (or III) stage of the process of degradation of the optic nerve continues the process of the previous stage. The processes of destruction of the cells of the optic nerve head continue to grow, the deflection of the cribriform plate increases and, accordingly, the OD escapation increases, approaching the edge of the disc. The neural ring completely disappears - there is a marginal subtotal escavation.

The zone of decrease in peripheral vision expands, reaching in some segments the border, only 15 ° distant from the point of fixation (the highest point of visual acuity, located at the top of the "hill" of vision). The field narrows especially rapidly in the upper nasal segment. If at first this process stopped when intraocular pressure normalized, then stage III glaucoma is characterized by an increase in the rate of vision loss. The patient notes the effect of "tubular" vision, as if looking through a gradually narrowing tube.

Advanced glaucoma is expressed in an increase in the size eyeball. In the study, retinal vessels are seen sharply bending over the edge of the optic disc. Retinal edema reaches an extreme degree, which is noticeable by the expansion of the diameter of the blind spot. Destruction of ganglion cells and discoloration of the optic disc continue. The disk acquires a pronounced gray, and sometimes a slaty gray hue (normally it color pink). The vascular bundle is displaced. The temporal edge of the ONH becomes steeper and "undermined".

Stage IV manifestations

Terminal (or absolute) glaucoma is an extreme degree of severity of the pathology, in which there is a complete and irreversible loss of object vision. In some cases, only light perception is preserved. terminal glaucoma characterized by destruction of the neuroretinal ring (girdle), while escaping the optic disc reaches 100%.

Absolute glaucoma is the ultimate disease.

The disintegration of the cells of the head of the optic nerve is not accompanied by the proliferation of stellate glial cells and connective tissue. Dystrophic processes are also noted in the retina, where changes in the ganglion cells characteristic of the pathological process can be seen. Exfoliating foci of hemorrhage appear on the optic disc itself and around it, caused by blood clots in the vessels.

As a result of the growth dystrophic changes in the retinal pigment layer choroid eye (choroid) an uneven ring is formed - a β-zone, which expands in the terminal stage. The absolute process of loss of vision is completed, leading to irreversible results.

Some scientists argue that in order to establish intraocular pressure in glaucoma, not just intraocular pressure should be assessed, but tolerant, individual for a particular person, in which visual analyzer is functioning normally. It also undergoes daily fluctuations and age-related changes, decreases with the progression of glaucoma.

This indicator is more informative, since the norms of intraocular pressure were determined by the method of variation statistics and did not take into account individual characteristics. Therefore, even in healthy people, there is an increased, compared with the norm, intraocular pressure, which reduces the diagnostic value of the indicator.

Classification and description of the progression of glaucoma are of great importance in the early diagnosis of the disease. Pathology has a pronounced age dependence. So, according to statistics, after 45 years, 2% of patients go blind from glaucoma, by the age of 75 this figure increases to 15%.

The correlation of the frequency of occurrence of pathology by gender is insignificant. It is believed that gender is not among the factors that determine the possibility of the onset of the disease. An increasing number of patients with glaucoma among the working population stimulate the study of the pathomorphology and etiology of glaucoma. In connection with new factors discovered by modern scientists, the classification of one of the most severe and poorly understood eye pathologies is also changing.

Nov 26, 2016 Doc



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