glaucoma
Introduction
Introduction to glaucoma Glaucoma caused by the increase of intraocular pressure caused by the optic disc (formerly called optic papilla) depression, visual field defect, can eventually lead to serious eye disease of blindness. Normal people's intraocular pressure is 10 ~ 21mmHg (Schitz tonometer), more than 24mmHg is a pathological phenomenon. Increased intraocular pressure can lead to visual impairment, large and deep depressions in the optic disc, and typical changes in glaucoma can be seen in the visual field. The longer the duration of intraocular pressure increase, the more severe the visual impairment. If left untreated, the vision can be lost or even blind. Glaucoma is one of the main diseases of blindness. The reason for the increase in intraocular pressure in glaucoma is that the dynamic balance of the aqueous humor cycle is disrupted. A small number of due to excessive secretion of aqueous humor, but most of the outflow of water has caused obstacles, such as anterior chamber angle narrowing or even closure, trabecular sclerosis. basic knowledge The proportion of sickness: 0.01% - 0.015% Susceptible people: no specific population Mode of infection: non-infectious Complications: nausea and vomiting
Cause
Cause of glaucoma
Genetic factors (15%):
Glaucoma is a multi-gene hereditary lesion with a family history. The incidence rate is 6 times higher than that without family history, accounting for 13%-47% of the total number of cases, and the incidence rate of relatives is 3.5%-16%.
Refractive factor (25%):
Due to dysregulation of the refractive system, dysfunction of the ciliary muscle, imbalance of aqueous humor secretion, and the anterior chamber angle of the iris root, the drainage of the aqueous humor is blocked, causing an increase in intraocular pressure. The clinical features of such patients are conscious fatigue symptoms. Or no obvious discomfort, wearing glasses can not correct vision, easy to misdiagnosis, so patients with a history of refractive error should be timely to find a doctor with glaucoma rich clinical experience in case of unexplained eye abnormalities, detailed examination.
Anatomical factors (10%):
The anterior chamber is shallow, the axial length is short, the crystal is thick, and the corneal diameter is short, resulting in a narrow anterior chamber angle, an obstacle to drainage of the aqueous humor, an increase in intraocular pressure, and glaucoma formation.
Age, gender (10%):
The open-angle type is mostly around 30 years old, and there is no obvious gender difference. Closed-angle patients over the age of 45 accounted for 68.2%-76.8% of glaucoma patients, more women than men.
Bad living habits (15%):
Smoking, alcoholism, impermanence, irregular diet, moodiness, habitual constipation, intractable insomnia.
Prevention
Glaucoma prevention
1. Maintain a good mood and avoid excessive emotional fluctuations. The most important predisposing factors for glaucoma are long-term bad mental stimulation, temper, depression, anxiety, and panic.
2, life, diet and living rules, work and rest, moderate physical exercise, do not participate in strenuous exercise, maintain sleep quality, diet light and nutritious, non-smoking wine, strong tea, coffee, appropriate control of water intake, can not exceed 1000-1200ml per day , disposable drinking water should not exceed 400ml.
3, pay attention to eye hygiene, protect the eyes, do not read under strong light, the dark room stay time can not be too long, the light must be soft enough, do not overuse the eye.
4, comprehensive conditioning of systemic complications.
5, pay attention to the impact of drugs.
6, women's amenorrhea, menopause, and dysmenorrhea, but elevated intraocular pressure should be highly valued, such as glaucoma manifestations during menstruation, should promptly see a specialist.
7, glaucoma family and risk factors, must be reviewed regularly, once there are signs of the disease, must actively cooperate with treatment to prevent sudden loss of visual function.
Complication
Glaucoma complications Complications, nausea and vomiting, refractive error
Acute angle closure glaucoma, often associated with nausea, vomiting, fever, chills and constipation, a small number of patients may have diarrhea, chronic angle closure glaucoma, often accompanied by visual Mongolian, Hongvision, the most serious complication of this disease is blindness.
Symptom
Glaucoma symptoms common symptoms increased eyesight, visual field of vision, red blood surface corneal opacity under the anterior chamber, "chicken blindness" or "bird blindness", elevated intraocular pressure, dizziness, insomnia, large cornea
First, congenital glaucoma
1. Infant glaucoma: Children with glaucoma from 0-3 years old are generally classified as this type. This type is the most common in congenital glaucoma. It is sick in the mother, and symptoms appear immediately or slowly after birth, usually in both eyes. Sexual lesions, but not necessarily at the same time, there are 25-30% of children with monocular onset, the clinical manifestations of the eyeballs are prominent after birth, quite like the eyes of cattle, so called "bull's eye", afraid of light, tears, eyes Eyelids, corneal opacity, irritability, crying, poor diet or vomiting, sweat and other systemic symptoms, the key to the prognosis of this type is timely and correct diagnosis, because the eye wall of children is in the developmental stage, check the eye pressure, may be normal And the fundus examination is not well matched, so there is a lack of glaucoma rich books.
2. Juvenile glaucoma: the incidence is concealed and extremely harmful. In recent years, this type has occurred in myopia patients and has a rising incidence. More than 90% of patients do not show typical glaucoma symptoms, but , depending on fatigue, headache, insomnia, and even unconsciously blinded to see a doctor, detailed examination to know that it is glaucoma, some patients found glaucoma, but I mistakenly believe that I have no feeling now, vision can also, no It may be as serious as the doctor said, and it is really blind. At that time, regret is too late, and it can only survive in the dark for a lifetime.
Second, primary glaucoma
1. Acute angle-closure glaucoma: severe eye swelling headache with sudden onset, sharp vision loss, hard eyeball like stone, conjunctival congestion, nausea and vomiting, constipation, high blood pressure, when the systemic symptoms are heavier and easily misdiagnosed as Gastroenteritis, encephalitis, neuropathic headache and other diseases, if you can not get timely diagnosis and treatment 24-48 hours can completely blindness and no light, this time called "violent glaucoma", but some patients clinically endure pain Light and strong, only manifested as eyelids and eye discomfort, even without any symptoms in the eye, and transferred to the forehead, ear, maxillary sinus, teeth and other pain, acute angle-closure glaucoma, in fact, due to chronic angle-closure glaucoma Repeatedly delayed.
2. Chronic angle-closure glaucoma: manifested as dry eyes, fatigue, discomfort, pain, blurred vision or decreased vision, rainbow vision, dizziness, insomnia, elevated blood pressure, relieved after rest, some patients without any Symptoms are blindness. When checking, the intraocular pressure can be normal or fluctuating, or not too high 20-30mmhg, the fundus can be normal in the early stage, this type is most easily misdiagnosed, so the anterior chamber angle can form a fulminant glaucoma once the adhesion is closed. (Ref: Acute angle-closure glaucoma).
There are four early symptoms:
First, I often feel that my eyes are tired and uncomfortable.
Second, the eyes are often sore, and will be relieved after the break.
Third, blurred vision, myopia or presbyopia suddenly deepened.
Fourth, the eyes often feel dry.
Third, secondary glaucoma
1. Refractive error (ie, myopia, hyperopia) secondary to glaucoma: The clinical features of such patients are conscious fatigue symptoms or no obvious discomfort, wearing glasses can not correct vision, easy to misdiagnosis, so patients with a history of ametropia Unexplained eye abnormalities should be promptly found in the doctor with rich clinical experience of glaucoma, detailed examination.
2. Angle, conjunctiva, uveitis secondary to glaucoma: intraocular inflammation causes turbid aqueous humor, ciliary muscle, iris, corneal edema, shallow angle of the anterior chamber, or adhesion of the pupil, trabecular mesh obstruction, abnormal water discharge The intraocular pressure is elevated. At present, Western medicine generally uses antibiotics for the disease, and the hormones are treated symptomatically. The humans interfere with the autoimmune function, causing the disease to recur and prolong the recovery.
3. Cataract secondary to glaucoma: crystal opacity in the development process, edema enlargement, or translocation leading to relatively narrow anterior chamber, blocked drainage of water, causing elevated intraocular pressure, once cataract surgery, rapid optic atrophy and blindness.
4. Traumatic glaucoma: tearing of the angle of the corner, disconnection of the iris root, or anterior chamber blood, vitreous hemorrhage, retinal concussion, so that the secretion of aqueous humor, drainage pathway blocked secondary glaucoma optic atrophy, if proactive Chinese medicine treatment has a good prognosis Surgery can only repair the injured intraocular tissue, but the fundus damage caused by it can not be corrected. Therefore, this type of patient is generally treated by Western medicine at that time, and it is considered to be good. It is no longer treated. Once it is found that the optic nerve is atrophy, it causes seriousness. Vision damage.
Fourth, mixed glaucoma
Two or more primary glaucoma exist at the same time, and the clinical symptoms are the same as those of the various types.
Family members have a history of glaucoma, and they have a headache, eyesight, and visual fatigue. Especially those who have earlier presbyopia, or those who frequently change glasses, should go to the eye examination and review it regularly.
In the early stage of glaucoma, intraocular pressure is often unstable, and intraocular pressure rises only a few hours in a day.
Fundus changes: the increase of optic disc depression is one of the common signs of glaucoma. The early optic disc can be changed without obvious changes. With the development of the disease, the physiological depression of the optic disc gradually enlarges and deepens, and finally reaches the edge to form a typical glaucoma cup-shaped depression. Adjacent retinal nerve fiber layer damage is the basis of visual field defects that occur before the optic disc or visual field changes.
Vision: When the open-angle glaucoma has a pathological change in the optic disc, visual field defects will occur.
Examine
Glaucoma examination
1 Application of ultrasound biomicroscopy: This technology can dynamically and statically record the anatomical structure and physiological function of the anterior segment of the living human body in a non-interfering natural state, and can be quantitatively measured, especially for the morphology of the ciliary body, the surrounding iris The posterior chamber morphology and physiological and pathological changes were recorded in real time, providing valuable information for the diagnosis and treatment of primary angle-closure glaucoma, especially primary chronic angle-closure glaucoma.
2 Confocal laser scanning ophthalmoscope: This machine uses low-energy radiation scanning technology, real-time image recording and computer image analysis technology. Through confocal laser fundus scanning, it can achieve high resolution through the light turbid refractive interstitial. High-contrast retinal tomographic image, accurate recording and quantitative analysis of optic nerve fiber distribution, stereoscopic image of optic disc, and simultaneous examination of blood flow status and local field of view in the optic papilla area, electrophysiological examination, early diagnosis of glaucoma, stage of disease And prognostic analysis have important value.
3 Quantitative static field of view, pattern visual evoked potential: When the typical visual field defect occurs in glaucoma, the loss of optic nerve fiber may have reached 50%. The computer automatic visual field meter provides a basis for the earliest diagnosis of glaucoma by detecting the change of visual threshold. Graphic visual electrophysiology PVEP, PE-RG examination, has certain sensitivity and specificity in glaucoma. If the above two examinations are combined, the early detection rate of glaucoma can be significantly improved.
Diagnosis
Glaucoma diagnosis
diagnosis
Chronic simple glaucoma, if diagnosed early, is extremely important for protecting visual function. The following points are helpful for early detection and early diagnosis:
Family history
Family members have a history of glaucoma, and they are conscious of headache, eye swelling, and visual fatigue. Especially those who have earlier presbyopia, or those who frequently change glasses, should go to the eye examination in time and review it regularly.
2. Check the eye pressure
In the early stage of glaucoma, intraocular pressure is often unstable, and intraocular pressure rises only a few hours in a day. Therefore, measuring the 24-hour intraocular pressure curve is helpful for diagnosis.
3. Fundus changes
The increase of optic disc sag is one of the common signs of glaucoma. There is no obvious change in the early optic disc. With the development of the disease, the physiological depression of the optic disc gradually enlarges and deepens, and finally reaches the edge, forming a typical glaucoma cup-shaped depression, the retina adjacent to the optic disc. Nerve fiber layer damage is the basis of visual field defects, which appear before the optic disc or visual field changes, and therefore can be used as one of the early diagnostic indicators of open angle glaucoma.
4. Check the field of view
Visual field is an important examination for the diagnosis of open-angle glaucoma. Open-angle glaucoma has visual field defects when pathological changes occur in the optic disc.
Differential diagnosis
Acute acute angle-closure glaucoma with acute headache, nausea, vomiting, etc., sometimes overlooking the eye symptoms, and misdiagnosed as acute gastroenteritis or nervous system disease, acute attack and acute iridocyclitis Or acute conjunctivitis is confused and needs to be identified.
