hypersecretory glaucoma
Introduction
Introduction of excessive glaucoma Hypersecretory glaucoma (hypersecretion glaucoma) is a rare special type of open-angle glaucoma characterized by elevated intraocular pressure, but the aqueous humor flow coefficient is normal. basic knowledge The proportion of sickness: 0.01% Susceptible people: no special people Mode of infection: non-infectious Complications: ocular hypertension
Cause
The cause of excessive secretion of glaucoma
(1) Causes of the disease
Increased aqueous humor production due to various causes.
(two) pathogenesis
The outflow balance between aqueous humor and aqueous humor is broken by the increase in the production of aqueous humor, causing elevated intraocular pressure and optic nerve damage.
Prevention
Exocrine glaucoma prevention
Excessive drinking water can increase intraocular pressure. As too much water is absorbed by the body, the aqueous humor in the eye will increase. Normal people can adjust by accelerating metabolism. The primary glaucoma is discharged due to dysfunction of the filter curtain. Abnormal, causing the intraocular pressure to rise. Therefore, patients with glaucoma should not drink more water.
Complication
Exocrine glaucoma complications Complications, high ocular hypertension
High intraocular pressure damage of the retina and optic nerve.
Symptom
Exocrine glaucoma symptoms common symptoms elevated intraocular pressure, high intraocular pressure visual field defect
The intraocular pressure is intermittently increased, up to 30mmHg. The amplitude and fluctuation of intraocular pressure increase depends on the rate of increase in aqueous humor production, the duration and the compensatory capacity of the patient's aqueous humor. The same amount of aqueous humor is different. Different situations may occur in the eyes. When the rate of aqueous humor production reaches 4-5 l/min, the intraocular pressure of most eyes will increase, while some people can still maintain normal intraocular pressure. The function of drainage of the elderly is mostly normal. Limit, trabecular mesh has limited metabolic function, so when the water production is slightly increased, it will easily cause an increase in intraocular pressure, often up to 30mmHg.
Because excessive secretion of aqueous humor is intermittent, the increase in intraocular pressure is also intermittent, and the optic nerve is well tolerated. Therefore, its neurological damage and visual field defects appear later than open-angle glaucoma, and the course progresses slowly. The degree is also mild, and some patients have persistently increased intraocular pressure. Failure to timely and effective intraocular pressure reduction therapy will also result in serious visual impairment.
Elevated intraocular pressure can not be diagnosed as excessive secretion of glaucoma, need to do intraocular pressure tactography when the intraocular pressure is elevated, only when the tonometry shows that the intraocular pressure is increased when the intraocular pressure is increased, that is, the normal flow coefficient of the aqueous humor is normal. Can be diagnosed, because only this can prove that the increase in intraocular pressure is not caused by the outflow of aqueous humor, but because of excessive secretion of aqueous humor, it is difficult to reduce the ease of discharge of aqueous humor by the measurement of intraocular pressure alone. The reduction of open angle glaucoma should emphasize the importance of intraocular pressure imaging in the diagnosis of this disease. During high intraocular pressure, intraocular pressure should be measured repeatedly. If the aqueous fluid flow coefficient is normal or slightly higher than normal, it is generally 0.25~ Between 0.60l/(min·mmHg), and the aqueous flow rate is higher than normal, the diagnosis should be considered. For patients with glaucoma with elevated intraocular pressure, the aqueous humor flow coefficient is normal, and the aqueous flow rate exceeds 4.00l/ Min, you can diagnose the secretion of excessive glaucoma.
In the case of intraocular pressure tracing, attention should be paid to the elimination of some human factors. If the weight of the weight used is not appropriate, attention should also be paid to measuring the hardness coefficient of the eye wall, except for the high scleral hardness and the tension and examination of the testee at the beginning of the intraocular pressure tracing. The illusion of a high coefficient of aqueous humor flow caused by the pressure of the fingers, etc., which can correct the measured fluidity coefficient of the aqueous humor by measuring the flattening intraocular pressure and the hardness coefficient of the eye wall, thereby eliminating the nervousness of the testee and preventing the examination. The fingers of the person oppress the eyeballs and the like to avoid.
Examine
Examination of excessive glaucoma
No special laboratory tests.
Mainly to understand the mechanism of elevated intraocular pressure, the simple measurement of intraocular pressure can not be diagnosed, intraocular pressure during the increase of intraocular pressure (repeated when necessary) is of great value for the diagnosis, intraocular pressure can be found that the normal flow coefficient of water , and the formation of aqueous humor increased, for patients with elevated intraocular pressure, if the aqueous flow fluency coefficient is normal [generally 0.25 ~ 0.60l / (min · mmHg)], and the aqueous flow rate exceeds 4.00l / min [normal (1.838) ±0.05) l / min], can diagnose excessive secretion of glaucoma.
In tonometry, care should be taken to select the appropriate weight and correct the eye wall stiffness to avoid measurement errors.
Diagnosis
Diagnosis of excessive glaucoma
Differential diagnosis
1. Glaucoma secondary to elevated upper scleral venous pressure This disease is caused by an increase in the upper scleral venous pressure caused by some eyelid or systemic diseases, resulting in a decrease in the pressure gradient of the aqueous humor outflow channel, which causes an increase in intraocular pressure, but The early aqueous fluency coefficient can be normal, so it may be misdiagnosed as excessive secretion of glaucoma, but the former has many clinical manifestations of ocular and systemic diseases that cause elevated upper scleral venous pressure. The upper scleral vein can be seen in the eye examination. Congestion, schm keratoscope can be seen in the Schlemm tube area congestion, the common cause of increased upper scleral venous pressure are eyelid inflammation, orbital tumor, endocrine exophthalmos, superior vena cava obstruction, cavernous sinus-arteriovenous fistula and mediastinal tumor, etc. These diseases can cause elevation of the upper scleral venous pressure and increase the intraocular pressure due to obstruction of ocular venous return. In addition, these diseases often have obvious signs of primary disease, such as eyeball protrusion and limited eye movement. The conjunctiva is highly edematous, the intraocular pressure changes significantly with the body position, optic disc edema, extensive retinal hemorrhage, etc., combined with other examinations such as endocrine examination, eye B Ultra, color ultrasound blood flow examination and CT examination are not difficult to exclude the above diseases, if the primary disease is treated promptly, the upper scleral venous pressure returns to normal, the intraocular pressure may return to normal, if the upper scleral venous pressure rises for a long time, it can cause the room The fluency coefficient of water decreased. Even if the primary disease was cured and the upper scleral venous pressure returned to normal, the aqueous fluid fluency coefficient remained low, but excessive glaucoma did not have the above characteristics.
2, chronic simple glaucoma in some early patients with elevated intraocular pressure also have a certain degree of volatility, if not for tonometry, or some early patients with aqueous humor flow coefficient at the normal low limit is easily misdiagnosed as excessive secretion of glaucoma, but The disease is caused by the increase of aqueous humor outflow resistance caused by the outflow channel of aqueous humor, and the decrease of aqueous humor leads to an increase in intraocular pressure, which may be accompanied by a decrease in the production of aqueous humor. The curve of day and night intraocular pressure can be measured first, at the peak of intraocular pressure. Doing tonometry can often find a decrease in the fluency coefficient of aqueous humor, often 0.11 l / (min · mmHg), and the aqueous flow is normal or reduced, which can be differentiated from excessive glaucoma.
3. In the early angle-closure glaucoma, when the pre-irisic adhesion is small in the early angle of the anterior chamber, especially when the tonometry is performed under high intraocular pressure, the tonometer presses the eyeball to make the aqueous humor rush to the corner. When the angle of the corner is large, a high initial pressure value and a good outflow rate can be obtained. The measured fluid flow coefficient can be normal, and it is easy to be misdiagnosed as excessive glaucoma. However, the water flow in this ward is not high, and the combined angle of the room is not checked. Difficult to identify.
4, primary open angle glaucoma has some barriers to aqueous circulation, but when the tonometer is placed on the cornea, its aqueous humor secretion can be inhibited and significantly reduced, some people call it false outflow rate, if measured It can be corrected at the time, and the true aqueous outflow rate is reduced, so the clinically true hypersecretory glaucoma is extremely rare.
