ocular hypertension
Introduction
Introduction to ocular hypertension High ocular hypertension is a special phenomenon that has been gradually recognized by decades of clinical practice during the diagnosis and treatment of primary open angle glaucoma. In clinical work, it has been confirmed that the vast majority of patients with clear diagnosis of glaucoma have the common feature of elevated intraocular pressure. Although ocular hypertension is slow to develop and causes less damage to the optic disc and visual field, it has an important pathological factor common to open-angle glaucoma, that is, elevated intraocular pressure. A relatively consistent understanding of ocular hypertension refers to multiple intraocular pressure measurements (Goldmann applanation tonometer), the intraocular pressure values of both eyes exceed the upper limit of normal statistical intraocular pressure values, the angle of the anterior chamber is normal, and long-term follow-up is not A state of glaucomatous optic disc morphological change and/or visual field damage was found. basic knowledge The proportion of illness: 0.004% Susceptible population: more women and mostly over 40 years old Mode of infection: non-infectious Complications: headache, insomnia
Cause
Cause of ocular hypertension
Causes:
Although ocular hypertension is slow to develop and causes less damage to the optic disc and visual field, it has important pathological factors common to open-angle glaucoma, that is, elevated intraocular pressure, then which factors affect high intraocular pressure? What are the risk factors for developing ocular hypertension into glaucoma?
Endocrine changes (25%):
There are many female patients with ocular hypertension and most of them are over 40 years old, suggesting that there may be a certain relationship with endocrine changes in women, especially autonomic dysfunction in premenopausal period.
High blood pressure (15%):
The data show that in female patients, elevated blood pressure is associated with high intraocular pressure, and the accompanying phenomenon of elevated blood pressure and elevated intraocular pressure is also associated with autonomic dysfunction of autonomic function in blood vessels.
Climate factors (10%):
The association between intraocular pressure and seasonal changes, as well as daytime changes (often higher in the morning), is thought to be associated with periodic changes in corticosteroids in the body.
Other (10%):
The systemic factors associated with high intraocular pressure are race (black is more common), height, weight and pulse rate, diabetes and smoking. The factors related to local and high intraocular pressure are mainly dark iris (ie, iris pigmentation). Corneal thickness and myopia, as the age factor in the Westerners reported that intraocular pressure increased with age, but epidemiological data in Japan and China showed that intraocular pressure decreased with age.
Previous research data suggest that age, abnormal optic disc morphology, elevated intraocular pressure, family history of glaucoma, cardiovascular disease, and central retinal vein occlusion are risk factors for optic nerve damage and visual field damage in patients with ocular hypertension. In 2002, Gordon et al. reported the latest multicenter randomized study of the ocular hypertension treatment study (OHTS) group, which performed an average of 72 months of follow-up observations on 1636 patients with ocular hypertension. Primary open angle glaucoma factors include age, race, gender, cup diameter and horizontal diameter ratio, intraocular pressure, glaucoma family history, visual field (Humphrey) index, myopia, heart disease, hypertension, hypotension Oral calcium channel blockers or beta-adrenergic receptor antagonists, cerebrovascular accidents, diabetes, migraine and central corneal thickness, etc., the results show that the above-mentioned baseline factors of ocular hypertension are older, cup Large disk ratio (including vertical diameter and horizontal diameter), high intraocular pressure and large visual field deviation (PSD), all of which are primary open angle glaucoma Predictive factor, and a thinner central corneal thickness is the most powerful predictive factor for glaucoma occurs.
Pathogenesis:
Although the development of high intraocular pressure is slow, it rarely causes optic disc depression and visual field damage, but after all, it has an important pathophysiological background common to open-angle glaucoma - elevated intraocular pressure, in fact, there is indeed a part of high intraocular pressure, and finally Turning to open-angle glaucoma, there is no clear boundary between high intraocular pressure and open angle glaucoma. In order to study the intrinsic relationship between high intraocular pressure and open angle glaucoma, ophthalmologists are working on Exploring the predictive index of high intraocular pressure to open angle glaucoma, high intraocular pressure is actually a suspicious glaucoma.
Prevention
High ocular hypertension prevention
Psychological attention
When the patient's mood is fluctuating, tired, and working in a dark environment for a long time, the sympathetic nerve is excited, causing the pupil to open the large muscle contraction, causing the pupil to expand, the sclera to accumulate to the periphery, making the corner of the room closed, the drainage of the aqueous humor, the increase of intraocular pressure, and the induction of glaucoma. attack. Let patients understand that the acute onset of glaucoma is related to the above factors, to maintain a happy spirit, regular life, and to avoid mood swings.
Pay attention to diet
Do not smoke, drink alcohol, drink tea, coffee and eat spicy foods, and properly control the amount of water, one time should not exceed 300ml, so as not to absorb a lot of water into the blood in a short time, so that the water will increase, causing intraocular pressure Raise; eat more vegetables, eat honey, honey can not only lower the intraocular pressure, but also laxative, avoiding the increase of intraocular aqueous secretion and causing increased intraocular pressure, so keep the stool smooth.
Review on time
Many patients in clinical practice often mistakenly believe that glaucoma can be cured after surgery, and no longer consult. Therefore, it is necessary to explain to patients that glaucoma intraocular pressure is controlled, but it does not mean that the disease is cured. Attention should still be paid to intraocular pressure, optic papilla and visual field changes. . After 1 week of discharge, review it, and review it every month. After 3 months, review it once every six months. If you see a rainbow, eye pain, blurred vision or decreased vision, you should check it immediately.
Complication
Complications of ocular hypertension Complications, headache, insomnia
High intraocular pressure has few complications, and some patients can cause headache, dizziness, decreased vision, affection, and poor energy, which can cause sleep, which leads to insomnia and poor sleep quality. Part of the cause of autonomic dysfunction, resulting in a series of symptoms. At the same time, patients may have problems such as iris pigmentation, corneal thickening, and myopia.
Symptom
Symptoms of ocular hypertension common symptoms pathological myopia nystagmus high intraocular pressure goldfish eye
There was only an increase in intraocular pressure. There was no damage to the optic disc and visual field after the follow-up. The development of high intraocular pressure was a slow and relatively benign process. Through long-term observation, the intraocular pressure of most people with high intraocular pressure was stable or even decreased. The trend, which is in sharp contrast to the slow progression of open-angle glaucoma, is considered to be a sign of transition to open-angle glaucoma, mostly located in the upper and lower poles of the optic disc, the lower extremities are more common, and those with high intraocular pressure should be treated. Close follow-up and observation were performed.
Because the clinical situation of ocular hypertension is more complicated, and indeed some ocular hypertension will eventually develop into primary open angle glaucoma, therefore, in addition to regular follow-up observation of ocular hypertension (regular review of intraocular pressure, optic disc) , retinal nerve fiber layer and visual field), for some ocular hypertension with primary open angle glaucoma risk factors or visual field damage risk factors, in recent years, most scholars tend to adopt "protective" intraocular pressure reduction treatment , including ocular hypertension with the following risk factors:
1. Intraocular pressure 4kPa (30mmHg).
2. There is a family history of positive glaucoma.
3. The contralateral eye is a primary open angle glaucoma.
4. High myopia.
5. The disc is large.
6. With systemic hemodynamics and hemorheological abnormalities that can cause optic disc hypoperfusion, such as diabetes, hypertension, history of cerebral vascular stroke, peripheral vasospasm, hyperviscosity, etc., "protective" eye drop The treatment of pressure is treated with drugs, and the principle of selecting drugs is the same as that of primary open angle glaucoma.
For mild ocular hypertension such as intraocular pressure <4 kPa (30 mmHg), there is no risk factor associated with visual field damage. Currently, there is a tendency to follow up regularly and not to treat.
Examine
Examination of ocular hypertension
No special laboratory tests.
1. Cup/disc ratio (C/D): It has long been the most commonly used indicator for clinically describing glaucomatous optic neuropathy. The normal fundus C/D value is mostly less than 0.4, if it is above 0.6, or two The C/D difference of the eye exceeds 0.2, which should be paid attention to. The regular follow-up found that the progressive deepening of the optic disc sag is more diagnostic of glaucoma, but before the obvious change of optic disc sag, detailed examination will find related glaucoma damage. Signs, in addition, the physiological cup-concave ratio of the optic disc in the normal population is 5% to 10%, so the C/D value is no longer an effective sign for the diagnosis of early glaucoma.
2. Visual field inspection: Traditional visual field examinations such as Goldmann field of view, curved field of view, etc. are qualitative examinations of dynamic visual field, which have been difficult to be used for the diagnosis of early glaucoma. Currently, the visual field examination for early glaucoma is mainly static of threshold quantitative detection. The field of view, that is, the actual sensitivity of each point in the field of view, can detect small changes and make statistical probability judgments. The visual field examination is a subjective examination, that is, psychophysical examination, which can be interfered by many factors. Therefore, the results of the analysis should take into account the degree of patient cooperation, the reliability parameters of visual field examination, exclude other artifacts, and combine the intraocular pressure and the shape of the fundus to make a comprehensive analysis and judgment. Visual field damage can also be seen in other eye diseases and nervous systems. In addition to the vascular system and other diseases, the current clinical visual field examination method can detect the damage of the optic nerve fiber to a certain extent, although the specificity of the diagnosis of glaucoma is higher than the morphological changes of the fundus, but the sensitivity is not as good as the fundus. Morphological change, so when it is difficult to judge whether there is damage to the visual field for a while, it can be used regularly. Visit the examination, compare and analyze the visual field changes, and do not exclude or determine the diagnosis of early glaucoma based on a single visual field examination.
3. Other visual function tests: In addition to visual field damage, glaucoma may have other visual function abnormalities in the early stage, including:
1 Space/time contrast sensitivity decreases.
2 The color discrimination is reduced, especially blue, and the yellow feeling is affected earlier and heavier.
3 Electrophysiological ERG amplitude decreased, graph VEP peak latency delay, etc. In recent years, the evaluation of early visual function of glaucoma by frequency-doubled field of view (FDP), short-wavelength field of view (SWAP) examination and multi-focal electrophysiology (MERG) It is expected to be able to detect characteristic glaucomatous visual impairment earlier. It should be emphasized that both ocular hypertension and primary open angle glaucoma are bilateral and the diagnosis of both eyes Should be consistent, but allow for differences in the degree of presence, if one eye has a clear glaucomatous optic disc and/or visual field damage, the other eye should be diagnosed as glaucoma instead of only if the intraocular pressure is elevated without damage to the optic disc or visual field. High ocular hypertension.
Diagnosis
Diagnosis and diagnosis of ocular hypertension
diagnosis
There is only a different degree of increase in intraocular pressure in this disease, without visual disc damage and visual field defects. The diagnosis of ocular hypertension depends on a single intraocular pressure index, but the measurement error should be fully taken into account when measuring intraocular pressure. High ocular hypertension should be noted in patients with early POAG who have not had optic disc damage and visual field defects. More detailed examinations and regular follow-up may be helpful in differential diagnosis.
Differential diagnosis
Different from other types of glaucoma.
