primary juvenile glaucoma
Introduction
Introduction to primary juvenile glaucoma Primary juvenile glaucoma (juvenileglaucoma) refers to congenital glaucoma after 3 years of age and even early adulthood. The pathogenesis is the same as that of primary infantile glaucoma, but the symptoms of glaucoma appear later, and the cornea and sclera of the eye are high. The ability of intraocular pressure is strong, so the appearance of no eyeball enlargement. Such glaucoma has a similar concealing process as the primary open angle glaucoma, and it is difficult to distinguish clinically. Therefore, in the glaucoma classification standard in China, the original hair before 30 years old will be used. Sexual open angle glaucoma is classified as adolescent glaucoma. basic knowledge The proportion of illness: 5% (high incidence of myopia, 60% of myopia in glaucoma patients, the incidence increased by about 5% in recent years) Susceptible people: no special people Mode of infection: non-infectious Complications: myopia
Cause
Primary juvenile glaucoma cause
(1) Causes of the disease
Similar to primary infantile glaucoma, it is associated with abnormal development of trabeculae and division and development of iris corneal angle, and abnormal differentiation.
(two) pathogenesis
The related theory of the pathogenesis of primary adolescent glaucoma can refer to primary infantile glaucoma. It is generally accepted that the abnormal development of iris keratoma caused by the outflow of aqueous humor is the cause of elevated intraocular pressure in this type of glaucoma.
Prevention
Primary juvenile glaucoma prevention
1, to maintain a happy mood: angry and anxious and mentally irritated, it is easy to raise the pressure of the eye, causing glaucoma, so usually keep a happy mood, do not be angry and anxious, not to worry about the chores of household chores.
2, maintain a good sleep: sleep uneasy and insomnia, easy to cause elevated intraocular pressure, induced glaucoma, the elderly should wash their feet before going to bed, drink milk, help fall asleep, if necessary, take hypnotics, especially those with higher intraocular pressure It is better to sleep well.
3. Work or play less in a dark environment: People who work in the darkroom should go out of the darkroom every 1 to 2 hours or turn on the lights appropriately. People who are emotionally excited should watch movies less and watch TVs with small lights next to the TV.
4, to avoid overwork: whether it is physical labor or mental work, the body is prone to fluctuations in intraocular pressure after overwork, so pay attention to the law of life, work and rest, avoid overwork.
5, do not overeating: overeating and eating too much, will increase eye pressure, induce glaucoma. Older people should "eat eight full meals, no smoking, no drinking, no coffee, no strong tea, no spicy and irritating food."
Complication
Primary juvenile glaucoma complications Complications
Glaucoma optic disc disease, myopia, etc.
Symptom
Primary juvenile glaucoma symptoms common symptoms blue visual field defect sunset syndrome visual field vision nausea eye irritation rainbow strabismus
Such glaucoma has similar clinical manifestations as primary open-angle glaucoma. The onset is concealed, and there are generally no symptoms in the early stage. It is difficult to detect. Most patients do not notice until visual visual impairment such as visual field defects. To a certain extent, rainbow vision, eye swelling, headache and even nausea may occur. Many patients are found to have glaucoma due to other eye diseases. Some may be treated with myopia, and some may even be treated as disused for the first time. Because the elasticity of the eye wall is worse than that of infants after 3 years of age, the eyeball and cornea are still normal after the increase of intraocular pressure, but some cases may show an increase in myopia due to the continuous stretching of the sclera, so that some cases have always been considered as myopia. Deepen, constantly change glasses, until the vision can not be corrected, it is already the central vision damage, such glaucoma can promote the occurrence and development of myopia, and myopia is also susceptible to glaucoma damage, the two can Influence, once glaucoma occurs, due to the presence of myopia, it can interfere with clinical examination, optic disc pathology of juvenile glaucoma The depression is shallow and wide, which is not as typical and easy to identify as the primary open-angle glaucoma optic disc depression. The angle of the angle is generally wide, and the iris attachment position is earlier. More iris protrusions (comb ligaments) or mesodermal leaves are visible. Tissue residual, the progression of the disease is the same as primary open angle glaucoma.
Examine
Primary juvenile glaucoma examination
Carry out genetic examinations when necessary.
Intraocular pressure measurement; iris keratoscopy: generally wide angle, high iris attachment position, there may be more iris protrusion and pigmentation; fundus examination; visual field examination, can understand the progress of disease from different measuring surfaces.
Diagnosis
Diagnosis and diagnosis of primary adolescent glaucoma
diagnosis
The early diagnosis of juvenile glaucoma is difficult. Because there are no symptoms and the appearance of the eye is normal. Young people who have progressive growth in myopia should consider the possibility of glaucoma. It is necessary to measure intraocular pressure and fundus multiple times. 5 Children under 6 years of age can make a rough visual field examination (face-to-face visual inspection). Most people over 8 years old can make a quantitative vision to help diagnose.
Juvenile glaucoma is more likely to be misdiagnosed and missed. The rate of misdiagnosis and missed diagnosis in domestic reports is 43.4%. Because glaucoma can promote the occurrence and development of myopia, myopia is particularly susceptible to glaucoma damage. The mutual influence is mutually causal, especially Because most of the patients who are close-up reading are young people with myopia and progression, they are easily misdiagnosed as myopia, and some patients are misdiagnosed as optic atrophy because the optic disc pathology of adolescent glaucoma is shallow. The width is not as typical and easy to identify as an open-angle glaucoma disc depression.
Differential diagnosis
1. Physiological large depression: Physiological large depression refers to a congenital optic disc abnormality in which there is no glaucomatous eye change except for the increase of the optic disc. The physiological depression often has a familial tendency. In the same family, there may be several members with similarly shaped optic disc depressions. In addition, such depressions are stable and do not progressively increase.
Physiological large depressions must be distinguished from glaucoma cups. It is relatively easy to distinguish the nature of large depressions in childhood, because if the large depression is a pathological phenomenon caused by glaucoma, it is often accompanied by elevated intraocular pressure, cornea. Corrosive, post-elastic layer rupture and corneal diameter increase and other corresponding signs, physiological depressions are lack of these signs, but younger age is not difficult for the visual field examination, the differential diagnosis is difficult, for these cases that are difficult to diagnose, Eye examinations should be comprehensively performed to make a diagnosis based on all parameters. In addition, examination of the optic disc of other members of the family may also facilitate the differential diagnosis of the two. If the patient cooperates, the optic disc should be taken for later comparison and observation.
2. Congenital optic disc defects: Congenital optic disc defects are caused by incomplete closure or dysplasia of the embryo, and others are called optic nerve entrance defects, which can be divided into two types:
1 optic disc defect combined with retinal and choroidal defects;
2 simple optic disc defects.
Patients with optic disc defects have a large variation in congenital anomalies, so the degree of visual acuity is affected. Most patients have poor eyesight, but they also have normal vision. If vision is poor, they may be accompanied by nystagmus and external Strabismus.
Patients with optic disc defects combined with retinal and choroidal defects may have other abnormalities in the eye.
Most of the optic disc defects are unilateral, and occasionally there are both eyes involved. This defect is non-progressive. The size and depth of the defect range between individuals are quite different. The lighter is only like a deep physiological depression; the heavy one is a large depression. , can reach 7 ~ 10mm, and often accompanied by posterior cysts, ophthalmoscope see the fundus defect area is round, vertical oval or blunt triangle, clear boundary, pigmented depression, the bottom of the depression is smooth, can not see the sieve plate, This defect area is generally several times larger than a normal video disk.
The morphology and extent of visual field defects are generally consistent with the extent of optic disc defects. Common visual field changes are physiological blind spot enlargement. Congenital optic disc defects should be differentiated from primary congenital glaucoma. The main points of identification are as follows:
(1) congenital optic disc defects are mostly affected by monocular, while congenital glaucoma is often affected by both eyes.
(2) The optic disc defect is non-progressive, while the cup of congenital glaucoma is progressive.
(3) Those who have a disc defect, the sieve plate is not visible in the depression area and the sieve plate is exposed in the congenital glaucoma.
(4) In the case of optic disc defect, the intraocular pressure and cornea are normal except for the change of glaucoma at the fundus.
