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Eye diseases. Glaucoma (most important)

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45. Glaucoma

Glaucoma is a chronic eye disease that manifests itself as a constant or periodic increase in intraocular pressure, a special form of optic nerve atrophy, and significant changes in the visual field.

Etiopathogenesis and classification. There are primary, secondary and congenital glaucoma. The development of primary glaucoma is influenced by both local and general factors. Local factors include changes in the drainage system and microvessels of the eye, general hereditary predisposition, neuroendocrine and hemodynamic disorders. Before an increase in intraocular pressure, trophic changes occur in the drainage system of the eye, which causes a violation of the circulation of aqueous humor and an increase in ophthalmotonus.

Classifying primary glaucoma, it is necessary to take into account the form and stage of the disease, the level of intraocular pressure and the dynamics of visual functions. The state of the iridocorneal angle of the anterior chamber and the site of violation of the main resistance to the outflow of aqueous humor determines the form of glaucoma. There are open-angle and closed-angle forms of glaucoma.

With open-angle glaucoma, dystrophic changes in trabecular tissue and intratrabecular canals of varying severity occur, as well as blockade of Schlemm's canal. Types of open-angle glaucoma include pigmentary, pseudoexfoliation and glaucoma with low intraocular pressure. In pigmentary open-angle glaucoma, the pigment completely covers the trabecular zone, which leads to impaired outflow of aqueous humor and increased intraocular pressure. Pseudoexfoliative glaucoma results in the deposition of pseudoexfoliation on the posterior surface of the cornea, iris, ciliary body and in the iridocorneal angle of the anterior chamber. Pseudoexfoliative glaucoma is often combined with cataracts. Glaucoma with low intraocular pressure is characterized by typical symptoms of primary glaucoma: changes in the visual field and partial atrophy of the optic nerve with glaucomatous excavation of the optic nerve head. Angle-closure glaucoma is characterized by blockade of the iridocorneal angle of the anterior chamber by the root of the iris, as well as the development of goniosynechia. Glaucoma occurs with pupillary block, shortening of the iridocorneal angle of the anterior chamber, flat iris and vitreolenticular block. With a mixed form of glaucoma, the signs of open-angle and closed-angle glaucoma are combined.

There are four stages of the disease: initial, advanced, advanced and terminal, and at the same time an acute attack of angle-closure glaucoma. The designation of each stage is carried out by a Roman numeral for a brief record of the diagnosis. The staging of glaucoma is determined by the state of the visual field and the optic disc. The initial stage is characterized by the absence of marginal disc excavation and changes in the peripheral boundaries of the visual field. For advanced and far advanced stages of glaucoma, the presence of marginal excavation is characteristic.

Author: Shilnikov L.V.

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