Eye diseases. Diagnosis of glaucoma (most important)

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Eye diseases. Diagnosis of glaucoma (most important)

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47. Diagnosis of glaucoma

Early diagnosis of primary glaucoma is extremely important. It is based on the patient's complaints, the history of the disease, the clinical picture, the results of the study of the functions of the eye, especially the central region of the visual field, the state of intraocular pressure and tonography data.

Tonometry is the main method for determining intraocular pressure. The pressure is measured in the supine position of the patient with a tonometer with a load of 10 g, while the tonometric pressure is determined, which normally should not exceed 27 mm Hg. Art. Intraocular pressure in the right and left eyes normally differ by about 5 mm Hg. Art. Daily tonometry is considered very important for the diagnosis of glaucoma. Measurement of intraocular pressure is usually made at 68 o'clock in the morning and at 68 o'clock in the evening, it is desirable to measure it in the middle of the day. Determination of daily changes in ophthalmotonus occurs in a hospital or in a glaucoma dispensary: morning measurement of intraocular pressure is carried out in a patient still in bed. The normal study duration is 710 days, with a minimum of 34 days. There is a calculation of the average morning and evening indicators of the level of intraocular pressure and the amplitude of the ophthalmotonus. The optimal range of ophthalmotonus fluctuations during the day should not be higher than 5 mm Hg. Art. The difference in fluctuations exceeding 5 mm Hg. Art., is the reason for suspicion of glaucoma. Of great importance is the absolute value of the rise in ophthalmotonus (more than 27 mm Hg). If they occur repeatedly, then this is a reliable sign of glaucoma.

Elastotonometry is a method for determining ophthalmotonus in the case of measuring intraocular pressure with tonometers of various masses. With elastotonometry, it is necessary to use a set of Maklakov tonometers weighing 5, 7,5, 10 and 15 g, with the help of which, in ascending order of their mass, intraocular pressure is measured 4 times. The readings of tonometers of different masses are plotted on a graph.

Tonography is a method for studying the dynamics of aqueous humor with graphic recording of intraocular pressure. Electronic tonographs help to conduct tonographic studies. A guaranteed confirmation of the diagnosis is a combination of the results of tonography, daily tonometry and perimetry of the central part of the visual field. The diagnosis of glaucoma is not in doubt if the outflow easiness coefficient is less than 0,15, and the diurnal curve is pathological, in addition, scotomas are noted in the central part of the visual field.

Glaucoma is suspected in the following cases: intraocular pressure equal to 27 mm Hg. Art. and higher; complaints characteristic of glaucoma; shallow anterior chamber; blanching of the optic disc (or part of it) or the beginning development of glaucomatous excavation; asymmetry in the condition of the two eyes (differences in the level of intraocular pressure, the depth of the anterior chamber, the condition of the optic discs); the presence of small paracentral relative and absolute scotomas in the field of view.

Author: Shilnikov L.V.

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