Eye diseases. Treatment of an acute attack of glaucoma (most important)

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Eye diseases. Treatment of an acute attack of glaucoma (most important)

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49. Treatment of an acute attack of glaucoma

An acute attack of glaucoma requires urgent specialized care, the main purpose of which is to reduce intraocular pressure and thus normalize impaired blood circulation in the eye, restore metabolism in the tissues of the eye and the optic nerve.

In an outpatient setting, treatment begins with instillations of a 1% (preferably 2%) solution of pilocarpine hydrochloride every 15 minutes for 1 hour, then every 30 minutes for the next 2 hours and then every hour. Instead of pilocarpine, a 1,53% solution of carbocholine can be administered. A 0,5% solution of Optimol is also instilled. Simultaneously with miotics, 0,5 g of diacarb or glycerol (50% glycerol solution) is prescribed orally at the rate of 11,5 g of glycerol per 1 kg of body weight. The decrease in intraocular pressure after taking glycerin begins after about 30 minutes, and after 11,5 hours its maximum decrease is achieved. Upon completion of emergency measures, the patient is sent to inpatient treatment. In the hospital, if the effect of previous treatment is insufficient after 23 hours and in the absence of arterial hypotension, the administration of chlorpromazine, which produces a pronounced sedative effect, is indicated. The drug reduces blood and intraocular pressure. The decrease in intraocular pressure under the influence of chlorpromazine is due to a decrease in the production of aqueous humor. Aminazine is administered as part of a lytic mixture containing a 2,5% solution of aminazine (1 ml), a 1% solution of diphenhydramine (2 ml) and a 2% solution of promedol (1 ml). Solutions of these medications are collected into one syringe, after which they are administered intramuscularly. After administration of the lytic mixture, patients must remain in bed for 34 hours in a horizontal position to prevent orthostatic collapse. In cases of severe corneal edema, eye baths with a 2040-810% glucose solution are indicated. If the described drug treatment does not stop an acute attack of glaucoma within XNUMX hours, anti-glaucoma surgery is performed.

General drug treatment for primary glaucoma includes the prescription of drugs that improve metabolic processes in the retina and optic nerve. Of these drugs, the most widely used orally are nicotinic acid (0,05 g 23 times a day for two to three weeks), nikoshpan (1 tablet 23 times a day for two to three weeks), noshpa (0,04 g 23 times a day), nigexin (0,25 g 34 times a day for the first 23 weeks and 2 times a day for another two weeks), aminalon (0,5 g 3 times a day for a month or more), Cavinton (0,005 g 23 times a day), Complamin (0,15 g 23 times a day), Trental (0,1 g 23 times a day), Riboxin (0,2 g 23 times a day), glio6, or pyridoxylate (0,1 g 23 times a day), biogenic stimulants, 1% solution of sodium salt of ATP (1 ml intramuscularly daily, 3 injections per course), 0,25% solution of cytochrome C, B vitamins.

Author: Shilnikov L.V.

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