Eye diseases. Juvenile and secondary glaucoma. Criteria for distinction (most important)

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Eye diseases. Juvenile and secondary glaucoma. Criteria for distinction (most important)

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51. Juvenile and secondary glaucoma. Criteria for difference

It develops at a young age due to congenital defects in the structure of the iridocorneal angle of the iris, there is a hereditary transmission of these defects. Usually people older than thirty years are ill. For some patients, changes in the iris are characteristic (hypoplasia, large crypts or their almost complete absence, eversion of the pigment sheet, coloboma), for others, the first symptoms appear in the second decade of life, develop slowly, the cornea is of normal size, the anterior chamber is deep.

In the diagnosis of erased forms, gonioscopic and tonographic studies are important. Many patients with juvenile glaucoma have a remnant of germinal mesodermal tissue in the anterior chamber angle. Topical application of various miotic drugs (pilocarpine, carbacholin, aceclidine, phosphakol, armin), as well as clonidine and optimol, is shown, diacarb is prescribed orally. In the absence of compensation for the glaucomatous process and the deterioration of visual functions, an operation is indicated.

The increase in intraocular pressure that occurs with secondary glaucoma is the result of another disease of the eye (or the whole body) or damage to the eye.

Glaucoma can develop at various times after cataract removal. An increase in intraocular pressure in the early stages after cataract extraction is associated with pupillary block as a result of obstruction of the pupil by the vitreous body, residual lens masses, or air introduced into the eye.

The reason for the increase in ophthalmotonus in the later stages after cataract removal may be pupillary or angular blockade, which developed as a result of postoperative complications (iridocyclitis, goniosinechia). Occasionally, glaucoma in an aphakic eye may be a manifestation of primary open-angle glaucoma not identified prior to cataract extraction.

The differential diagnosis is based on the data of tonometric, tonographic studies and gonioscopy of both eyes.

Treatment consists of dilating the pupil, reducing ophthalmotonus, reducing the production of intraocular fluid, eliminating the inflammatory reaction, and also depends on the cause of the increase in intraocular pressure. A 12% solution of pilocarpine hydrochloride, preparations of timolol maleate (0,250,5% timoptik, 0,250,5% oftan timolol, 0,250,5% proxodolol, etc.), combined preparations (fotil, timpilo), Diacarb is prescribed orally at 0,125-0,25 g 23 times a day. If ineffective, surgical intervention is indicated. This consists of adequately reducing intraocular pressure, optimizing the visual functions of the eye, and most importantly, eliminating, if possible, the cause that caused the development of glaucoma.

Author: Shilnikov L.V.

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