Update: October 2018
Glaucoma is a lesion of the optic nerve due to an increase in
внутриглазного pressure. The optic nerve is responsible for the transmission
imaging into the brain, therefore, with late treatment, high
intraocular pressure will cause irreversible loss of vision. With
глаукоме это происходит в течение нескольких years old.
Since most patients with glaucoma have early symptoms
повышения внутриглазного pressure отсутствуют или остаются без
attention, it is important to regularly undergo a medical examination. It will help
timely identify diseases and prevent serious violations
People over 40, especially with hereditary
predisposition, must undergo a full examination of the oculist
annually or more often.
The main and only cause of glaucoma is elevated
The disease develops when normal circulation is disrupted.
внутриглазной жидкости в передней части eyes.
AT норме эта жидкость вытекает из глазницы через специальный
channel. With его закупорке (обычно это врожденная аномалия)
there is an excessive accumulation of fluid inside the eye, and
Other causes of blockage of the discharge channel are physical
or chemical injuries of the eye, acute infectious and inflammatory
diseases, blood vessel thrombosis in the eye area, and
травмы во время проведения операций на eyes.
Since chronic forms of glaucoma can lead to loss of
Before the development of clear symptoms of the disease,
Certain risk factors have been specifically identified.
it is necessary to undergo regular eye examinations and more thoroughly
control the appearance of any, even minor signs
ухудшения view. TO факторам риска относятся:
- Increased intraocular
- ATозраст старше 60 лет
- Withнадлежность к негроидной или латиноамериканской расе;
- The presence of cases of the disease in the family;
- Diabetes, diseases of the cardiovascular system,
sickle cell anemia;
- Перенесенная травма глаза или операция на eyes;
- Estrogen deficiency, such as after removal of the ovaries,
developing up to 43 years;
- Withем кортикостероидов, особенно глазных капель, в течение
a long time;
In most people, the disease is asymptomatic until
development of severe vision problems. First patient complaints
usually loss of peripheral vision, which is often also
remains unheeded, and the disease continues to progress.
Therefore, glaucoma is called the “silent thief of sight.”
Sometimes disturbing signs may appear in the early stages,
когда у больного повышается intraocular pressure. ATозникающие при
glaucoma symptoms and treatment of the disease depend on the stage and form
Chronic open-angle form
With хроническом течении видимых симптомов может не быть из-за
медленного развития diseases. Often patients do not even suspect
that their eyesight is deteriorating because areas are damaged first
глаз, отвечающие за периферическое vision. Vision begins
deteriorate from the outer corner of the eye, slowly approaching
center. TOроме постепенного ухудшения зрения других симптомов при
this form is not marked.
Typically, violations become noticeable in the elderly and senile
age, therefore, in this population group, regular
Also characteristic features of the open-angle
- Unevenly distributed fallout areas of central or
периферического зрения, часто развивается на обоих eyes
- The narrowing of the visual fields in the late stages of the disease (there are
complaints of blurred vision “as if you are walking through a tunnel and see
only what happens at its end “).
Acute closed angle shape
With острой закрытоугольной форме у больного отмечаются:
- Severe headache (usually there is a pressing pain in the parietal
and temporal areas)
- Боль в eyes
- Nausea and vomiting (resulting from nervous tension from
- Blurred vision
- The appearance of a halo around sources of light
- Red eyes
These symptoms are not always present, they may occur in
one to two hours, then subside and subsequently again
to arise. But with each new occurrence occurs
damage to visual function. This damage is not
are being restored, therefore it is necessary to start as soon as possible.
ATторичная глаукома вызвана другими заболеваниями, такими как
uveitis (inflammation of the middle of the eye), injuries and
With данной форме отмечаются такие же симптомы, как и при острой
closed-angle shape, but sometimes they can be erased by manifestations
основного diseases. For example, the diagnosis of glaucoma may
затруднить уверенность врача, что причиной появления боли в eyes
and headache is uveitis.
Look for characteristic features such as blurring.
view or the appearance of halos around light sources.
ATыявить признаки врожденной глаукомы very hard because
inability to determine patient complaints.
However, a child may experience the following symptoms:
- Increased eye size due to increased intraocular
- characteristic external manifestations in the form of “blurred” in
- increased tearing
- eye twitching
- strabismus (not always a sign of glaucoma, but often
indicates increased intraocular pressure)
Regular examination by an ophthalmologist is recommended for
early detection of the first symptoms of glaucoma. This will allow time
start treatment and prevent irreversible vision loss.
It is recommended to undergo a regular examination by an ophthalmologist:
- Every 4 years after 40 years in the absence of risk factors
- Every 2 years with risk factors or people over 65
Eye damage in glaucoma is irreversible, but regular checkups
and treatment can slow or stop development
blindness, especially with early detection of symptoms.
Целью лечения является снижение внутриглазного pressure. AT
depending on the severity of the disease and severity
Glaucoma treatments such as eye drops,
laser therapy or surgical treatment.
Treatment глаукомы обычно начинается с назначения глазных капель.
They reduce intraocular pressure by improving outflow
fluid from the eyes.
For the treatment of glaucoma prescribed eye drops with drugs.
- Hormonal drugs (prostaglandins). It is effective
препараты для снижения внутриглазного pressure. In their application
side effects such as redness and
ощущение покалывания в eyes, потемнение радужной оболочки,
change in pigmentation of the eyelashes, blurred vision. Confirmed
drugs like Xalatan have a positive effect,
Lumigan, Travatan, Reskul.
- Beta blockers. Inhibit the process of fluid production in
eyes. Possible side effects include a decrease in heart rate,
снижение артериального pressure, импотенция, усталость. TO
Beta blockers used in glaucoma include Timoptic XE,
Betoptik C et al.
- Agonists of alpha adrenergic receptors. At the same time reduce
продукцию жидкости и улучшают ее отток из eyes. Side effects:
аритмия, повышение артериального pressure, сухость во рту. TO
alpha agonists approved for use in ophthalmology,
include lopidin, alfagan, alfagan-p.
- Carboanhydrase inhibitors. Rarely used for glaucoma.
The action is based on reducing the production of intraocular fluid.
Among the side effects emit a metallic taste in the mouth,
frequent urination and tingling in the fingers and toes. TO данной
group drugs include drugs troisopt, azopt and others.
If the eye drops do not have a positive effect, for
Glaucoma treatment doctor may prescribe oral medications. AT
Carboanhydrase inhibitors are prescribed in tablet form.
For example, it is diamoks, neptazan, daranid. About 50% of patients are not
may continue taking tablets of inhibitors
carbonic anhydrase due to the development of systemic side effects.
Surgery and other treatments
TO этим методам лечения относятся лазеротерапия и различные
Among the procedures that improve the outflow of fluid from the eyes and reduce
intraocular pressure, emit:
Laser trabeculoplasty – a way to treat patients with
open-angle glaucoma. Treatment основано на применении
the laser beam to open the blocked channels of the trabecular
network. Until reaching the full effect after this procedure can
take a few weeks.
The operation is performed under local anesthesia (eye drops with
analgesic effect). Before the patient’s eye is set
special lens through which the laser beam is passed. This
the beam makes small punctures in the trabecular network through which
происходит отток жидкости, и внутриглазное давление going down.
An alternative method is the so-called cyclodiode.
laser treatment. It consists in the destruction of certain
eye areas in which fluid is formed. AT результате в глазу
less fluid is produced and a reduction in intraocular
Treatment лазером отличается быстротой и безболезненностью. Him
can be carried out at any age.
Trabeculectomy. This is the most common method.
surgical treatment. Applying a procedure called
trabeculectomy, the surgeon creates a hole in the sclera (eye protein),
через которое удаляет часть trabecular network. Through
the formed opening is provided by the outflow of fluid to reduce
The operation is performed under local anesthesia (the patient remains in
consciousness) or under general anesthesia (unconscious patient). Operation
can be performed at any age, but in older people the total
anesthesia may be associated with a high risk of complications,
therefore, local anesthesia is recommended.
Among the others surgical methods are distinguished:
- Vysokokanalstomy – operation to remove part of the sclera (white
outer membrane of the eye), as a result of which the fluid passes
by filtering from the eye into the tissues of the body.
- Deep sclerotomy – surgery to implant a small
devices for expanding the trabecular meshwork;
Minimally traumatic procedure during which is performed
trabecular tissue removal
(special cautery device).
Treatment of acute angle-closure glaucoma
A closed angle form is an emergency condition. When
urgent need to identify this form of the disease
treatment for rapid reduction of intraocular pressure. Usually this
achieved by the simultaneous use of drugs and
surgical procedures. All are suitable for the treatment of such patients.
the above methods, including surgical, without
In some cases, doctors resort to emergency laser
peripheral iridotomy, which makes an incision in the rainbow
shell through which fluid flows out and pressure in the eye
Currently, new treatments are under development.
For example, positive preliminary results demonstrate
iStent device. This is the first Microinvasive device.
surgical treatment of glaucoma, which improves the natural outflow
liquids to safely reduce intraocular pressure.
The device is used to create a permanent hole in
trabecular network. The benefits of iStent include:
- Installation safety;
- Spreads the tissues of the eye, which with standard methods of treatment
- Do not limit the use of other treatments for
preservation of vision.
iStent is the smallest device ever
approved for use in medicine. It is set to
to the patient’s eye during cataract surgery and is
so small that the patient does not see it and does not feel it.
This device creates a hole in the trabecular meshwork
which functions continuously, improving the flow of fluid. On this
iStent moment, which is inserted through a 1.5 mm long incision,
is the only approved new method in the treatment
open-angle glaucoma of mild to moderate severity, which
can be successfully applied to both young and old
There are also various recipes for treating glaucoma
means, for example, using nettle, aloe, anise. Can
to meet the stories of how alcohol tincture with lice juice helped
will improve vision for patients with glaucoma, but these data are not confirmed
documented, and the methods can only be used as
adjuvant treatment when taking drugs prescribed by the attending
Celebrities who coped with glaucoma
This serious disease affecting the optic nerve is
one of the leading causes of blindness worldwide. Total on earth
about 60 million cases have been reported. Here are the stories
some celebrities who were able to cope with this
In October 2014, U2 singer Bono told
public reason he constantly wears
Sunglasses. It turned out that he was ill with glaucoma
20 years, and all this time he continued to be treated.
Glaucoma causes an increase in photosensitivity, therefore
ophthalmologists recommend wearing sunglasses every time
when the patient goes outside. According to the recommendations of the Organization
for Glaucoma Research, you need to choose glasses that
block 99 – 100% of ultraviolet radiation. More protection
provide glasses with large curved glasses that cover
eyes on the sides.
In April 2014, it became clear that the actress uses marijuana
to relieve the symptoms of glaucoma. As Goldberg herself says, this
helps her get rid of the constant headache.
Астронавт John glenn был не только первым американцем,
circled in orbit around the Earth, but also the most adult
who ever flew into space. But these titles he could not
if he failed to cure glaucoma in time and save
And in 2002, as part of a public campaign, Glenn campaigned
of Americans check risk factors and pass inspection for
symptoms of this disease.
When he was 7 years old, Charles was already completely blind. Although
it was not confirmed by any research, it is believed that
Ray Charles’ blindness was caused by untreated glaucoma. Charles grew up
in poverty and did not have access to qualified medical
services that can provide timely assistance.
According to statistics, only half of people who are sick
glaucoma, know about their illness. Regarding the development of the disease
in childhood, to repair damage effectively
surgical treatment is applied. One common method
is a filtration microsurgical operation, during which
a small drain hole is formed for removing fluid from
Kirby Puckett, скончавшийся в 2006 году, был бейсболистом,
to the Hall of Fame as a player who won two World Series in
part of the Minnesota Twins team in the 80s and 90s. Once in 1996
year he woke up in the morning and found himself blind in his right eye.
It turned out that the cause of blindness was glaucoma. Because of this
diseases he had to retire.
Forecast заболевания недостаточно благоприятный. Without
treating the disease leads to complete blindness. And even held
in glaucoma, treatment and prophylaxis of complications do not always lead to
improvement. Approximately 15% of patients over 20 years completely
lose sight, at least on one eye.
Автор: TOоробов Никита Александрович врач-анестезиолог