The Glaucoma|

The Glaucoma

Glaucoma is an eye disease in which the optic nerve is damaged in a characteristic pattern. This can permanently damage vision in the affected eye(s) and lead to blindness if left untreated. It is normally associated with increased fluid pressure in the eye (aqueous humour).

 
 Normal  Vista Afectada con Glaucoma


Symptoms

ˇ Vision of flying or sparkling flies
ˇ Loss of the lateral or peripheral vision
ˇ Pain in the eye
ˇ Headache
ˇ Blurred Vision
ˇ Vision of halos type rainbow
ˇ Nausea and vomiting
ˇ Blindness


Diagnosis

ˇ The clinic history and the symptoms should suggest glaucoma. Then other explorations are carried out:
ˇ The measurement of the intraocular tension trough a tonometer, is carried out trough local anaesthesia.
ˇ The gonioscopy, is an inspection of the angle of drainage trough some lens.
ˇ La ophthalmoscopy is carried out after the application of some drops to expand the pupil, the ophthalmologist will be able to observe the optical nerve and its possible alterations.
ˇ The campimetry is carried out to prove the possible peripheral visual lost.

The ocular tension should be proved:

ˇ Each 3-5 years in persons older than 39 years
ˇ Each 1-2 years in persons older than 50 years, who have relatives with glaucoma, or in persons who take steroids.


Treatment

In the glaucoma of open angle medicaments which reduce the intraocular pressure are used
The medicaments in eyewash of direct application in the eye are:

ˇ The miotics (pilocarpine) or epinephrine or medicaments derived from them. Its function is improve the passage of the liquid between the chambers of the eye.
ˇ The beta blockers and the inhibitors of the carbonic anhydrase which reduce the quantity of liquid produced. Sometimes medicaments oral, inhibitors of the carbonic anhydrase are used so that the reduction of liquid to be constant
ˇ One or another medicament or associated can be used according to the case.
ˇ In the glaucoma of close angle the case is more acute, for this reason is necessary a fast treatment to reduce the ocular tension. Hyperosmotics solutions are used in injection or trough the mouth, trough this solution we can control the tension some hours but then we should pass to other treatments of maintenance (miotics, beta blockers, of the carbonic anhydrase inhibitors).
ˇ The persistent cases which do not improve with medical treatment should be treated with surgery.
ˇ Surgery with Laser, a trabeculoplasty is carried out which improves the drainage of the liquid between chambers. This can be carried out with local anaesthesia in less than an hour.
ˇ The Iridotomy is carried out to treat the glaucoma of close angle, in this operation part of the iris is extracted. Both operations do not have great risk and the recuperation is in 1 or 2 days.
ˇ When the case of intraocular tension is very intense and this is not controlled incisions in the sclera are carried out (small holes of drainage).
ˇ This intervention is carried out under sedation and local anaesthesia in ambulatory regime. The recuperation is fast, is recommended do not get wet nor wash during 2 days. Also, the sports or violent exercises should be avoided in some days


Complications

Similar to any surgery and the specific of this

ˇ Infection
ˇ Bleeding
ˇ Unexpected changes in the intraocular tension
ˇ Loss of sight

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