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Glaucoma - Symptoms and signs
Last reviewed: 11.04.2020
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Acute attack of glaucoma
An acute attack of glaucoma can develop at any stage of the disease. An acute attack of glaucoma can be played out without any seemingly obvious reasons. In other cases, an acute attack of glaucoma is promoted by a strong emotional shock, an infectious disease, inaccuracies in eating or drinking, erroneous instillation into the eye of atropine or other means dilating the pupil. Therefore, in the treatment of elderly patients prone to increased intraocular pressure, I must refrain from the appointment of these funds.
An acute attack of glaucoma on a healthy eye often occurs without any reason.
It starts suddenly, most often at night or in the morning. There is a sharp pain in the eye, orbit. Headache is accompanied by vomiting, general weakness of the body. Patients are deprived of sleep and appetite. Such common symptoms of an acute attack of glaucoma can cause diagnostic errors.
Accompanied by pronounced phenomena from the side of the eye: edema of the eyelids and conjunctiva, often there is watery eyes.
To provoke an acute attack of glaucoma can be stressful situations, stay in the dark, long work in an inclined posture, instillation into the eye of the mydriatic, side effects of some common medicine.
In the eye there are severe pains, irradiating to the corresponding overhead or half of the head. The eye is red, the vascular pattern on the conjunctiva and sclera sharply increases. The cornea looks rough, dull, unclear compared to a transparent, shiny, healthy cornea; Through a pinched cornea is seen a wide oval pupil that does not respond to light. Iris changes color layer (as a rule, it becomes greenish-rusty), its pattern is smoothed, unclean. The front camera is either very small, or none at all, which can be seen with focal (side) illumination. Palpation of such an eye is painful. In addition, there is a stony density of the eyeball. Vision is sharply reduced, the patient seems to have a thick fog before his eye, around the light sources rainbow circles are visible. Intraocular pressure rises to 40-60 mm Hg. Art. As a result of constriction of a part of the vessels, the phenomena of focal or sectoral necrosis of the iris stroma develop with subsequent aseptic inflammation. The formation of the posterior synechiae but the edge of the pupil, goniosinechia, deformity and pupil displacement. Often due to severe pain in the eye due to the compression of sensitive nerve fibers, blood pressure rises significantly, nausea and vomiting appear. For this reason, this clinical condition is mistakenly regarded as a hypertensive crisis, a dynamic disorder of cerebral circulation or food poisoning. Such errors cause the patient to start lowering intraocular pressure too late, when disturbances in the optic nerve become irreversible and lead to the development of chronic, closed-angle glaucoma with constantly increased intraocular pressure.
[10], [11], [12], [13], [14], [15]
Open angle glaucoma
Open angle glaucoma often begins and progresses imperceptibly for a patient who does not experience any unpleasant sensations and consults a doctor only when gross visual impairments appear (developed or advanced stages), at these stages it becomes very difficult to stabilize the process, if at all perhaps.
Open-angle glaucoma can be confused with cataract, leave the patient without treatment and allow the development of an incurable blindness.
With cataracts, intraocular pressure is normal, and when examining transmitted light, the pink glow of the pupil is weakened and black strokes and spots of more intense opacities can be distinguished against it.
Subacute attack of primary occlusive glaucoma
Subacute attack of primary closed-angle glaucoma occurs in a lighter form if the angle of the anterior chamber is not closed all over or is not tight enough. With subacute attacks, vagulation does not develop and necrotic and inflammatory processes in the iris do not occur. Patients usually complain about blurring the vision and the appearance of rainbow circles when looking at the light. Pain in the eyeball is mild. When examined, there is a slight corneal edema, a mild dilatation of the pupil, hyperemia of the episcleral vessels. After a subacute attack there is no deformation of the pupil, segmental atrophy of the iris, the formation of the posterior synechia and goniosinechia.
Congestive form of glaucoma
For the congestive form of glaucoma is characterized by the appearance of early subjective signs, which facilitates early diagnosis of the disease. In the initial stage, patients complain of blurred vision, the appearance of iridescent circles, unpleasant sensations, sometimes slight pain in the eye area, a change in refraction - the appearance of myopia. Often these symptoms appear after emotional stress, mental and physical overload. The cause of these complaints is a short-term increase in intraocular pressure, causing transient, unstable changes in the anterior part of the eye.
In the initial stages of congestive glaucoma there are still no organic changes in the organ of vision. Periods of rising of intraocular pressure are short-lived, therefore at inspection of patients visual acuity, the field of vision is not changed, there are no changes and from an optic nerve. The initial period lasts from a few days to a year.
Over time, increased intraocular pressure is repeated more often, periods of increased intraocular pressure are prolonged, glaucoma passes into the stage of pronounced stagnant glaucoma. At this stage there are persistent objective changes in the anterior part of the eye, a violation of visual functions is detected.
[16]
Simple glaucoma
Simple glaucoma is much less common than a congestive form of glaucoma: in 4-5% of cases in relation to stagnant. It flows without objective changes in the anterior part of the eye. The disease begins imperceptibly, so that patients very often do not suspect that they have one eye struck, and they discover it by accident.
The appearance of the eyes with simple glaucoma is normal: the phenomena of irritation are completely absent, occasionally a few enlarged veins and a slightly enlarged and slightly reacting pupil to the pupil can be noted. The main sign of glaucoma is an increase in intraocular pressure - with simple glaucoma may be only mild.
Often during the first study, intraocular pressure appears to be normal, and only by repeated and systematic measurement at different hours for several days can some increase and instability of this pressure be established. At the same time, it appears that in the evening the pressure is much lower than in the morning (a difference of 5 mm Hg will speak in favor of glaucoma).
With simple glaucoma, as with stagnant, the field of vision gradually decreases and the visual acuity decreases. Since the pupil glows with a grayish color and therefore it seems not quite clean, an inexperienced doctor who does not know the technique of ophthalmoscopy can take a simple glaucoma for senile cataract. Essentially, simple and stagnant glaucoma is the same disease, and these forms can go one into another: congestive glaucoma passes into a simple and back.
Simple glaucoma, unlike congestion, is characterized by an even, slow course, intraocular pressure rises are low, sudden fluctuations in intraocular pressure are rare. But the disease is steadily progressing.
The main symptoms of simple glaucoma are increased pressure, the development of atrophy of the optic nerve with the excavation of its disc, the narrowing of the field of vision and reduced visual acuity. The absence of early subjective sensations leads to the fact that patients turn to the doctor only when there is a decrease in visual functions, that is, when irreversible changes already occur. Often sight on one eye is already completely lost or sharply reduced. Later, the treatment of the patient to the doctor, respectively, worsens the prognosis of simple glaucoma. With late recognition and irregular treatment of glaucoma, blindness occurs.
Absolute glaucoma
Absolute glaucoma is the outcome of all clinical forms of glaucoma that go on unfavorably and result in blindness. Under the influence of a constantly acting elevated ophthalmotonus, disturbance of circulation and metabolism in the eye tissues, sharp atrophic changes occur, the function completely fades, the eye is hard as a stone. Sometimes severe pains begin. Absolute glaucoma becomes an absolute sore glaucoma. In the eye with absolute glaucoma, dystrophic processes are noted, often cornea is affected in the form of dystrophic keratitis, ulcers of the cornea, etc. Dystrophic ulcers can become infected, a purulent corneal ulcer develops, often resulting in perforation of the cornea. When the cornea is perforated on the eye with high intraocular pressure, expulsive hemorrhage can swell - a disruption of the long posterior ciliary arteries under the choroid. In this case, all the shells of the eyeball or part of them under the pressure of blood are pushed out of the eyeball.
[17], [18], [19], [20], [21], [22], [23]
Secondary glaucoma
Secondary glaucoma has the same stages and degrees of compensation as primary glaucoma, but there are some special features:
- one-sided process;
- can proceed either as an open-angle glaucoma, or as an angle-closure glaucoma (i.e., paroxysmal);
- Invented type of the intraocular pressure increase curve (evening ascent);
- very quickly reduced visual function, within 1 year;
- with timely treatment, lowering of visual functions is reversible.