Primary glaucoma

In 1952, at the All-Union congress on glaucoma, a classification was proposed, proposed by Professor BL Polyak.

The classification reflects the main clinical forms of glaucoma, the dynamics of the process - the state of the eye function and the degree of compensation of intraocular pressure.

• Forms: congestive and simple glaucoma.
• Stages: initial, advanced, far-reaching, almost absolute and absolute.
• By the degree of compensation: compensated, subcompensated, uncompensated, decompensated.

[1], [2], [3], [4],

Congestive glaucoma

Congestive glaucoma is the most common form of glaucoma. With her, a number of characteristic changes in the anterior part of the eye are found. Most often, glaucoma is characterized by a prolonged chronic course. Very rarely the disease begins acutely, in the form of a first attack in a healthy eye before. Glaucoma, as a rule, affects both eyes, but the process begins first on one. The gap between the diseases of both eyes in most cases is small: several months, a year, two. But it is not uncommon for glaucoma in the second eye to be found after many years (10-15) after determining it in the first eye.

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.

In the advanced stage of congestive glaucoma, there are:

1. congestive hyperemia of the anterior ciliary vessels. These vessels are visible on the sclera near the limbus, represent a continuation of the muscular arteries and veins;
2. dullness of the cornea;
3. decreased sensitivity of the cornea. The decrease in the sensitivity of the cornea occurs as a result of compression of sensitive ends, and later as a result of deep trophic disturbances in them;
4. a decrease in the depth of the anterior chamber as a consequence of an increase in the vitreous volume;
5. the pupil is somewhat enlarged, sometimes it has the shape of a vertically elongated oval, and reacts weakly to light. This depends on the compression of the ciliary nerves and the onset of atrophy of the iris, an increase in the tone of the sympathetic nervous system;
6. with ophthalmoscopy, optic nerve atrophy, disc excavation, kink and vasodilation are detected;
7. At the same time, the functions of the eye are disturbed: the central vision is lowered, the field of view tapers (first from the inside, then from the rest of the periphery), the blind spot is usually enlarged and merges with the visual field defect.

With a pronounced narrowing of the field of vision, not only from the nose, but also from other sides and a decrease in visual acuity, one can think of a far-gone glaucoma.

As a result of the continuing atrophy of the visual fibers, almost absolute glaucoma can occur when the patient is only able to catch the movement of the hand or light.

[5], [6], [7], [8], [9], [10],

Absolute glaucoma

Absolute glaucoma is a sad completion of the disease, when vision is completely lost (equal to zero).

The transition of glaucoma from one stage to another takes place gradually or rapidly, depending on the degree of compensation of the process in this patient. To achieve a state of compensation for glaucoma is to stop the development of glaucoma. With compensated (non-progressive) glaucoma, visual functions are preserved. To do this, it is necessary to create the right conditions for treatment and treatment (labor and life) from the very beginning of the disease (in the stage of initial glaucoma). To compensate for glaucoma, first of all, the intraocular pressure should be normalized.

Depending on the degree of compensation for the glaucomatous process, the following are distinguished:

1. compensated glaucoma, in which intraocular pressure due to treatment is normalized and visual functions do not fall;
2. subcompensated, in which the intraocular pressure fluctuates between 23 and 35 mm Hg. P.
3. uncompensated, in which the intraocular pressure exceeds 35 mm Hg. P.
4. decompensated glaucoma, or its acute period, in which there are all the phenomena characteristic of the initial glaucoma, but expressed in the river form and coming suddenly.

Comparative signs of glaucoma and iritis

Attack of glaucoma Attack of the irit 1. Intraocular pressure increased 1. Intraocular pressure is usually normal and only occasionally slightly reduced or slightly elevated 2. The cornea is edematous, muddy, dull 2. Normal cornea 3. There is an expansion of venous vessels on the eyeball 3. Significant ciliary injection 4. The pupil is wider than on the healthy side 4. The pupil, if not widened by atropine, already, than on the other side 5. The sensitivity of the cornea is lowered 5. The sensitivity of the cornea is normal 6. The front camera is shallow 6. Normal-depth front camera 7. Pains irradiate into the forehead, jaw, occiput 7. Pain in the eye itself 8. Complaints about rainbow twists before the eye 8. There are no rainbow circles

These symptoms are mainly related to congestive glaucoma.

[11], [12], [13], [14], [15], [16], [17]

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 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.

In 1975, at the All-Union Congress of Ophthalmologists on the pathophysiological mechanisms of hypertension, the following forms were singled out:

1. closed angle glaucoma, in which the increase in intraocular pressure is caused by blockade of the anterior chamber angle, intraocular structures (iris, lens, vitreous body) or goniosinchia;
2. open angle glaucoma caused by damage to the drainage system of the eye;
3. mixed glaucoma, in which both mechanisms of increasing intraocular pressure are combined. There is also a non-glaucoma ophthalmic hypertension caused by an imbalance between production and outflow of watery eyes.

When formulating the diagnosis, the stages of glaucoma are indicated.

• I stage (initial) - the peripheral field of vision is normal, but there are defects in the central field of vision. The ocular bottom without visible changes, but there may already be a small excavation of the optic nerve disc, not reaching its edge.
• (Stage I (developed) - the peripheral field of vision is narrowed from the nose by more than 10 °, the excavation of the optic nerve disk is moderately pronounced and reaches the edge in some areas.
• III stage (far gone) - peripheral field of vision narrowed from the nose to 15 °, deep marginal excavation of the optic disc.
• IV stage (terminal) - there is no objective vision or light perception with an incorrect projection of light, total excavation and atrophy of the optic nerve is preserved.

Condition of intraocular pressure. For its designation the following gradations are used:

• A - normal pressure (does not exceed 21 mm Hg);
• B - moderately elevated pressure (from 22 to 32 mm Hg);
• C - high pressure (more than 32 mm Hg).

Dynamics of glaucomatous process:

1. stabilized glaucoma - with prolonged observation (no less than a sin of months), the condition of the visual field and the optic disc remains stable;
2. unstabilized glaucoma - the narrowing of the field of vision and excavation of the optic disc are increasing. Primary open-angle glaucoma. Primary acute angular glaucoma occurs at a young age, but it is more typical for mature and elderly people and is the most common form of glaucoma. The disease is observed equally often in both men and women. The primary open-angle glaucoma is attributed to genetically determined diseases, in most cases there is a polygenic transmission of the disease.