What is it?

What exactly is glaucoma?

Glaucoma (glaucoma) is a common eye disease affecting millions of people. It is characterized as an insidious and irreversible eye condition that can even lead to complete blindness if not treated early. Glaucoma is usually due to high fluid pressure inside the eye. This pressure is called intraocular pressure, increases the risk of progressive destruction of the optic nerve leading to vision loss.

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Glaucoma develops slowly over a period of years. It is a "silent" disease, since most patients in the early stages, often do not show symptoms. Increased intraocular pressure (typically over 20-22 mmHg) is the first indication of the existence of the disease, although there are rare cases when we have glaucoma even with normal pressure (low pressure glaucoma – the vascular factor plays an important role).

Causes and symptoms

What causes glaucoma?

Glaucoma is caused by the inability of the liquid extraction which is normally generated inside the eye. This leads to an increase in the intraocular pressure. Over time, the pressure on the optic nerve can lead to progressive and irreversible damage and permanent vision loss. Note that an increased intraocular pressure, does not mean glaucoma, if no optic nerve damage is observed. In this case, it is called ocular hypertonia.

Are there any symptoms?

Glaucoma, at least in the initial stages, presents no symptoms. It is the main cause for the high risk of this insidious disease. In advanced stages but apart from damages to the peripheral vision alteration starts in the central vision as well.

 glaucoma3   glaucoma4

Predisposing factors:

  • heredity (family history)
  • advanced age (aging)
  • diabetes
  • hypertension
  • myopia
  • black race
  • Long-term administration of cortisone, especially locally (eye drops)
  • eye injury
  • vascular diseases
  • eye inflammations

Glaucoma, in most people, remains undiagnosed, so it is necessary to perform an ophthalmologic testing after age 40.

Types

The main types of glaucoma are:

  • Open-angle glaucoma (chronic simple glaucoma - the most common) when the angle between the peripheral cornea and the iris is open. It is the most insidious form of glaucoma as it is completely asymptomatic. In chronic simple glaucoma although the angle is open, increased resistance to outflow of aqueous fluid through the trabecular meshwork can be detected. This resistance to drainage causes an increase in the intraocular pressure, resulting in optic nerve damage. So while the eye shows normal and painless loss of vision, patients do not realize the presence of the disease. Chronic simple glaucoma literally "steals" the vision silently.
  • Closed-angle glaucoma (acute glaucoma) occurs when the angle between the peripheral cornea and the iris is closed and usually occurs in older people and farsightedness. The intraocular pressure is extremely high and the vision is too blurry. The symptoms may be particularly acute with severe pain in the eye and redness. Acute closed-angle glaucoma requires immediate treatment and treatment e.g. drops to lower the intraocular pressure. If the pressure remains in high enough levels, surgery is required
  • Congenital glaucoma: very rare but serious. It appears in the first 4 years of life (early childhood). A child with congenital glaucoma is quite restless, has many tears, rubs their eyes often and shows increased sensitivity to light
  • Normal tension glaucoma: occurs in people who have an optic nerve with great sensitivity, capable to be influenced by intraocular pressure values considered perfectly normal for most people
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Treatment

How can glaucoma be treated?

The primary objective is to reduce the intraocular pressure. Usually it is initially treated by administering eye drops (eye drops). Laser treatments or surgery are applied if the medication is not proving effective.

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  • Argon Laser trabeculoplasty (ALT - Argon Laser Trabeculoplasty): in open-angle glaucomas, we apply thermal laser in a filter, the angle of the anterior chamber in order to open it up
  • Selective Laser trabeculoplasty (SLT - Selective Laser Trabeculoplasty): we apply a special non-thermal laser in a filter, in the angle of the anterior chamber, which results in the reformation and opening of the filter. With SLT tissues are not disrupted (Reusable in case of a relapse)
  • Peripheral iridotomy: using a special thermal laser, the ophthalmologist opens small holes in the periphery of the iris, in order to ensure directl communication of the anterior with the posterior chamber. Applied to glaucoma of narrow or closed angle
  • Cycloablation: a modern application earlier method, that of cycloablation. With this method, a special laser is applies, external or internal to the eye in the region of the ciliary body behind the iris, in order to reduce the production of aqueous fluid
  • Surgery: Trabeculectomy is the most common method. With this method, we surgically construct an artificial drainage pathway of aqueous fluid from the anterior chamber to the outer surface of the sclera. The implantation of artificial valve mechanisms and canaloplasty prove, however, as promising techniques

Tips

Basic rules:

The chronic simple glaucoma is entirely asymptomatic. Remember that your role in treating the disease is important. Your chronic commitment is essential for the preservation of your precious eyesight. Take your medication (eye drops, tablets), just as recommended by your ophthalmologist. Tell your doctor about all adverse reactions to medication. Because of the hereditary factor, encourage your adult relatives so they can regularly undergo an eye examination.

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