1. What is Glaucoma
Glaucoma is a common and difficult eye disease with intermittent or continuous increase in intraocular pressure. The disease is rapid, harmful and can cause blindness at any time.Continuous high intraocular pressure can cause damage to various parts of the eyeball and visual function, resulting in atrophy of the optic nerve, visual field, and vision loss. Blindness is only a matter of time. It can be completely blind within 24-48 hours of the acute attack. Without timely treatment, the field of vision can be lost and blind.
Glaucoma is one of the three major blinding diseases that cause blindness in humans. The incidence rate of the total population is 1%, and it is 2% after 45 years of age. The clinical manifestations and characteristics of various types of glaucoma are different, so early detection and early treatment should be achieved.
2. Causes of Glaucoma
Pathological increase in intraocular pressure is the main risk factor for glaucoma. The increased intraocular pressure leads to optic nerve damage through two mechanisms: mechanical compression and causing optic nerve ischemia.The longer the duration of increased intraocular pressure, the more serious the visual impairment. The reason for the increased intraocular pressure in glaucoma is that the dynamic balance of the aqueous humor cycle is disrupted.
A few due to excessive secretion of aqueous humor, but most of them still have obstacles in the outflow of aqueous humor, such as narrowing even closing of the antantior chamber angle, trabecular sclerosis, etc.
Increased intraocular pressure is not the only risk factor for glaucoma. Some patients have normal intraocular pressure but have typical glaucoma pathological changes.
Although some patients with Glaucoma have controlled intraocular pressure, the optic nerve damage continues to develop, indicating that there are other factors. It is related to the onset of glaucoma, such as variation of eye anatomy, age, race, family history, myopia, cardiovascular disease, diabetes, and abnormal blood rheology.
3. Classification/ Types of Glaucoma
1. Congenital glaucoma
According to the age of onset, it can be infantile glaucoma and juvenile glaucoma. Glaucoma under 30 years old falls into this category. Causes of congenital glaucoma are formed during embryonic development, dysplasia front chamber angle, resulting aqueous discharge blocked, causing the intraocular pressure rises. 25-80% of patients show within six months, 90% of children can be diagnosed by the age of one year. 10% of patients develop symptoms at the age of 1-6.
1.1) Infantile glaucoma
Children with glaucoma aged 0-3 years are generally classified as such. This type is the most common in congenital glaucoma. The mother is ill and shows symptoms immediately or slowly after birth. It is usually binocular disease, but it does not necessarily start at the same time, and 25-30% of children have monocular disease. The clinical manifestation is that the eyeballs are obviously prominent after birth, and the cow-like eyes are called "bull eyes". They are afraid of light, tearing, rubbing their eyes, blepharospasm, corneal opacity, irritability to cry, poor diet or vomiting, sweating Wait for systemic symptoms.
The key to the prognosis of this type is the timely and correct diagnosis. Because the eye wall of children is in the developmental stage, the intraocular pressure may be normal, and the fundus examination is not well coordinated, so doctors who lack glaucoma's rich clinical experience are prone to misdiagnose such patients. Diagnosed, the optic nerve has already shrunk.
1.2) Adolescent glaucoma
The age of onset is between 3-30 years old. The clinical manifestations of this type are similar to those of open-angle glaucoma, and the onset is subtle and extremely harmful. In recent years, this type has mostly occurred in patients with myopia and the trend of increasing incidence. More than 90% of the patients do not show typical glaucoma symptoms, but come to the clinic with "myopia, visual fatigue, headache, insomnia", or even blindly blind, and it is known that glaucoma after detailed examination.
Some patients found glaucoma, but they mistakenly thought that I don't have any feeling now, and my eyesight can be. It's impossible to be as serious as the doctor said, and I'm really blind. At that time, I regretted it was too late to suffer in the dark. Spent a lifetime.
2. Primary glaucoma
According to the shape and anxiety of the anterior chamber anterior horn, it is divided into acute and chronic angle-closure glaucoma, open-angle glaucoma, etc.:
2.1) Acute angle-closure glaucoma
This type is more common in middle-aged and elderly people, accounting for 90% of people over 40 years old. The incidence of females is relatively high, with a male to female ratio of 1:4. Come on fiercely, the symptoms are mild, the anterior chamber is narrow or completely closed at the time of onset, showing sudden onset of severe bulging headache, sharp losses of vision, hard eyeballs like stones, conjunctival congestion, nausea and vomiting, constipation, blood pressure increase. The severe systemic symptoms are easily misdiagnosed as gastroenteritis, encephalitis, neuropathic headache and other diseases. If you can't get timely diagnosis and treatment for 24-48 hours, you can be completely blind and dull. At this time, it is called "burst glaucoma".
But some patients in the clinic have a strong tolerance for pain, only showing orbital and ocular discomfort, even Then there is no symptom in the eye, and it is transferred to the forehead, ears, maxillary sinus, teeth and other pains. Acute angle-closure glaucoma is actually caused by chronic angle-closure glaucoma.
2.2) Chronic angle-closure glaucoma
This type accounts for more than 50% of patients with primary glaucoma and the age of onset is more than 30 years old. In recent years, with the continuous acceleration of life rhythm, social competition has become increasingly fierce, and mental workers have a tendency to rise sharply. Obvious incentives, such as emotional excitement, visual fatigue, excessive brain use of eyes, long-term insomnia, habitual constipation, women during menstruation, or inappropriate local and systemic medication, can be induced, manifested as dry eyes, fatigue discomfort, pain, Blurred vision or decreased vision, rainbow vision, dizziness, insomnia, and income pressure blood pressure.
It can be relieved after rest, and some patients are blind without any symptoms. During examination, the intraocular pressure can be normal or fluctuating, or not too high about 20-30mmhg, and the fundus can be normal in the early stage. This type is most likely to be misdiagnosed. Such repeated attacks can form burst glaucoma once the anterior chamber angle is closed (see: acute angle-closure glaucoma).
2.3) Primary open angle glaucoma
It occurs more than 40 people. 25% of patients have a family history. The vast majority of patients have no obvious symptoms, and some have no discomfort until they become blind. The anterior chamber angle was opened during the attack. This type of diagnosis is the most critical. At present, once the diagnosis is confirmed by Western medicine, there have been obvious fundus changes. Therefore, every patient with glaucoma signs must be comprehensively and carefully excluded. Early diagnosis and early treatment should not wait until the diagnosis of glaucoma is confirmed. The best time to treat has been lost.
3. Secondary glaucoma
Glaucoma caused by eye and systemic diseases are of this type. The etiology is quite complex and there are many types. Now only a few brief descriptions of the most common secondary glaucoma:
3.1) Refractive errors (i.e. nearsightedness, farsightedness) secondary glaucoma
Due to dysregulation of the refractive system, dysfunction of the ciliary muscles, unsteady secretion of the aqueous humor, and the compression of the anterior chamber angle by the root of the iris, the drainage of the aqueous humor is blocked, which causes an increase in intraocular pressure. The clinical feature of these patients is the symptoms of conscious visual fatigue Or there is no obvious discomfort, wearing glasses can not correct vision, and it is easy to misdiagnose, so patients with a history of refractive errors should promptly find a doctor with extensive clinical experience for glaucoma and detailed examination if there is an unexplained eye abnormality.
3.2) Glaucoma secondary to cornea, conjunctiva and uveitis
Intraocular inflammation causes turbidity of the aqueous humor, ciliary muscles, iris, cornea edema, shallow angle of the chamber, or pupil adhesion, trabecular meshwork obstruction, and the aqueous humor cannot be discharged normally, causing increased intraocular pressure.Generally, treats the disease symptomatically with antibiotics and hormones, which artificially interferes with the autoimmune function, causing the disease to recur repeatedly and it is difficult to heal.
3.3) Cataract secondary glaucoma
During the development of crystal opacity, edema or swelling or translocation leads to a relatively narrow anterior chamber and obstruction of aqueous humor discharge, resulting in increased intraocular pressure. Once cataract surgery, the optic nerve atrophy and soon become blind.
3.4) Traumatic glaucoma
A corneal tear, iris root detachment, or antantior chamber hemorrhage, vitreous hemorrhage, retinal concussion, which hinders the secretion and discharge of aqueous humor, secondary to glaucoma and optic nerve atrophy. The damaged intraocular tissue, but the fundus injury caused by it cannot be corrected, so this type of patient is generally treated after Western medicine at that time and thinks it is good, no longer treated, once found that the optic nerve atrophy has caused serious vision damage.
4. Symptoms of glaucoma
1). Increased intraocular pressure
Measured with a Schurz tonometer, the normal intraocular pressure range is 10-21 mm Hg. Touching the eyeball with your finger is full of flexibility. When the intraocular pressure rises to 25-40 mmHg, touching the eyeball with your finger seems to be playing . The beriberi ball is harder. When it reaches 40-70 mm Hg, and then touch it with your finger, the eyeball is as hard as a stone.2). The field of vision becomes narrower and the vision is reduced
Due to high intraocular pressure, the optic nerve is damaged. Early vision loss and foggy vision often occur at night, and disappear in the next morning.3). Headache and bulging eyes
Due to the sharp increase in intraocular pressure, the trigeminal nerve is slightly stimulated, causing reflexive pain in the trigeminal nerve distribution area. Patients often feel migraine and eye pain.4). Nausea and vomiting
Increased intraocular pressure can also reflexively cause excitement of the vague nerve and vomiting nerve center, causing severe nausea and vomiting.5). Rainbow Vision
Due to increased intraocular pressure, obstruction of fluid circulation in the eye causes corneal edema and refractive changes. At this time, when looking at the sun, especially when looking at the lights, there will be a red ring in the outer circle, a purple ring in the inner circle, and a green ring in the middle. When the intraocular pressure returns to normal, the color ring disappears. This phenomenon is called rainbow vision in medicine. If it is physiological or cataractic rainbow, there will be no symptoms of headache and increased intraocular pressure.5. Hazards of Glaucoma
1). Optic nerve damage:
The main reason is high intraocular pressure, and a small number of patients have normal intraocular pressure, called normal-tension glaucoma.Although the clinical features of glaucoma are diversified, the most important hazard is impairment of visual function, which is manifested by Decreased vision and visual field defects. Vision loss generally occurs during acute high intraocular pressure.
The initial stage of visual loss is due to the high intraocular pressure that prevents the corneal endothelium from discharging the water in the cornea normally, resulting in corneal epithelial edema; acute sustained high intraocular pressure can reduce vision to light perception.
2). Chronic high intraocular pressure and persistent high intraocular pressure cause optic atrophy in the later stage: lead to visual field defect
Glaucoma optic nerve atrophy is multifactorial, but the main causes are mechanical compression and optic disc ischemia. The high intraocular pressure forces the membrane sieve plate to swell backward, and the optic nerve fibers passing through the sieve plate are squeezed and pulled, blocking the axoplasmic flow of the optic nerve fibers. High intraocular pressure may cause optic disc ischemia and aggravate optic nerve fibers The injury eventually caused atrophy of the optic nerve.6. Daily diet care for Glaucoma
1. Foods rich in vitamins A, B, C, and E have a good preventive effect on glaucoma, so eat more vitamin-rich foods in daily life, such as fresh vegetables, such as fresh fruits, and moderate amounts of liver, fish, and meat , Coarse grains, vegetable oils, etc.; eat peanuts, walnuts, soy milk and other foods tonic liver and kidney.2.General glaucoma patients will be accompanied by high blood sugar diseases. If patients have high blood sugar, they can take honey, watermelon, loofah and other foods in daily life. These foods have diuretic effects and can effectively reduce the production of aqueous humor in the eyes., Has a good effect on reducing intraocular pressure.
3. Should be the law of the daily life of patients with glaucoma diet, eating three meals a day can not eat too full Toto slowly, which benefits both to the stability of blood vessels, nervous and endocrine systems.
4. The main cause of visual impairment in patients with glaucoma is because of blood supply problems of the optic nerve. Therefore, it is best for patients to eat more light foods. Foods with high sugar and high fat should be eaten as little as possible or not, spicy and irritating. Food should not be eaten, and fried foods should not be eaten.
7. Sort out some bad habits that cause Glaucoma
1). Unreasonable use of eye drops
For many offices workers now, if the eyes show discomfort symptoms, busy work or other reasons can not take the medicine on time, suddenly remembered or the eyes are uncomfortable to order medicine. Such unreasonable medications often easily delay treatment. It is one of the causes of glaucoma.2). Sleep on the table
Some people are used to lying on the table to sleep in the morning. During sleep, once the eye is pressed against the arm, it will cause pressure on the eye. Over time, it is easy to damage the cornea and retina. It may also cause increased intraocular pressure and induce glaucoma. one of the reasons.Best Sleeping Time for Different Age Groups: Benefits and Factors
3). Bad habits
Poor lifestyle habits can also lead to the causes of glaucoma, such as smoking and drinking, impermanence of daily life, irregular diet, moodiness, habitual constipation, intractable insomnia, etc. These are the factors that affect the causes of glaucoma.4). High myopia is easy to get glaucoma
In patients with high myopia, the eyeball is elongated, the tension of the eyeball wall is reduced, and the resistance of the optic nerve to compression is relatively low. Patients often think that the degree of myopia is deepening, constantly changing glasses, and finally found that it is glaucoma, and the discovery is already late. Therefore, it is recommended that people with high myopia check the visual field and visual function once a year or once every two years.5). Tie
People with glaucoma really should not wear a tie often. When the tie is too tight, it can cause a certain pressure on the neck veins, causing more blood to flow to the eye, resulting in increased eye pressure. But it does not mean that wearing a tie increases the risk of glaucoma. In addition, patients with glaucoma should practice yoga less.6). Turn off the lights and play with your phone
How many times did I fall asleep while holding my mobile phone in the dark and smashing my phone on my face to wake myself up, but after waking up, I played with my phone for a while. Night after night, every day is spent in such a cycle. I don't feel like a day is not complete without brushing my phone before going to bed! But do you know? The pupils will be enlarged in the dark, and the large amount of strong light entering the eyes may cause angle-closure glaucoma and even permanent blindness.8. Early signal of Glaucoma
1. After getting up in the morning, reading books and newspapers is more difficult, prone to sore nose roots and orbital forehead pain. Because normal people's intraocular pressure fluctuates day and night, it is generally higher in the morning and lower at night. 24-hour intraocular pressure fluctuations of glaucoma patients are greater, so the morning IOP is higher and symptoms will appear.2. Seeing colorful halos in the light at night, like a rainbow in the sky after rain, medically called rainbow vision. This is due to changes in corneal refractive due to increased intraocular pressure and corneal edema.
3. The eyesight gradually declines, and the vision correction of optometry and optics is less than 1.0 (logarithmic vision chart is 5.0), especially those with high myopia, who still have headaches and bulging eyes after wearing moderate glasses. As the sclera (white part of the eyes) of high myopia becomes longer, the elasticity decreases significantly. Therefore, when there is high intraocular pressure, the symptoms are not obvious or asymptomatic, the patient is easy to neglect, but the vision is quietly lost, and the doctor is often easy to miss the diagnosis.
4. Emotional excitement or staying in the dark for too long (such as watching movies, TV or working in a dark room), there will be bulging eyes, headache, blurred vision, and there is a layer of cloud in front of the eyes . This is an early symptom of angle-closure glaucoma. After repeated recurrences, it is possible to suddenly enter an acute episode.
5. Patients with glaucoma usually drink more water and have headaches when drinking more than 300 ml at a time. This is because the drinking water is fast and the amount is large, which can reduce the osmotic pressure caused by blood dilution, and the aqueous humor entering the eye will increase, which will cause the increase of intraocular pressure. Patients often have bulging headaches 15 to 30 minutes after drinking water.
9. Self-test of Glaucoma
1). Rainbow vision:
This is a very special symptom of glaucoma, which appears every night. When looking at the lights, especially when looking at round bulbs, you can see a colorful halo around the lights, like a rainbow after a rain.2). Haze vision:
Temporary blurred vision appears as if looking at the outside scene in the fog. If the symptoms are mild, the symptoms can disappear after a night's sleep.3). Eye pain:
It often occurs at the same time as haze vision, but also occurs alone. When you have symptoms of bulging eyes, please do not forget the possibility of suffering from glaucoma.4). Migraine:
Some patients with chronic glaucoma often have migraine headaches, and some have total headaches. See an ophthalmologist to see if they have glaucoma.5). Symmetry:
A person diagnosed with glaucoma in one eye, if the other shows one of the same symptoms, then this eye may also be suffering from glaucoma.According to the above performance, once you predict the possibility of suffering from glaucoma, you should go to the hospital to confirm the diagnosis in time.
10. How to effectively prevent glaucoma
1. Feel comfortable and avoid excessive mood swings.2. Regular life and diet, enough rest and sleep every day. Appropriate amount of physical exercise of collar, collar should not be too tight, head should not work for a long time, diet is light and rich, smoking is prohibited, alcohol is prohibited, strong tea and coffee are prohibited, water intake is appropriately controlled to increase the waterproof content and increase intraocular pressure.
3. Pay attention to eye hygiene, do not read for a long time or work or stay in the dark room and low light conditions for too long, and have a weak light when watching TV.
4. Use the medicine carefully, and pay attention to avoid the cold or hot stimulation when the seasons change.
5. The glaucoma family and risk factors must be reviewed regularly. Once the symptoms occur, they must actively cooperate with treatment to prevent sudden loss of visual function.
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