symptoms of glaucoma, early symptoms and signs of glaucoma
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Typical symptoms: high intraocular pressure, sudden and rapid increase of intraocular pressure, eye swelling and eye pain, and visual impairment
Related symptoms: high intraocular pressure, sudden and rapid increase of intraocular pressure, eye swelling, eye pain and visual impairment
1. Congenital glaucoma
According to the onset age, it can be infantile glaucoma and adolescent glaucoma. Glaucoma under 30 years old belongs to this category. Congenital glaucoma is caused by abnormal development of anterior chamber angle during embryonic development, which leads to blocked aqueous humor discharge and increased intraocular pressure. 25-80% of patients show up within six months, and 90% of children can be diagnosed by one year old. 10% of patients developed symptoms when they were 1-6 years old.
1) Infantile glaucoma:
Children with glaucoma aged 0-3 years are generally classified as such. This type is the most common congenital glaucoma. It is sick in the mother's body and shows symptoms immediately or slowly after birth. Generally, it is binocular disease, but it does not necessarily start at the same time, and 25-30% of children have monocular disease. The clinical manifestations are obviously prominent eyeballs after birth, which are quite similar to cattle's eyes, so they are called "cattle's eyes". They are afraid of light, tears, like rubbing eyes, blepharospasm, unclear cornea, easy to cry, poor diet or vomiting, sweating and other systemic symptoms. The key to the prognosis of this type lies in timely and correct diagnosis. Because the eyeball wall of children is in the developmental stage, the intraocular pressure may be normal, and the fundus examination is not well coordinated, so there is a lack of glaucoma.
2) Juvenile glaucoma:
The onset age is between 3 and 30 years old. The clinical manifestations of this type are similar to those of open-angle glaucoma, with hidden onset and great harm. In recent years, this type mostly occurs in myopia patients and its incidence is on the rise. More than 90% of patients do not show typical glaucoma symptoms, but come to see a doctor with "myopia, asthenopia, headache, insomnia" or even unconsciously blindness. Only after detailed examination can they know that it is glaucoma. Some patients found out glaucoma, but they mistakenly think that I don't feel anything now, and my eyesight is OK. It is impossible to be as serious as the doctor said, and I am really blind. It is too late to regret at that time, and I can only spend my life in pain in the dark.
2. Primary glaucoma
1) Primary acute angle-closure glaucoma:
The occurrence of acute angle-closure glaucoma is caused by the sudden narrowing or closing of intraocular chamber angle and the failure to discharge aqueous humor in time, which leads to full aqueous humor and sharp increase of intraocular pressure. Most of them are middle-aged and elderly people, and 90% are over 40 years old. The incidence rate of women is higher, and the ratio of male to female is 1: 4. The symptoms are fierce, and the anterior chamber is narrow or completely closed at the time of onset, showing sudden severe eye swelling and headache, sharp loss of vision, hard eyeball, conjunctival congestion, nausea and vomiting, constipation and elevated blood pressure. At this time, the systemic symptoms are severe and it is easy to be misdiagnosed as gastroenteritis, encephalitis, nervous headache and other diseases. If you can't get timely diagnosis and treatment for 24-48 hours, you can be completely blind and have no light sensation, which is called "fulminant glaucoma" at this time. However, some patients have strong tolerance for pain in clinic, which only shows discomfort in orbit and eyes, and even no symptoms in eyes, but transfers to pain in forehead, ears, maxillary sinus and teeth. Acute angle-closure glaucoma is actually caused by repeated prolongation of chronic angle-closure glaucoma.
2) Primary chronic angle-closure glaucoma:
This type accounts for more than 50% of patients with primary glaucoma, The onset age is over 30 years old, In recent years, with the accelerating pace of life, Social competition is becoming increasingly fierce, There is a sharp rise in mental workers, This type of attack generally has obvious inducement, such as emotional excitement, visual fatigue, excessive use of eyes and brain, long-term insomnia, habitual constipation, which can be induced by women during menstruation, or improper local and systemic medication, and is manifested as dry eyes, fatigue discomfort, distending pain, blurred vision or decreased vision, rainbow vision, dizziness and pain, insomnia, and elevated blood pressure. After rest, it can be relieved. 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. In this way, once the adhesion of anterior chamber angle is closed, fulminant glaucoma can be formed.
3) Primary open angle glaucoma:
Most of them occur in people over 40 years old. 25% of patients had a family history. Most patients have no obvious symptoms, and some have no discomfort until they are blind. The anterior chamber angle is open during the attack. The diagnosis of this type is the most critical. At present, once it is diagnosed by Western medicine, there have been obvious fundus changes. Therefore, every patient with glaucoma signs must be comprehensively and seriously excluded, and early diagnosis and treatment should be carried out. Don't wait until it is diagnosed as glaucoma before treatment. At that time, the best treatment opportunity has been lost.
3. Secondary glaucoma
Glaucoma caused by eye and systemic diseases belongs to this category, and its etiology is quite complex and there are many kinds. Now only the most common secondary glaucoma is briefly described:
1) Glaucoma secondary to ametropia (i.e. myopia and hyperopia):
Due to the abnormal adjustment of refractive system, ciliary muscle dysfunction, atrial moistureLoss of secretion, combined with iris root compressing anterior chamber angle, The discharge of aqueous humor is blocked, which leads to elevated intraocular pressure. The clinical characteristics of such patients are conscious asthenopia symptoms or no obvious discomfort. Wearing glasses can't correct vision and is easy to be misdiagnosed. Therefore, patients with a history of ametropia should find a doctor with rich clinical experience in glaucoma for detailed examination once they have unexplained eye abnormalities.
2) Inflammation-related glaucoma:
Intraocular inflammation causes turbidity of aqueous humor, edema of ciliary muscle, iris and cornea, shallow angle of chamber, or pupillary adhesion, obstruction of trabecular meshwork, and abnormal discharge of aqueous humor, resulting in elevated intraocular pressure. At present, Western medicine generally uses antibiotics and hormones for symptomatic treatment of this disease, which artificially interferes with autoimmune function, making the disease recurring and prolonging difficult to heal.
3) Glaucoma due to cataract:
① Glaucoma caused by lens swelling: That is, glaucoma caused by swelling cataract refers to glaucoma caused by swelling of senile cataract or turbid swelling after lens trauma.
② Lens soluble glaucoma: Inflammatory glaucoma caused by lens protein leaking through lens capsule when cataract occurs in mature or over-mature stage
③ Lens protein allergic glaucoma: It is rare clinically, which is caused by allergic reaction caused by lens protein after cataract surgery or lens injury.
4) Trauma-related glaucoma:
Angle tear, iridodialysis, or hyphema, vitreous hemorrhage, retinal concussion, Obstruct the secretion and discharge of aqueous humor, secondary glaucoma optic atrophy, If the prognosis is good after active treatment with traditional Chinese medicine, surgery can only repair the damaged intraocular tissue, but the fundus damage caused by it cannot be corrected. Therefore, patients of this type are generally treated by Western medicine at that time, and they are considered fine and no longer treated. Once optic atrophy is found, serious visual damage will be caused.
5) Secondary open angle glaucoma
① Pigmented glaucoma: Secondary open-angle glaucoma caused by pigment dissemination in anterior segment. It has characteristic clinical manifestations: pigment spreading in anterior and posterior segments, iris shape and transillumination defect, etc.
② Drug-related glaucoma: Glaucoma caused by corticosteroids is open-angle glaucoma, which occurs after ocular or systemic use of corticosteroids, including eye liquid or eye ointment, periocular injection, external application to skin, systemic inhalation and oral administration or injection. After long-term use, intraocular pressure rises.
③ Hypersecretory glaucoma: It is a rare special type of open-angle glaucoma, which is characterized by elevated intraocular pressure but normal aqueous humor fluency coefficient.
6) Other continuing glaucoma
① Glaucoma caused by lens dislocation: Glaucoma caused by elevated intraocular pressure caused by lens dislocation.
② Hyphema and glaucoma: Hemorrhage-related glaucoma includes hyphema, hematocellular glaucoma, hemolytic glaucoma and hematocellular glaucoma, among which hyphema is the most common.
③ Neovascular glaucoma: The common manifestations are eye pain and photophobia. The visual acuity is usually from anterior index to manual, the intraocular pressure can reach more than 60mmHg, moderate to severe congestion, often accompanied by corneal edema, iris neovascularization, pupil margin pigment eversion, and different degrees of peripheral anterior adhesion in the angle.
④ Ciliary ring block glaucoma: It is a rare and serious special type of angle-closure glaucoma, which can cause blindness in one or both eyes.
4. Mixed glaucoma
More than two kinds of primary glaucoma exist at the same time, and the clinical symptoms are the same as those of various types.
5. Intraocular pressure-related glaucoma
Normal intraocular pressure glaucoma: It refers to glaucoma with optic disc damage, retinal nerve fiber layer defect and corresponding visual field damage similar to other glaucoma. Without any intraocular pressure lowering drugs, the intraocular pressure does not exceed 21mmHg in 24 hours, the angle structure is normal and completely open, and there are no other eye and systemic diseases that may cause the above diseases.
Hypotonic glaucoma: For this kind of eye disease with no exact cause, normal intraocular pressure, glaucomatous optic papilla atrophy and visual field damage, it is classified as hypotonic glaucoma.
Malignant glaucoma: It is a kind of intractable glaucoma with difficult diagnosis and intraocular pressure control. It is generally considered as a serious complication after anti-glaucoma surgery, which is characterized by elevated intraocular pressure, forward movement of iris septum of lens, and obvious shallower or even disappearance of all anterior chambers.
Second, diagnostic criteria
Early diagnosis of open angle glaucoma is very important to protect visual function. The following points are very helpful for early detection and diagnosis:
Family history: Family members have a history of glaucoma, and feel headache, eye swelling and visual fatigue, especially those who have presbyopia earlier or the elderly who frequently change presbyopic glasses, should go to the ophthalmology department for examination in time and have regular reexamination.
Check intraocular pressure: In the early stage of glaucoma, intraocular pressure is often unstable, and it only rises for a few hours a day. Therefore, measuring the 24-hour intraocular pressure curve is helpful for diagnosis.
Fundus changes: Enlargement of optic disc depression is one of the common signs of glaucoma. In the early stage, there is no obvious change in the optic disc. With the development of the disease, the physiological depression of the optic disc gradually expands and deepens, and finally reaches the edge, forming a typical glaucoma cup-shaped depression. Damage of retinal nerve fiber layer adjacent to optic disc is the basis of visual field defect, which appears before optic disc or visual field changes. Therefore, it can be used as one of the early diagnosis indexes of open angle glaucoma.
Visual field: Visual field is an important examination for the diagnosis of open angle glaucoma. Open-angle glaucoma will have visual field defect when the optic disc changes pathologically.
It is best to treat glaucoma with drugs first. If intraocular pressure cannot be controlled under the maximum dosage, surgical treatment may be considered. Low-concentration liquid medicine should be used first, and then high-concentration liquid medicine should be used to drop eyes. According to the effective antihypertensive time of different drugs, the number of doses per day should be decided. The most important thing is to ensure that the effective dosage can be maintained within 24 hours, and eye ointment can be applied before going to bed.【小于】 /p >Follow-up after treatment of open-angle glaucoma is also very important. Even if intraocular pressure has been controlled, it should be reexamined every 4 ~ 6 weeks, including intraocular pressure, fundus and visual acuity, and visual field should be checked once a year to ensure the continuity and stability of treatment.