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GLAUCOMA OPTIC NEUROPATHY: MODERN METHODS OF EARLY DIAGNOSIS
AND PREDICTION OF PROGRESSION
Scientific supervisor:
Jalalova Dilfuza Zuhridinovna
Department of Ophthalmology, Samarkand State Medical University
Xolmatov Ixtiyor
Samarkand State Medical University, Department of Ophthalmology, 1st year clinical ordinator
Ismailov J. J
Department of Ophthalmology, Samarkand State Medical University
https://doi.org/10.5281/zenodo.15680201
Abstract.
The space between the cornea and the iris is the anterior chamber of the eye, and
the space between the iris and the lens is the posterior chamber. Both chambers are filled with
intraocular fluid (its second name is "aqueous humor"). This fluid is necessary for the refraction
of light, and is also saturated with nutrients necessary for the normal functioning of the organ of
vision. Glaucoma is a leading cause of blindness. This eye disease is difficult to diagnose because
its symptoms often do not appear until late and is difficult to treat because of the irreversible loss
of retinal neurons. Although dead neurons cannot be restored, the progression of glaucoma can
be slowed with proper therapy.
Keywords:
Complications, Diagnosis
,
Glaucoma, Prevalence, Classification, Causes and
progression of the disease, Symptoms.
Introduction:
The space between the cornea and the iris is the anterior chamber of the eye,
and the space between the iris and the lens is the posterior chamber. Both chambers are filled with
intraocular fluid (its second name is "aqueous humor"). This fluid is necessary for the refraction
of light, and is also saturated with nutrients necessary for the normal functioning of the organ of
vision.
The transparent, white outer layer is called the sclera. At the front of the eye, the membrane
turns into a transparent convex cornea, which largely controls the refraction of light. The main
function of the outer shell is to maintain intraocular pressure and the correct shape of the eye. As
we age, the outer shell of all people loses its elasticity and becomes stiffer.
Behind the iris is the ciliary div, which produces intraocular fluid and holds the crystalline
lens, a transparent biological lens, capable of changing its curvature, thereby providing a clear
image.
The depth of the anterior chamber is approximately 3-3.5 mm, the posterior chamber is
significantly narrower. Both cavities communicate with each other through the pupil. Normally,
the volume of the eye chambers does not change due to the inflow and outflow of intraocular fluid.
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One of the most important structures of the eye is the anterior chamber angle. It is formed
where the cornea meets the sclera and the iris meets the ciliary div. It is here that the Schlemm's
canal is located, through which moisture flows. This is the drainage system of the eye, the
dysfunction of which leads to increased intraocular pressure.
The inner layer (retina) contains visual receptors known as cones and rods. Electrical
signals from the receptors are transmitted to the optic nerve, which, through its fibers, enters the
cerebral cortex.
The place where the optic nerve exits is called the blind spot - it contains neither rods nor
cones.
Under the retina of the eye is the vitreous humor, a transparent, jelly-like substance that
maintains the shape and tone of the eye and also participates in the transmission of light rays. In
front, the vitreous humor is limited by the lens.
Glaucoma is a general name for a group of eye diseases in which intraocular pressure (IOP)
is constantly or periodically increased. As a result, irreversible changes occur in the retina and
damage to the optic nerve, which leads to impaired vision and even blindness.
The term "glaucoma" (from the Greek glaukos - "watery blue") was first mentioned in the
works of Hippocrates around 400 BC. He called it an eye disease that leads to blindness. As it
turned out later, the famous physician did not see the difference between glaucoma and cataracts,
so he combined them into one disease.
The disease is named glaucoma because in the later stages, the cornea of the eye may take
on a cloudy bluish color.
A "cloudy" eye can be a sign of not only glaucoma, but also other diseases that can only
be diagnosed by a doctor.
In the International Classification of Diseases, 10th revision (ICD-10), glaucoma is
designated by the code H40. Separate codes are allocated for different variants of the disease:
a.
H40.0 - suspected glaucoma;
b.
H40.1 - Primary open-angle glaucoma;
c.
H40.2 - Primary angle-closure glaucoma;
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d.
H40.3 - secondary glaucoma after trauma;
e.
H40.4 - Glaucoma secondary to inflammatory eye disease;
f.
H40.5 - glaucoma secondary to other eye diseases;
g.
H40.6 - glaucoma secondary to drug use;
h.
H40.8 - Other glaucoma;
i.
H40.9 - glaucoma, unspecified;
j.
Q15.0 - Congenital glaucoma.
Glaucoma is a serious disease and the main cause of irreversible blindness. In most patients,
pathological changes affect both eyes. Every second person with glaucoma does not even suspect
that they have the disease.
According to the World Health Organization (WHO), about 600,000 new cases of
blindness due to glaucoma are recorded each year, and the total number of people suffering from
this disease in the world has already exceeded 100 million.
Every minute, one adult in the world becomes blind from glaucoma, and every 10 minutes,
one child becomes blind.
Research methods and materials:
Glaucoma can be primary (occurs spontaneously and
affects only intraocular structures) and secondary (a consequence of injuries and other diseases).
The disease is also classified by origin, course, level of intraocular pressure, and condition
of the optic nerve.
Open-angle glaucoma is glaucoma that develops due to problems with the drainage system,
meaning the angle of the anterior chamber of the eye is open. If the angle is blocked by something,
it is a closed-angle form. There is also a mixed type of glaucoma.
One of the most important indicators in glaucoma is the level of intraocular pressure (IOP).
The measurement of IOP is called tonometry. Depending on the measurement method, a
distinction is made between tonometric (contact method) and true (non-contact method)
intraocular pressure.
Intraocular pressure level
a.
IOP level
b.
Tonometric (Pt),
c.
mmHg Art.
d.
True (Po),
e.
mmHg Art.
Simple
a.
< 25
b.
< 21
Moderately elevated
a.
26–32
b.
21–26
High
a.
> 32
b.
> 26
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stabilized - the patient is observed for 6 months or more, during which time the vision and
condition of the optic nerve do not deteriorate;
Unstable - the doctor detects deterioration during subsequent examinations.
Stages of glaucoma depending on the condition of the optic nerve
:
a.
elementary;
b.
developed;
c.
advanced stage;
d.
terminal.
The condition of the optic nerve can only be assessed through an ophthalmological
examination. The division of the development of glaucoma into stages is arbitrary.
By time of onset of glaucoma
:
a.
congenital: in children under 3 years of age;
b.
infantile: from 3 to 10 years old;
c.
Minors: from 11 to 35 years old;
d.
Glaucoma in adults over 35 years of age.
When making a diagnosis, doctors take into account the type of glaucoma, its stage, the
level of intraocular pressure, and changes in vision. An example of a diagnosis: primary open-
angle, advanced stage with moderately elevated pressure, stabilized glaucoma.
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Results
: In a healthy eye, aqueous humor circulates easily and unhindered. If the
production or outflow of this fluid is impaired, glaucoma develops: when its large amount
accumulates, intraocular pressure (IOP) increases.
Normal IOP is 18-24 mm Hg. Art. If intraocular pressure is high, it is called ocular
hypertension. Doctors may suspect glaucoma in a person who has no symptoms of the disease but
has elevated IOP.
Increased intraocular pressure leads to irreversible damage to the optic nerve and blindness.
The causes of ocular hypertension and glaucoma are very diverse, many of which are still
controversial in scientific circles.
Primary glaucoma
The main cause of primary glaucoma is tissue dystrophy due to a metabolic defect at the
cellular level, which leads to impaired or loss of vision. Translated from Greek, dystrophy means
"disorder of tissue nutrition."
There are two main forms of primary glaucoma: open-angle and closed-angle. The disease
is most often diagnosed in people over the age of 40.
Approximately 90 percent of all glaucoma cases develop primary open-angle glaucoma.
Primary open-angle glaucoma (POAG) occurs when the outflow of aqueous humor from
the angle of the anterior chamber of the eye is impaired, meaning that changes affect the drainage
system of the eye.
The process develops over a long period of time and is not noticeable to the patient. As a
result, excessive pressure damages the optic nerve: first, peripheral vision is lost, and then central
vision. Due to the insidious nature of the disease, primary open-angle glaucoma is sometimes
called the silent thief of vision.
In primary open-angle glaucoma, there is an open angle in the anterior chamber of the eye
and a violation of the outflow of fluid in the drainage system.
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Open-angle glaucoma symptoms
Primary open-angle glaucoma is the most common type of glaucoma. The damage to the
eye occurs slowly and painlessly, so many people are unaware they have the disease. Often, the
disease has caused irreversible vision damage long before it is diagnosed.
A typical symptom of primary open-angle glaucoma (POAG) is the gradual loss of
peripheral (side) vision. Patients describe this condition as the appearance of "blind spots" in the
periphery. This is followed by a loss of central vision - it is difficult for a person to see objects that
are directly in front of them. The process can progress to complete blindness.
Visual impairment in open-angle glaucoma depending on the stage of the disease
a.
Patients with glaucoma have atypical complaints:
b.
temporary blurred vision;
c.
rainbow circles around light sources;
d.
flashing mosquitoes;
e.
headache;
f.
eye pain;
g.
lacrimation.
Examination of patients with POAG reveals periodic or persistent elevations in
intraocular pressure. The difference between the two eyes may be more than 2-3 mmHg. Art., and
the range of fluctuations during the day may exceed 5 mm Hg. Art.
On average, it can take 1 to 5 years from the onset of the disease to its first symptoms. In
some cases, glaucoma can go through all stages from initial to final within 5 years.
Symptoms of angle-closure glaucoma
Primary angle-closure glaucoma (PACG) is less common and the "silent thief of sight" -
manifests itself much more clearly than the open-angle form of the disease.
Often, angle-closure glaucoma is characterized by attacks that occur due to a sudden
blockage of the angle of the anterior chamber and a violation of the outflow of intraocular fluid.
Between attacks, patients do not feel any discomfort. And only when the process becomes chronic,
do patients with POAG develop complaints similar to those of patients with POAG.
Symptoms of an attack of closed-angle glaucoma:
a.
sudden and very severe pain in the eyes;
b.
severe headache (localized in the area of the superciliary arches);
c.
blurred vision;
d.
vomiting and/or nausea;
e.
halos or colored rings that appear around light sources;
f.
redness of the eyes;
g.
excessive lacrimation;
h.
Pupil dilation - asymmetrical in both eyes.
Although the disease is bilateral, an acute attack rarely develops in both eyes
simultaneously.
External signs of an acute attack of glaucoma:
a.
loss of corneal transparency - due to swelling of the cornea and clouding of the
aqueous humor;
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b.
asymmetry, pupil dilation and lack of response to light;
c.
gray-green color of the pupil - when the lens swells, it loses its transparency and
becomes clogged in the pupil area;
d.
sharp thickening of the eye - a significant increase in tone when pressing on the eye;
e.
flattening of the iris pattern due to swelling;
f.
narrowing of the space between the iris and the cornea;
g.
redness of the eye - as a result of constriction of blood vessels and impaired blood
flow.
h.
In closed-angle glaucoma, vision loss can occur within hours of the onset of the
disease.
i.
To prevent damage to the optic nerve, you should seek medical attention
immediately - doctors will immediately lower the eye pressure.
j.
Acute eye pain can be caused by an acute attack of glaucoma - without urgent help,
a person can lose their vision.
In a patient with closed-angle glaucoma, various factors can trigger an acute attack:
a.
stress,
b.
excessive excitement,
c.
working for long periods of time with your head bowed,
d.
large amounts of drunk liquid,
e.
hypothermia,
f.
medical dilation of the pupil to treat or diagnose eye disease.
If the angle of the anterior chamber of the eye does not close completely, the patient
develops a subacute attack of glaucoma. Its manifestations are not as pronounced as in an acute
attack:
a.
mild pain in the eye,
b.
rainbow circles facing the light,
c.
blurred vision,
d.
mild corneal edema,
e.
moderate pupil dilation.
Even minor manifestations of glaucoma cannot be ignored - with each attack, the optic
nerve becomes more and more damaged, which threatens complete loss of vision.
Long-term glaucomatous processes - impaired fluid outflow and increased intraocular
pressure - lead to serious consequences.
Glaucoma optic neuropathy is damage to the optic nerve due to compression and
circulatory problems. This initially leads to partial loss of vision and then blindness.
Terminal painful glaucoma is a condition in which the affected eye experiences constant
pain that occurs in the final stages of the disease. Painkillers are ineffective, and the only way to
alleviate the condition is to lower the intraocular pressure, but even this therapy only provides
temporary relief.
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Surgical methods for painful glaucoma are also ineffective and often cause postoperative
complications. A radical method to relieve a patient with terminal glaucoma from severe pain is
to remove the eyeball.
Conclusion
: It is important to detect glaucoma before vision problems occur. A person
who develops this pathology does not experience discomfort for a long time and does not seek
medical attention, so an ophthalmologist can detect the insidious disease, for example, during a
medical examination.
Laboratory tests are not prescribed to diagnose glaucoma, instrumental diagnostics are
performed using various methods;
Tonometry is a measurement of intraocular pressure. When analyzing the data, absolute
IOP values, its daily fluctuations, the difference in tone between the two eyes, and the
characteristics of fluctuations when changing div position from horizontal to vertical are taken
into account. If an excess of the norm is detected, monitoring is carried out for several days.
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