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Glaucoma
 

Glaucoma doesnot only mean raised eye pressure. Glaucoma is a disease complex in which elevated eye pressure causes optic nerve damage.The optic nerve is made up of many nerve fibers, when damage to the optic nerve fibers occurs, blind spots develop. If the entire nerve is destroyed, blindness results.
Early detection and treatment are the key to preventing optic nerve damage and blindness from glaucoma. Glaucoma is a asymptotic in the early stages and might be missed if a patient doesn’t come for frequent eye checkups. Every patient after the age of 40 must have eye pressure measurement.
Glaucoma is a leading cause of blindness especially for older people. But loss of sight from glaucoma can often be prevented with early treatment.

CAUSES AND SYMPTOMS

A liquid called aqueous humor circulates inside the front portion of the eye. To maintain a healthy level of pressure within the eye, a small amount of this fluid is produced constantly while an equal amount flows out of the eye through a microscopic drainage system. The perfect inflow and outflow of the fluid maintain the normal pressure of the eye
Because the eye is a closed structure, if the drainage area for the aqueous humor—called the drainage angle—is blocked, the excess fluid cannot flow out of the eye and hence the Fluid pressure causes increased intra ocular tension. Within the eye the pressure increases, causing damage by strangulating the nerve fibres causing pressure atrophy.

DIFFERENT TYPES OF GLAUCOMA

Chronic open-angle glaucoma
The risk of developing chronic open-angle glaucoma increases with age. The cause of this Glaucoma is unknown. The dranage angle of the eye becomes less efficient over time and pressure within the eye gradually increases, which can damage the optic nerve. Treatment is necessary to prevent further vision loss.
Typically, open-angle glaucoma has no symptoms in its early stages, and vision remains normal. As the optic nerve becomes more damaged, blank spots begin to appear in your field of vision. You typically won’t notice these blank spots in your day-to-day activities until the optic nerve is significantly damaged and these spots become large. If all the optic nerve fibers die, blindness results.

Closed-angle glaucoma:
This is the commonest type of Glaucoma in the India population. Some eyes have the iris (the colored part of the eye) too close to the drainage angle. In these eyes, which are often small and farsighted, the iris can block the drainage angle. Since the fluid cannot exit the eye, pressure inside the eye builds rapidly and causes an acute closed-angle attack.

Symptoms may include:

• Red Eye
• Blurred vision;
• Severe eye pain;
• Headache;
• Rainbow-colored halos around lights;
• Nausea and vomiting.
This is a true eye emergency. The eye pressure may increase more than 50 mm of m Mercury (Normal Pressure 14 to 21mmhg) If. Unless this type of glaucoma is treated quickly, blindness can result.

RISK FACTORS FOR GLAUCOMA

The most important risk factors include:
• Age;
• Family history of glaucoma;
• Farsightedness or nearsightedness;
• Past eye injuries;
• Systemic health problems, including diabetes, migraine headaches, and poor circulation.
Diagnosis
A combination of tests is required for the diagnosis
1. Measuring intraocular pressure (tonometry);
2. Inspecting the drainage angle of your eye (gonioscopy);
3. Evaluate whether or not there is any optic nerve damage (ophthalmoscopy);
4. Test the peripheral vision of each eye (visual field testing, or perimetry).
These tests may need to be repeated on a regular basis to monitor any changes in your condition and to see for progression of damage.

TREATMENT

As a rule, damage caused by glaucoma cannot be reversed because optic nerve is part of brain tissue and cannot regenerate.
Eyedrops, lasers, and surgery are used to help prevent further damage. In some cases, oral medications may also be prescribed.

1. Medication and Care to be Taken
Open angle Glaucoma is usually controlled with eyedrops taken daily. These medications lower eye pressure, either by decreasing the amount of aqueous fluid produced within the eye or by improving the flow through the drainage angle.

Glaucoma medications can preserve your vision, but they may also produce side effects.
You should notify your ophthalmologist if you think you may be experiencing side effects.
Some eyedrops may cause:
• A stinging or itching sensation;
• Red eyes or redness of the skin surrounding the eyes;
• Changes in sense of taste;
• Headaches;
• Blurred vision;
• Change in eye color.

2. Laser surgery
Laser surgery treatments may be recommended for different types of glaucoma.
In open-angle glaucoma the laser is used to modify the drain- Argon laser trabeculoplasty to help control eye pressure.
In closed –angle glaucoma, the laser creates a hole in the iris- laser iridotomy to improve the flow of aqueous fluid to the drain by providing an alternate pathway.

3. Surgery in the operating room – Trabeculectomy
When surgery in the operating room is needed to treat glaucoma, fine microsurgical instruments are used to create a new drainage channel for the aqueous fluid to leave the eye. This is like a by pass surgery of the eye. Surgery is recommended if your ophthalmologist feels it is necessary to prevent further damage to the optic nerve.

 
 
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