Glaucoma

WHAT YOU NEED TO KNOW ...

• It occurs as a consequence of ocular hypertension, which produces progressive and irreversible damage to the fibers of the optic nerve.
• As it is an asymptomatic disease until its final stages, 50% of those who suffer from it are undiagnosed.
• Pharmacological treatment can be given with eye drops, resorting to lasers or different types of surgeries.

The functions of the eyeball, many of them depend on the uniform and constant size of it, this is achieved by the structures or "humors" that fill the globe. In the first place, the Vitreous Humor, gelatinous in nature, fills the posterior cavity of the eye. In the anterior part is the Aqueous Humor, of a liquid nature and that circulates from its origin in the ciliary body, to a filter, called Trabeculum that extends at the junction between the sclera and the cornea.

From the balance between the quantity produced and the quantity filtered, we will obtain an «intraocular pressure», whose normally accepted values ​​vary between 10 and 21 millimeters of mercury (mmHg). Pressures lower than 10 will be called ocular hypotension and greater than 21 ocular hypertension.

The consequences of ocular hypertension consist essentially of progressive and irreversible damage to the fibers of the optic nerve, which we call Glaucoma.

Glaucoma is a relatively common disease in our environment, it affects 2.8% of those over 40 years of age, but the most important problem is that it is asymptomatic until its final stages, so it is estimated that 50% are found undiagnosed.

There are several types of glaucoma, but the most common is Simple Chronic Glaucoma. Of unknown cause, it has a certain hereditary pattern that should alert family members. In all types of glaucoma, early diagnosis is the basic element, since the visual losses that occur before diagnosis and treatment are irrecoverable. The first fibers to be affected in glaucoma are those that transmit the vision of a paracentral area (about 20º from the visual center) so that the patient does not perceive the progression of the disease, which can leave a vision in « shotgun tube 'or finally, in highly evolved and exceptional cases, blindness.

Diagnosis:

Routine examination of intraocular pressure in those over 40 years of age and in cases of family history, and in suspected cases (ocular hypertension), perform diagnostic and follow-up tests that basically consist of quantifying peripheral vision (campimetry computerized) and the "counting" of the fibers of the optic nerve using fiber analysis systems such as HRT, GDX or OCT.

Treatment:

Once glaucoma (ocular hypertension that initiates damage to the optic nerve) has been diagnosed, it comprises several families of drugs, which, alone or in combination, aim to reduce the production of aqueous humor, or to increase its filtering.

Another way to increase filtering, in cases that do not respond well enough to pharmacological treatment with eye drops, is through laser (laser trabeculoplasty), or, finally, through various types of surgeries, aimed at producing a "fistula" into the space that is found below the conjunctiva.

A special type of glaucoma is Narrow Angle Glaucoma. In this case, the difficulty of getting out of the Accused Humor, occurs because the eye is excessively small, (hypertrope eye), and / or the underlying cataract progressively pushes the iris forward, leaving the trabeculum blocked, essentially when the pupil is enlarged due to darkness, stress, antidepressants, and a multitude of drugs, which can produce a sudden closure and therefore an abrupt rise in intraocular pressure, calling the picture: Acute Closed Angle Glaucoma. If you do not act in time, the consequences are dire for your vision.

In this case, being of acute onset, with a very important rise in pressure, if it produces symptoms. Severe pain ("nail pain"), Red eye, decreased visual acuity with "rainbow" vision in light sources, and symptoms such as nausea or vomiting, sometimes mistaken for acute abdomens.

Regarding treatment, it is urgent and basically consists of making a small hole in the iris with a laser to break the blockage.

PREVENTION:

It consists of the preventive performance of that hole called «laser iridectomy», which, as it is not very annoying, can be indicated in cases of narrow angle with or without associated hypertension. If it is not practiced, a strict review of the leaflets of the drugs used should be advised, in case they favor angle blockage.