DEFINITION

The glaucoma or ocular tension is an increase of the pressure intraocular, a drainage of the watery humor, which produces injuries in the optical nerve with problems in the vision and if blindness is not corrected on time. If it is not detected on time, this pressure increase can affect to the optical nerve producing a progressive deterioration of the visual field and a decrease of the vision.

The normal tension of the eye is from 12 to 22 mm of mercury.

The increase of the pressure intraocular happens when the watery humor does not flow correctly towards out and it was doing to inside of the eye. This obstruction produces an increase of this liquid inside the eye with increase of the pressure intraocular and on the optical nerve. Nevertheless there are persons who present injuries of the optical nerve type glaucoma without having the tension developing intraocular, and there are persons with tension intraocular raised without injuries of the optical nerve.

Normal drainage

FORMS OF PRESENTATION

• Glaucoma of open angle, in this type of glaucoma the watery liquid that flows across the pupil towards the previous camera cannot do it. The increase of the tension takes place intraocular and the injury of the optical nerve.

• The glaucoma of closed angle blocks the way of the liquid to itself between the iris and to cornea what produces an increase sudden of tension, which is urgent for the injury of the optical nerve that is immediate. In this type of sharp picture there appear associate symptoms of morning sickness vomiting, lights in the shape of rainbow and pain in the eyes

• There can be a subsharp form of glaucoma of closed angle.

The form of glaucoma with injury of optical nerve with tension intraocular normal is very rare, as there it are also the infantile and congenital forms. There usually a familiar glaucoma history, and be be necessary persons of advanced age.

SYMPTOMS

The most typical are:

• Vision of flying or gleaming flies
• Loss of side or peripheral vision
• Pain in the eye
• Migraine
• Blurry vision
• Auras vision type rainbow
• Morning sickness and vomiting
• Blindness

DIAGNOSIS

The case history and the symptoms must be sugerentes of glaucoma. Then other explorations are realized:

• The measurement of the tension intraocular by means of a tonómetro, it is realized by means of local anesthesia.
• The gonioscopia, is an examination of the drainage angle by means of a few lenses.
• The oftalmoscopia is carried out after the application of a few drops to dilate the pupil, the oculist will be able to observe the optical nerve and his possible alterations.
• The campimetria is carried out to verify the possible peripheral visual losses.

The ocular tension must be verified every:

• Every 3-5 years in persons older than 39 years
• Every 1-2 years in persons older than 50 years, ó glaucoma relatives, or in persons who take steroids.

TREATMENT

In the glaucoma of open angle there are used medicines that diminish the pressure intraocular.

The medicines in eyewashes of direct application in the eye are:

• The mióticos (pilocarpina) or epinefrina or medicines derived from them. His function is to improve the step of liquid entity the cameras of the eye.
• The betabloqueantes and the inhibiting ones of the carbonic anhidrasa that diminish the quantity of produced liquid.
• Sometimes medicines use oral route, inhibiting of the carbonic anhidrasa, so that the diminution of the liquid is more constant.

One can be used or another medicines or associates according to the case.

In the glaucoma of closed angle the picture is sharper for it we are necessary an immediate treatment to diminish the ocular tension. Hyperosmotic solutions are used in injection or for mouth, by means of this solution we can control the tension a few hours but then we must go on to other treatments of maintenance (mióticos, betabloqueantes, inhibiting of the carbonic anhidrasa).

The rebellious cases that they do not improve with medical treatment must be agreements with surgery.

• Surgery with Laser, realizes a trabeculoplastia, which improves the drainage of the liquid between cameras. It is possible to realize with local anesthesia in less than one hour.
• The iridotomía is carried out to treat the glaucoma of closed angle, in this operation part of the iris is extracted.

Both operations it does not have big risk and the recovery is in 1 ó 2 days.

When the tension picture intraocular is very intense and is not controlled incisions are realized in the esclera (small holes of drainage).

This intervention is realized under sedation and local anesthesia, in ambulatory diet. The recovery is rapid, it is recommended not to wet nor to wash itself for 2 days. Also there must be avoided the achievement of sport or violent exercises in a few days.

COMPLICATIONS

• Those of any surgery more the specific ones of this one
• Infection
• Hemorrhage
• Unforeseen changes in the tension intraocular
• Loss of vision

WHAT DOCTOR CAN TREAT ME?

• OPHTHALMOLOGISTS
• Consult the Ophthalmologist

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