The disease glaucoma, which is also known in colloquial use as glaucoma, belongs to the eye diseases and is treated by ophthalmologists both as an outpatient and as an inpatient. Glaucoma should be distinguished from the disease cataract.
What is glaucoma?
Infographic of the anatomy and structure of the eye in glaucoma. Click image to enlarge. The definition of glaucoma, or glaucoma, is that the optic nerve in particular, which is responsible for vision, is damaged by various influences and can no longer perform its function. The common characteristic of glaucoma is also a narrowing of the field of vision and visual field, as well as an internal pressure of the eyes above the normal limit. Glaucoma or glaucoma is characterized by different types of disease. These different forms of glaucoma differ from each other in their symptoms to a greater or lesser extent. Most patients suffering from glaucoma are diagnosed with so-called open-angle glaucoma. Besides this glaucoma, angle-closure glaucoma, narrow-angle glaucoma and secondary glaucoma also play an important role. A special form of glaucoma is normal tension glaucoma.
Causes
There is no single cause for the development of glaucoma. A variety of different complexes of triggers can lead to glaucoma, or glaucoma. Basically, glaucoma is closely related to the altered internal pressure in the eye. In addition, an insufficient supply of blood to the optic nerve is also a condition that can cause glaucoma. These causes are the so-called risk factors that favor glaucoma. Primarily, an imbalance between the supply and the drainage of the aqueous humor needed in the eye chamber is the basis for abnormal intraocular pressure. Persistent pressure develops on the optic nerve, constricting it and contributing to deterioration of vision. In addition, irregular and low blood pressure, advanced age, nearsightedness and farsightedness, metabolic diseases, and a thin-layered cornea are other causes. In addition, there may also be a genetic predisposition that is a possible reason for glaucoma.
Symptoms, complaints and signs
Glaucoma is often diagnosed late because it initially remains asymptomatic. This is mainly true for primary open-angle glaucoma. When it is detected, the only option is often to prevent progression of the disease. Open angle glaucoma is characterized by increasing visual disturbances with a narrowing of the visual field from the outside. Towards the center of gaze, deficits may also occur. Without treatment, complete loss of vision is imminent. In the event of a sudden increase in intraocular pressure, a so-called angle block may occur. This is a medical emergency characterized by sudden severe pain in one eye and the corresponding half of the head, an extremely hard eyeball, a reddened eye, and the perception of rainbow-like rings and veils around light sources. At the same time, nausea and vomiting occur. Without immediate treatment, blindness is imminent. Secondary glaucoma can also lead to blindness. Their symptoms depend on the particular cause. The most common secondary open-angle glaucoma is the so-called PEX glaucoma in elderly patients. Here, too, the symptoms appear very late with the restriction of vision at the periphery and in the center of the visual field as well as the appearance of double images. If left untreated, blindness often occurs in this case as well. In babies, glaucoma, which may be congenital, can quickly lead to severe visual impairment or even blindness if not treated in time.
Course
The course and development in glaucoma (glaucoma) are individually variable and differ in their symptoms. Affected patients suffer from an impairment that contributes to the inability of the aqueous humor of the eye to drain to a sufficient extent. The rising intraocular pressure leads to acute glaucoma. Intense headache, redness of the eyes, dizziness, vomiting, nausea, chills and fever occur. Other classic accompanying symptoms of glaucoma are a restricted, severely limited field of vision, so-called visual loss and blurred perception of images.Some patients report seeing colorful ring structures around bright lights. In glaucoma, the field of vision is hazy.
Complications
Because glaucoma or glaucoma does not develop symptoms in the form of visual disturbances or vision loss until the disease is advanced, the disease is usually not noticed and treated until very late. As a result, considerable damage to the optic nerves is already present. In many cases, special eye drops are the treatment of choice. However, depending on the stage of the disease, it may also be necessary to perform glaucoma surgery to preserve the remaining vision. If glaucoma is not treated, the affected eye may go completely blind. In many patients with glaucoma, the disease can be treated with eye drops. Today, prostaglandins or alpha-agonists are mostly used for this purpose, which can very effectively lower intraocular pressure. However, if the eye drops are not sufficient, an artificial drain is created during eye surgery to permanently equalize the pressure in the eye. In rare cases, bleeding may occur in the anterior chamber of the eye during surgery, but this will resolve on its own. There are also laser surgical treatment methods for glaucoma, but these only reduce the intraocular pressure slightly and not permanently. In a special form of glaucoma, congenital glaucoma, there are early signs in adults such as watery eyes, sensitivity to light or cloudy cornea. This inherited form can only be treated by surgery to prevent increasing vision problems.
When should you see a doctor?
If the affected person suffers from vision disorders, he needs a medical examination. If there are changes in the existing vision, there is reason for concern. Restrictions in the field of vision and blurred vision should be examined and treated. A visit to the doctor is necessary as soon as there is pain in the eyes or head. If the pain persists for several days, a doctor should be consulted as soon as possible. Taking an analgesic medication should always be discussed with a doctor in advance. In case of sensitivity to light or impaired vision under normal light conditions, a doctor should be consulted. If redness of the eye or eyelids is noticed, it is advisable to discuss the observations with a medical professional. If dizziness, nausea or vomiting persists, a physician should be consulted. If the symptoms increase the risk of accidents, help is needed. People in adulthood over 40 years of age should participate annually in offered preventive medical checkups. During the check-ups, even the smallest changes and irregularities can be detected, which are often not noticed in everyday life. Since glaucoma leads to blindness if left untreated, a doctor should be consulted in good time at the first signs of impaired vision. If psychological stress, fluctuations in blood pressure or anxiety occur, a visit to the doctor is necessary.
Treatment and therapy
Acute glaucoma is treated as an emergency. Appropriate diagnosis and early detection, if possible, can significantly improve the success of treatment for glaucoma. Initially, drug therapy is possible, which may be supplemented by medical intervention using laser technology and other surgical procedures that are more or less invasive. The drugs focus on eye drops as beta-blockers, cholinergics, prostaglandins and other drug groups. The drugs are intended to lower intraocular pressure, increase the transparency of the ciliary body, and promote aqueous humor outflow. In many cases, these drugs are administered in a combination. Laser surgery for glaucoma treatment includes sclerotherapy of the ciliary body, argon laser trabeculoplasty, and laser-assisted optimization of the aqueous humor passage between the posterior and anterior chambers of the eye. Another laser-based option to treat glaucoma is iridectomy. Surgical techniques performed on the ciliary body, sclera and conjunctiva improve vision in glaucoma and prolong the course of the disease. Surgical treatment of the iris and a procedure called cataract surgery can also realize a reduction in intraocular pressure.
Outlook and prognosis
Glaucoma not infrequently leads to complete blindness.This can be explained by the gradual course of the disease. Those affected do not notice their disease for long periods of time. By the time the deterioration in vision is noticed, the optic nerve is usually already severely damaged. Immediate treatment will not be able to improve the prognosis. To improve the prognosis, regular check-ups with an ophthalmologist are advisable. Thus, it is necessary to act in advance to avoid consequential damage. This is especially true for certain risk groups. People over 40 years of age, people with a family history of glaucoma, or diabetics are more at risk. The primary goal of treatment is to lower intraocular pressure. If impairments have already occurred, treatment is aimed at preventing further progression of the disease. Although the disease progresses gradually, it is always chronic. If treated in time, the prognosis is quite positive and the progression can be slowed down or stopped. However, the patient must expect limitations in his or her vision. However, blindness can often be averted by timely treatment. Without exception, untreated glaucoma leads to complete blindness.
Prevention
An individual prophylaxis against glaucoma is hardly possible, only a good perception of the visual ability and a quick reaction in case of deterioration can enable a timely early detection. A diagnosis of glaucoma can only be made by a specialist and is the prerequisite for a successful therapy, which can start at an early stage. Especially in diseases associated with circulatory disorders such as the metabolic disease diabetes mellitus, a regular check of the eyes by the ophthalmologist with a measurement of intraocular pressure is essential.
Follow-up care
Proper follow-up care for glaucoma is critical to the success of treatment. Follow-up care is highly individualized and can take many weeks and years. It is medication and control in nature. First of all, it is necessary to have regular eye examinations even after the treatment is considered to be completed. Intraocular pressure measurement is the most important component. It can never be completely ruled out that glaucoma will recur. In addition, a temporary reduction in vision is normal after eye surgery, and patients should keep this in mind during their follow-up care. Immediately after surgery, preparations may be used to lower intraocular pressure. In addition, agents are prescribed to inhibit scarring. This is to ensure that scars caused by surgery do not restrict the field of vision. Tablets or drops are also prescribed for some time for wound healing and tissue regeneration. Furthermore, the form of aftercare also depends on the selected surgical procedure. Surgical procedures require different aftercare measures than, for example, pure laser operations. It may occasionally be necessary to undergo surgical treatment again because the desired result was not achieved. In follow-up, as in the treatment of glaucoma, the principle is to start with the least invasive procedures.
Here’s what you can do yourself
Glaucoma cannot be treated on your own. Once diagnosed, the damaged optic nerve can usually only be restored with surgery or medication. In the early stages, the spread of glaucoma can be delayed or even prevented by a change in lifestyle. Experts recommend above all comprehensive eye care, regular exercise and a healthy and balanced diet. Those affected should avoid sugary foods as well as caffeine, alcohol and nicotine. Instead, foods that cleanse and purify the body should be consumed, such as fruits and vegetables as well as sprouts and seedlings. Regular therapeutic fasting is particularly effective. Accompanying this, it is important to reduce stress and, above all, to reduce the strain on the eyes. Anyone who works at a computer every day can significantly reduce the risk of glaucoma through targeted eye training and at the same time provide mental relief. An effective exercise: stretch out the arm with the thumb upright, move it in different directions and follow the thumb with the eyes while the head does not move.Lastly, regular preventive examinations should be performed by an ophthalmologist. Especially at-risk groups (people over 40, patients with other eye disease, etc.) should take these measures and thus effectively counteract glaucoma.
