Increased intraocular pressure /Glaucoma | The intraocular pressure

Increased intraocular pressure /Glaucoma

If there is an outflow disturbance at the so-called chamber angle of the eye, the produced aqueous humor can no longer drain properly. This leads to a fluid accumulation in the eye and thus to an increase in pressure. From an intraocular pressure of more than 21 mmHg one speaks of increased intraocular pressure.

This is dangerous because too high a pressure can damage the optic nerve and the retina and in the long run lead to blindness. Increased intraocular pressure is an important risk factor for the development of glaucoma (cataract). This results in the loss of nerve fibres of the optic nerve, which is immediately noticeable by visual field failures and finally by complete blindness of the affected eye.

However, increased intraocular pressure is not necessarily a prerequisite for the development of glaucoma. About 40% of glaucoma patients have a completely normal intraocular pressure (normal pressure glaucoma). Nevertheless, increased intraocular pressure is often involved in the development of glaucoma.

It is particularly unfavourable in combination with low blood pressure in the optic nerve, as this causes the loss of nerve fibres to progress more rapidly and glaucoma can worsen more quickly. The most common form of glaucoma is the so-called primary chronic glaucoma, which preferably manifests itself from the age of 40. Over the course of time, patients develop a flow disorder in the chamber angle of the eyes due to signs of aging, as a result of which the aqueous humor can drain more slowly.

As this process develops over several years, the intraocular pressure increases slowly but steadily over time. Those affected therefore usually have no symptoms. However, if the angle of the chamber is suddenly displaced and the aqueous humor suddenly builds up, this leads to a glaucoma attack.

This suddenly causes extremely high intraocular pressures (up to 70mmHg) and those affected suffer from severe headaches, eye pain and sometimes nausea and vomiting. The affected eyeball is usually severely hardened on palpation. Since most patients with increased intraocular pressure do not feel any symptoms, even if they already have damage to the eye, regular preventive check-ups by an ophthalmologist are the only way to detect and treat increased intraocular pressure early enough.

In this way, most consequential damage and blindness of affected patients can be prevented in most cases. If an increased production of aqueous humor occurs or there is a mismatch between inflow and outflow, this can lead to increased intraocular pressure. This increased intraocular pressure can damage the optic nerve, which leads to visual field loss, and can also be the cause of glaucoma.

It is therefore very important to lower the intraocular pressure. Now there are several ways to lower the intraocular pressure. On the one hand you can use eye drops.

There are different kinds. For example, there are carboanhydrase inhibitors that reduce the production of aqueous humor. Then there are so-called beta-blockers or alpha-blockers, which block various channels and thus also reduce the production of aqueous humor and thus the intraocular pressure.

Furthermore, the outflow of aqueous humor can be improved or normalized. This can be done with the help of a minor surgery. In this case, the doctor cuts a part of the trabecular meshwork with a trabecular tom, which often becomes stiffer with age and therefore makes the outflow of aqueous humor very difficult.

A trabeculectome looks like a pen with a small electric knife at the end and a suction and infusion channel. This small procedure is performed under local anesthesia and usually takes no longer than 10 minutes, but achieves great success. Most patients have to use much less eye drops afterwards.

A more extensive procedure, however, is the trabeculectomy. This is a larger operation in which the surgeon cuts open the conjunctiva over a large area, thereby creating an artificial drain for the aqueous humour. Even after this operation, patients are much less dependent on eye drops to lower the intraocular pressure, but the follow-up treatment is very intensive and can be associated with reduced vision.

Another possibility to lower the intraocular pressure is laser treatment. Here the chamber angle is treated with a laser beam, which causes more aqueous humor to flow off. However, this procedure is only suitable if the disease is not too far advanced.

Finally, there is the sclerotherapy – icing. Here the so-called ciliary body is sclerosed. The ciliary body is responsible for the production of the aqueous humor.

By partially sclerosing it, the production of aqueous humor can be greatly reduced and thus also the intraocular pressure. It is important to mention that a surgical intervention is only used when the disease is progressing. If the intraocular pressure is slightly increased, eye drops are completely sufficient!

The intraocular pressure can be pathologically increased for various reasons. The cause can be, for example, both in the intake of certain medications, as well as in a flow disturbance of the aqueous humor in the eye. Depending on how high the intraocular pressure is, the optic nerve and the retina can be permanently damaged, which is why drug therapy is recommended.

However, there are also possibilities to lower the intraocular pressure by natural means. For example, homeopathic eye drops with the ingredient Euphrasia (eyebright) are available in pharmacies. These can help to lower the pressure.

Eyebright is also available as a tincture in combination with other medicinal herbs (St. John’s wort, mistletoe essences) for internal use. In many cases, the use of alternative healing methods such as acupuncture, foot reflexology and kinesiology has also proven successful. A blockage of the cervical spine can also cause increased intraocular pressure.

Spinal gymnastics and targeted physiotherapy can provide relief. Certain eating habits can additionally promote increased intraocular pressure. It is therefore recommended to avoid caffeine consumption to a large extent and to follow a vitamin-rich diet.

Selenium, zinc and vitamins A, B, C and E have a positive influence on intraocular pressure. Therefore, smoking is not conducive to increased intraocular pressure. However, regular endurance training has a positive effect.

This can also help to lower high blood pressure, which is often the cause of increased intraocular pressure. In some cases, dental problems also have an influence on the pressure in the eye. If problems of the dental apparatus are present, they should be medically repaired if possible.

In some circles, amalgam fillings are also considered to interfere with the intraocular pressure. Under certain circumstances, outdated fillings can be replaced. However, if the intraocular pressure is greatly and permanently increased, conventional medical treatment is usually unavoidable. This involves the use of effective medication or even surgery to bring the intraocular pressure back to a normal level.