Acute Attack of Glaucoma

Acute attack of glaucoma is the greatest degree of disorders of the IOP regulation in closed-angle glaucoma. Acute attack rises usually in the second half of the day or in the evening after emo?tional tension, taking of great amount of fluid.

Clinical course. The visual acuity lowers up to 0.09-0.01, some?times to a photoperception. There is strong pain in the eye and in the corresponding half of the head with an irradiation to the trigeminal nerve and remote organs: in heart, epigastric area, stom?ach. Nausea, vomiting are typical.

Objective signs are: lacrimation, the corneal syndrome, oede?ma of the lids; stagnant injection of vessels of a front department of the eye ("the head of Medusa"); oedema of the cornea, lowe?ring of its sensitivity, the surface of the cornea is rough, as if pricked by a needle; a narrow anterior chamber; a wide pupil (midriasis) with weak or no reaction to light; greenish colour of the eye fun?dus reflex; if the eye fundus is visible, the atrophy of the optic nerve, pulsing of central artery of the retina are defined; IOP is 60-80 mm Hg; the eye is hard, as a stone (T+3).

Outcomes may be as follows:

? fast decrease of IOP leads to visual functions recovery, but the pupil usually remains wide;

? terminal (absolute) painful glaucoma develops with the strong steady pain in the eye, stagnant injection ("the head of Medusa"), bullous (vesicles) keratopathy, rubeosis of the iris. Vi?sual acuity is 0;

? secretion of aqueous humour and IOP reduces, all clinical signs disappear gradually, but the vision, as a rule, never returns;

? acute attack of glaucoma may recur.

Differential diagnosis of the acute attack of glaucoma should be carried out with: acute gastrointestinal diseases, poisonings; hypertonic crisis; attack of stenocardia, if the attack of glaucoma is on the left eye; acute iridocyclitis (Table 3).

First aid in acute attack of glaucoma. 1-2% pilocarpin solution is instilled every 15-20 minutes; per os diacarb 0,5 (fonurit 0.25 or hypothiazid 25-100 mg) is given. A patient must immediately be refered to ophthalmological clinic.

Specialized help in acute attack of glaucoma. In ophthalmolog?ic clinic 1% or 2% pilocarpin solution is instilled every 15 minutes during 2 hours and then every hour. 25 mg of aminacin or lytic mixture (1 ml of 2.5% aminacin + 1 ml of 1% dimedrol or 1.0 ml of 2.5% pipolphen + 1.0 ml of 2% promedol) is entered intravenous?ly. Diacarb is administered orally in the dose of 0.25-0.5 g 2 times a day. The hyperosmotic agents are used (urea, glycerol, manni-tol, salt laxative). Diverted procedures (hot baths for legs, leech on temples, mustard plasters on a nape) are used too. The antiglau-comatic operation (iridectomy) is necessary, when medical thera?py has failed within 24 hours. If IOP decreases after medical the?rapy, it is recommended planned antiglaucomatic operation in a period of IOP normalization.

Table 3. Differential diagnosis of the acute attack of glaucoma and iridocyclitis

Secondary Glaucoma

The secondary glaucoma is a consequence or complication of other diseases of the eye. The following forms of secondary glau?coma are distinguished.

1. Uveal,postinflamatory glaucoma is caused by peripheral an?
terior synechiae or seclusio of the pupil.

Treatment. It is conducted therapy of uveitis, midriatics and mas?sage of the pupil.

2. Phacogenicglaucoma: phacotopycal (subluxation, dislocation of lens); phacomorphic (enlarging of the lens size in traumatic cat?aract or in intumescent stage of senile cataract); phacolytic (in hypermature senile or traumatic cataract).

Treatment is surgical (extraction of cataract).

3. Neovascular, postthrombotic glaucoma (it is complication of central vein of retina occlusion).

Treatment consists in treatment of the basic disease and symp?tomatica! therapy.

4. Traumaticglaucoma: contusional, burny glaucoma; wound
glaucoma.

Treatment includes anti-inflammatory, surgical therapy.

5. Neoplasticglaucoma (glaucoma is associated with intraocu?lar tumors: uveal melanoma or retinoblastoma).

Treatment. Enucliation of the eye or exzanteration of the orbit.

6. Degenerativeglaucoma (it is caused by diabetic retinopathies,
uveapathies).

In all forms of secondary glaucoma (except the neoplastic form) against a background of treatment of the basic disease, carbonic anhydrase inhibitors (diacarb) are administered, the surgical treat?ment is performed in case of need.

In summary it is necessary to tell, that the glaucoma cannot be treated, but it is possible to conduct prophylaxis of blindness caused by glaucoma. For this purpose it is necessary the early diagnosis of this disease. Early detection of glaucoma is performed by ex?amination of all people older than 40 years old. The patients with hypertonic disease, diabetes mellitus and the persons, which have relatives suffered from glaucoma, represent a risk group for glau?coma and must be measured IOP1 time a year. Other persons at the age above 40 are made tonometry 1 time per every 3 years. All the patients with glaucoma must be under a dispensary obser?vation, in IOP compensation they are examined 1 time per 3 months.

Date: 2016-06-12; view: 362