Glaucoma 

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Glaucoma is a group of disorders involving gradual and irreversible damage of the optic nerve. Usually occurs because the fluid pressure inside the eye (intraocular pressure) is too high or sometimes ,blood supply to the optic nerve is inadequate. 

•Glaucoma can not be cured,however,if it is detected and treated early blindness can be prevented.

•Early detection through regular eye examination is extremely important as in most cases it gradually develops without noticeable symptoms.

•Once diagnosed, it is essential that treatment programmes be rigorously adhered to or blindness can result.

High risk group :

Although glaucoma can develop in any eye, the following factors tend to make it more likely :

•elevated intraocular pressure

•people above 40 year of age

•family history of glaucoma

•Nearsightedness

Diabetes mallitus

•Race: African decent

smoking 

People with any of the above risk factors should undergo regular eye examination so that the condition is detected early.

How glaucoma is detected :

The doctor will do following test:

•check the intraocular pressure with tonometers. 

•Examine the optic nerve with special lenses or instrument to see the damage.

•Test the field of vision for characteristic defects.

Gonioscopy to see the drainage angle.

Diagnosis, screening and testing for glaucoma :

During a routine eye exam, a tonometer is used to measure your intra ocular pressure, or IOP. Your eye is usually numb with a topical  eye drop, and a small probe is placed on the surface of the eyes slowly. Other tonometers leave a gust of wind on the surface of your eye.

An abnormally high IOP reading indicates a problem with the amount of fluid in the eye.  Either the eye is producing too much fluid, or it is not coming out properly.

Generally, the IOP must be below 21 mmHg millimeters of mercury ( a unit of measurement that is based on how much force is within a certain defined area).

If your IOP is greater than 30 mmHg, the risk of vision loss from glaucoma  is 40 times higher than someone with an intraocular pressure of 15 mmHg or less. 

Other methods of monitoring glaucoma include the use of sophisticated imaging techniques to create a baseline image and measurement of the optic nerve and internal structures of the eye.

Then, at specified intervals, additional images and measurements are taken to ensure that no changes have occurred that may indicate damage from progressive glaucoma .

Treatment of glaucoma :

Treatment for glaucoma  may include surgery, laser treatment, or medication depending on the severity.  Eye drops with medication intended to reduce IOP are usually first tried to control glaucoma .

Because glaucoma  disease often does not cause pain, many people become careless about the strict use of eye drops to control eye pressure and help prevent permanent eye damage.

In fact, not properly using prescribed glaucoma medicines is a major cause of blindness caused by glaucoma.

If you find out that the eye drops you are using for glaucoma , and you feel are uncomfortable or uncomfortable, never consult your eye doctor first about any possible alternative medicine. Never close those eye drops without doing it.

Exercise may reduce the risk of glaucoma :

Can you reduce the disease of glaucoma ? According to a recent European study, if some people are developing glaucoma disease, exercise reduces this possibility because it helps to improve the blood flow in your body and your eyes.

In addition to regular exercise and an active lifestyle, you can reduce your risk for glaucoma by not smoking, maintaining a healthy weight, and eating a variety of healthy foods.

Types of Glaucoma :

1.open angle glaucoma 

Even though the drainage channels are open there is increased resistance and the fluid does not drain properly so that the intraocular pressure rises, damaging the delicate optic nerve.
Patient usually do not have any noticeable symptoms until their vision begins to narrow, creating a ”tunnel vision “, which if not treated promptly, may also be lost. Medication is usually the first line of treatment. However, recent studies indicate that surgery as the first line of treatment preserve the vision best.

The sergeon may choose to perform one of the following surgical procedure :

1.Laser trabeculoplasty. 

It is done on an argon laser equipped slit lamp, using a Goldmann gonioscope lens mirror
2.Trabeculotomy
It is surgery  of glaucoma.
3.Trabeculectomy:
Making a small hole in the eye wall(sclera).
That’s why lowering the intraocular pressure.

4.Seton insertion:
When all other measures fail, surgeon may insert a valve system is called Seton, in to the scleral wall.

5.viscocannulostomy:
It is an effective procedure in lowering intraocular pressure (IOP) in open-angle glaucomatous eyes.

6.Endoscopic cyclophotocoagulation :
In this procedure, ablating the ciliary body epithelium to decrease intraocular pressure (IOP).

2.Normal tension Glaucoma :

Glaucomatous optic nerve damage may occur even though the internal pressure of eye is within normal range. This condition also known as low pressure glaucoma.
In this condition may be hardening of blood vessels of the optic nerve. The condition is controlled by bringing the pressure down below normal by medication, regular exercise, low fat diet  etc..
If above all fail, then surgery may be performed.

3.Congenital glaucoma :

Babies may be born with defective drainage system. Surgery is only treatment.

4.secondary glaucoma :

Injury to eye, 
Certain drugs specially steroids, 
Tumors, 
Inflammation and other factors can block the drainage canal. So, in this case first cause is identified and then, treat it.

5.Acute angle closure Glaucoma :

Sudden build up of pressure due to iris blocking the drainage channels produce dramatic symptoms such as
Nausea, 
Vommiting, 
Severe pain, 
Blurred vision, 
Rainbow colour holes around the lights, 

Immediately reduction of pressure by medication followed by laser surgery peripheral iridotomy is essential.
A similar surgery is done in other eye to prevent similar attack.

Repeated attack, through unnoticed, may produce parmanant blockage of drainage channels and raised intraocular pressure. 

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