Specially developed classification of glaucoma simplifies case management. Having correctly determined what type of pathology belongs to, the doctor will quickly and better select a therapeutic course, more accurately formulate a prognosis. To identify belonging to a certain class, it is necessary to analyze the symptoms of the case and its key features, as well as the underlying causes and complications observed in the patient.
What are there?
All cases are divided into primary and secondary. An important criterion for dividing into groups is the open or closed camera angle. Assessing the pressure, the case is classified as normotensive or accompanied by local hypertension. The disease is stabilized and not being such. Based on the time of manifestation of symptoms, cases are divided into infantile, juvenile, congenital and diagnosed in adults. Taking into account the progress of the pathology, they determine belonging to the initial, developed, progressive, terminal.
Let's consider these typesmore details.
Congenital
In the current classification, glaucoma of this type is called a disease caused by dysgenesis of the outer chamber angle. Other factors are possible, but classifying the case as congenital is allowed only with genetic underlying causes or improper formation of the embryo. From medical statistics it is known that in the predominant number of patients with such a disorder, concomitant abnormal nuances of the structure of the visual system are revealed. Quite often, a congenital type of pathology is diagnosed against the background of microcornea, that is, the development of the eye, in which the cornea is less than normal. There is a possibility of a pathological condition of the vitreous body. There are frequent cases of delayed manifestation of symptoms, which makes it possible to diagnose a juvenile or infantile form. With congenital pathology, the patient often has an eyeball that exceeds normal dimensions. The phenomenon was called hydrophthalmos.
In the current classification, congenital glaucoma is a pathological condition in which the outflow of fluid from the eye is disturbed, since the mesenchyme in the anterior chamber angle has developed with pathological abnormalities. The etiology of the disease has not yet been clarified. Statistical studies have shown that the hereditary type is formed on average in every tenth patient with this glaucoma. All these cases can be explained by autoimmune recessive gene transfer. The remaining 90% are considered sporadic, among the close relatives of the patient there are no people with similar disorders. It is known that congenit altype is more often detected in males.
Innate Type: Forms and Mechanisms
In the current classification, congenital glaucoma is a pathological condition caused by anterior chamber angle dysgenesis. With such a pathology, the process of formation of this area proceeds with violations. The iris is attached near the trabeculae, which blocks the outflow of fluid from the eye. The impossibility of adequate circulation is explained by the mesenchyme. In different cases, the volume of this tissue varies significantly.
Congenital type can be in a newborn - then the disease is called that. Symptoms can be seen as soon as the baby is born. Neonatal glaucoma is detected if the primary symptoms are established before reaching the age of three months. Many people born with the condition have hydrophthalmos. The growth of internal pressure provokes the growth of the eye, buphthalmos is formed, the sclera becomes thinner, the cornea degenerates, corneal syndrome appears. The child has tears, red eyes, irritated condition. The patient sleeps poorly and tends to cry.
Forms of congenital pathology: continuing consideration
Since the classification of glaucoma takes into account the moment of manifestation of pronounced signs of the disease, the case is classified as infantile if the signs of pathology were formed at the age of more than three months, but less than ten years. The clinical picture is rather blurred if we compare the case with the one developing immediately after birth. Most patients with this disorder do notcomplex angular syndrome.
Juvenile type of the disease is detected in people of the age group 11-35 years. The disease develops according to a scenario close to the open-angle type. The patient notes soreness of the eyes, deterioration in the ability to see. Stable headache.
Status Progress
Since the classification of glaucoma takes into account not only the age of the patient, but also the development of pathology, a particular patient can be attributed to a group of people suffering from a typical form of congenital glaucoma. The manifestation of symptoms characteristic of the disease is observed once every couple of months or every quarter of the year, mainly the angular syndrome worries, tears are released, the eyes turn red, the mucous membranes are irritated, the person is afraid of bright light.
There is a possibility of a malignant type. Symptoms progress at a rapid rate. Most patients with this form of the disease suffer from hydrophthalmos from birth. For many, the pressure inside the eye rises strongly in the first or second month of existence.
With a benign form of congenital glaucoma, symptoms can be noticed before the child reaches the age of one year or twice as much. The clinical picture is blurred, the disease is detected as part of a preventive examination.
Finally, there is an abortive type in the classification of congenital glaucoma. Its distinctive feature is the increase in pressure inside the eye, the formation of a pronounced angular syndrome already in the first months of life. Further, the symptoms regress, the patient's condition spontaneously improves.
Terminal glaucoma
In all the types listed earlier in the classification of glaucoma, the terminal type of the disease was mentioned. The term describes the final stage of the disease, the main symptom of which is the irreversible loss of the ability to see. Some patients retain the ability to distinguish between light and dark. Terminal glaucoma is diagnosed if a person has suffered from some type of this eye disease for a long time, but has not received adequate treatment. The progress of the disease is accompanied by an increase in local symptoms and pathological deformation of the fundus. The nervous system atrophies, dystrophy covers the retina, the ability to see deteriorates. The progress of the disease to the terminal form is noticeable by the deterioration of peripheral vision.
Sometimes terminal painful glaucoma is diagnosed. In the classification of glaucoma by stages, this term refers to a pathological condition accompanied by severe pain. The sensations are sharp and greatly exhaust the suffering person. Soreness extends to the head, partially covers the face. Strength is similar to pain due to a tooth, neuralgia. Correction with medication is possible with great difficulty. Most are shown surgery as the only way to stabilize pressure and eliminate pain.
Symptomatics
The existing system of classification of glaucoma and its stages involves an assessment of the manifestations of the disease, taking into account the identified features of different classes. In particular, the terminal form is diagnosed if the patient suffers from a fear of light, he is sick. Common manifestations - activetearing and redness of the eyes. All of them are explained by edema of the corneal tissues, accompanied by local nervous irritation. Corneal tissues are easily infected. For many, terminal glaucoma is accompanied by frequent keratitis, corneal perforation, iridocyclitis.
Can it be expelled?
The main problem of glaucoma is a relatively weak clinical manifestation. The patient is not bothered by unpleasant syndromes, so the person does not turn to the doctor on time. The pathology progresses, the ability to see worsens. Experts advise to visit an ophthalmologist at least once every year to determine the features of the condition of the eye. Such a measure is recommended even for those who consider themselves completely he althy.
If glaucoma is diagnosed, visit the eye doctor twice or thrice annually. The frequency will be determined by a specialist based on the identified deviations. The doctor will select a therapeutic course. Following the program, applying corrective methods, regular check-ups are the main ways to exclude the progress of pathology and loss of vision.
If, taking into account the classification of glaucoma by visual fields, a terminal course is diagnosed, the prognosis is poor. Changes cannot be reversed, it will not be possible to restore the patient's vision. The main objective of the therapeutic program is to relieve pain and preserve cosmetic ocular functionality, if possible.
Primary glaucoma
In the domestic and foreign classification of glaucoma, this term is used to denote a conditionin which the pressure inside the eye increases, despite the absence of organic eye pathologies. Several factors provoking such a disease have been identified. One of them is genetic, that is, burdened heredity. Glaucoma is usually a polygenic disease. From generation to generation, the features of the formation of a network of trabeculae, iris attachment, and the dimensions of individual areas inside the eye are transmitted. A complex of factors leads to the formation of glaucoma.
Ocular anatomy plays an important role. In the classification of glaucoma and its forms, it is specified: the primary form more often haunts people with hyperopia, since the eye chamber is small in front, the angular dimensions are less than standard. From the specifics of the anatomy leading to glaucoma, there are increased dimensions of the lens and a narrowed or too small eye chamber in front.
Age is no less significant. Over the years, local ocular blood flow is disturbed, drainage works worse. Such factors can provoke the formation of pathology.
Primary disease: what happens?
Classification of glaucoma by IOP involves the division of all cases into those accompanied by high and normal internal pressure. The dynamics allows classifying the pathology as a stabilized variant or not. Primary glaucoma may be initial, as it progresses, it is ranked as an advanced case or advanced. The final stage is the terminal primary.
There are three known mechanisms for the formation of the disease. Mixed occurs quite often,characterized by two pathogenesis of the disease: open, closed. In the classification, open-angle glaucoma of the primary type is a pathological condition due to a failure of the drainage system of the eye. The cause may be an iris pigment deposit affecting the apparatus of the trabeculae, a change in its structural features. The closed-angle form is detected if the movement of aqueous humor, which normally passes through the pupil, is disturbed. With the disease, the iris periphery is prone to prolapse. The iris root covers the anterior chamber of the eye. The circulation of ophthalmic fluid is interrupted.
Symptomatics
To determine what type the case belongs to according to the classification (angle-closure glaucoma, open angle, combined course), it is necessary to analyze the features of the manifestations. Glaucoma is formed as a chronic, accompanied by acute cases. Outside of these, clinical manifestations are insignificant. The man has a headache. Vision gradually worsens, including peripheral, soreness occurs near the eye, in the eyebrow. The pathology progresses, which affects the state of the fundus and leads to a worsening of the manifestations. If progress has reached the terminal stage, it will not be possible to reverse the loss of vision.
Acute attack is a serious condition that requires urgent qualified help. The patient feels a sharp cutting soreness in the eye, spreading to the face. Man vomits, sick. Pain occurs in the heart, gastric area. A veil is seen before the eyes or rainbow circles appear. The patient needshelp to reduce pressure and prevent ischemia of the fundus of the eye. Shown drugs to stabilize pressure, antioxidants, neuroprotectors. When the condition stabilizes, surgery may be offered to prevent recurrence.
About pressure
There is a classification of glaucoma by pressure, since not all cases are accompanied by an increase in this parameter. The normotensive course is known for stable normal pressure values characteristic of a he althy person. In this case, the pathology covers the fundus of the eye, where unhe althy changes are localized, and the nervous system that provides the visual organs atrophies. Examination of the neural disc reveals hemorrhagic streaks.
More often this type of pathology is formed in young people with a relatively low level of spinal fluid pressure. In the classification of primary normotensive glaucoma, it is taken into account that mainly people suffering from this form are characterized by lower pressure indicators in the ophthalmic system compared to the standard. At the same time, an exceptionally weak tolerance to the growth of the parameter is observed. Pathology often develops slowly, flows in the form of a chronicle, can stabilize in advanced years due to compensation by the vascular system. With such a disease, it is especially important to regularly visit a doctor to monitor progress, since there are no pronounced symptoms, but degeneration still occurs, vision deteriorates, and this process cannot be reversed.
How to detect?
Adequate and timely diagnosis of glaucoma is an extremely important problem of modern medicine. A classification that includes specific manifestations inherent in different cases somewhat simplifies the clarification of the specific. First of all, the doctor checks the pressure inside the eye, using specialized devices designed for this. Indicators in the range of 12-21 units are considered normal. At the same time, it is necessary to determine the tolerant pressure, that is, the level at which pathological tissue deformations are not formed. The next diagnostic step is gonioscopy. The method involves identifying the dimensions of the anterior eye chamber and its other important features. Need to visualize the front corner.
Diagnosing glaucoma, taking into account the current classification, involves ophthalmoscopy, that is, research activities to determine the characteristics of the eye fundus. This method helps to detect complications in a timely manner and determine exactly to what stage the disease has developed.
Open Angle Glaucoma (OAG)
The term refers to a disease in which the pressure inside the eye increases, but there are no pathological changes in the anterior chamber angle of the eye. It is believed that OAG is formed due to the innate specificity of the structure of the ophthalmic system. External factors play a role. Most cases are characterized by polygenic mechanisms of transmission of pathology between generations.
Pathology is formed in violation of eye drainage. Areas near the limbus suffer. Over the yearsdegeneration progresses, dystrophy is more pronounced, the symptoms of the disease worsen. The pathology covers the intratrabecular spaces, the network of trabeculae and the canal of Schlemm.
Pathology can form in a pigmented form. This is the name of the disease, which is explained by the washing out of the iris pigment and its penetration into the network of trabeculae. More often, the disease is detected in people of the middle age group, in old age.
Secondary glaucoma
This is a pathological condition of the eye system, formed as a complication against the background of another pathology. According to the current classification, secondary glaucoma is a pathology that appears due to an injury received by a person, an active inflammatory focus or surgery. The cause of the disease can be tumor processes, cataracts, tissue degeneration. There is a possibility of vascular disorders as an underlying cause. Usually the disease develops unilaterally, often accompanied by an increase in local pressure in the evening. There is a possibility of a crisis. Vision is rapidly deteriorating, potentially reversible if a therapeutic program is started in time.
As you can see from the classification of primary glaucoma and the description of its symptoms, this disease is quite close in manifestation to the secondary. When an eye disorder is formed against the background of other causes, a person notes soreness of the eyes and a deterioration in the ability to see. Circles appear before the eyes, other phenomena of vision are possible. Most have a headache. The primary task of the doctor is to determine the cause that provokedblurred vision and increased blood pressure.
Secondary: subtypes
In the classification of secondary glaucoma there is a post-traumatic form of the disease. It is formed due to soldering. Often appears with hyphema, that is, local intraocular hemorrhage. Sometimes this type appears after a burn, wound or concussion.
Postoperative - a pathology, the risk of which is on the background of any surgery. Usually the pressure rises temporarily, then the parameter stabilizes. If the probability of nervous atrophy is assessed as increased, the patient is offered a second surgical intervention. Such glaucoma is often fixed with an aphakic eye that does not have a lens. The vitreous body shifts, the communication processes of the eye chambers are disrupted.
Inflammatory subtype is possible with uveitis, keratitis, scleritis. Phacogenic observed against the background of cataracts. Neovascular is explained by vascular neoplasms. The neoplastic type is associated with formations in the eyeball, which blocks the internal fluid circulation.
Step by step
To make an accurate diagnosis, you need to determine the stage of the pathology. Initial is characterized by normal vision in the periphery with defects in the central area. Visually fixed changes in the fundus are not detected, but there is a possibility of excavation of the nerve visual block. The second stage is associated with a narrowing of vision in the periphery by 10 degrees or more. Nervous excavation is expressed moderately. The third stage is characterized by narrowing of vision in the periphery by 15 degrees, excavation is deep. At the terminalIn principle, there is no objective vision at a step, but some retain the ability to distinguish between light and shadow. The light projection inherent in the state is wrong. The nervous system is subject to atrophic processes, the excavation of the disk is complete.
Classification of glaucoma by visual fields involves taking into account the dynamics. With a stabilized course, observation of the patient for a quarter of a year and a longer period does not allow to detect changes in the visual fields, the nervous system. An unstabilized course is accompanied by a narrowing of the visual fields. The nervous system is subject to pathological processes, disc excavation is observed.
Closed angle and flat iris
In the current classification system, this class of pathological cases includes UG, accompanied by a flat iris. This specific feature is due to the anatomy of the visual system. Anatomical deviation is referred to as a factor with a high degree of probability initiating an increase in pressure inside the eye. In the case of a flat iris, the anterior chamber angle is blocked due to the specific internal structure. The iris prevents access to the corner, if the pupil expands, the peripheral parts become thicker, folds appear. The iridocorneal angle from below can overlap completely. The fluid inside the eye cannot circulate normally, and internal pressure builds up. The likelihood of aggravation of the condition and the formation of MAG increases with age.
Attack is possible if the anterior chamber angle is absolutely blocked. This happens with a strong expansion of the pupil. Iris blockage in medical practice occursinfrequently, it is possible to simultaneously prevent fluid outflow by pupillary and iris block. Differential diagnosis of these two pathologies is difficult. Acute attack, subacute attack are explained by the blockage of the narrow anterior chamber angle by the iris fold on the periphery. This is possible with the use of drugs that dilate the pupil, strong arousal and being in a very dark room.
