Glaucoma (eye pressure) , which occurs when the pressure of the fluid inside the eye damages the optic nerves, is a chronic eye disease and one of the main causes of partial or complete loss of vision. A patient diagnosed with glaucoma must be under the supervision of specialist physicians throughout his life and receive appropriate treatment in order to avoid blindness.
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What is Glaucoma? What are the Symptoms of Eye Pressure?
The disease, which has entered the medical literature as “glaucoma” (also called “eye pressure”), is an optic neuropathy, that is, a disease of the optic nerve. With its emergence, it damages the nerve cells (ganglion), which are components of the visual pathway. Nerve cells that begin to die also cause vision to deteriorate over time.
It is difficult to recognize the disease in the early period when the person does not have any vision problems. Eye twitching, itching, etc. These conditions are not indicative of glaucoma . In fact, when glaucoma first begins, it does not cause eye pain; it progresses insidiously asymptomatic, that is, without causing any complaints.
Over time, the increase in the number of nerve cells affected by glaucoma begins to manifest itself as a deficiency in vision (dark spots), but the patient is still unaware of the existence of glaucoma because his brain fills in the missing parts imaginary. After this stage, if the patient has glaucoma in both eyes, he begins to be unable to distinguish close color tones from each other. (To detect the existence of such a situation, it will be useful to close the right and left eyes alternately and look at close colored/transitional objects.).
As the disease progresses, it is expected that some images will fade and dark spots will merge and create gaps. This condition can be described as a circular narrowing from the periphery to the center (In some patients, there is a loss of vision in the opposite direction.)
Apart from all these, situations such as persistent pain in one or both eyes, vision starting to become blurred, or seeing colored halos when looking at a light source are among the important signs to evaluate whether glaucoma is present.
It is very important for people over the age of 40 to have an eye examination once a year, even if they have no complaints, in order not to miss the diagnosis of eyepressure , which we describe as an insidious disease.
Classification of Glaucoma
It is possible to generally divide glaucoma into three groups: primary, secondary and congenital. While primary glaucoma develops spontaneously, secondary glaucoma occurs due to a disease.
Glaucoma (eye pressure) may also occur due to developmental disorders. In this type of congenital glaucoma, the channels that play a role in expelling intraocular fluid to maintain pressure balance do not develop while the baby is still in the womb. The baby may have glaucoma in one or both eyes . The typical sign of glaucoma in infants is that the affected eye is unusually large. In addition, the opacity or enlargement of the corneal layer or constant tearing in the eye also brings to mind the presence of eye tension .
The most common (about 90%) glaucoma in adults is chronic simple glaucoma (primary open-angle glaucoma), which belongs to the primary glaucoma group. The trabecular network, which plays a role in excreting eye fluid, cannot perform its filtering function properly, thus glaucoma occurs as the intraocular pressure increases. It is usually seen in individuals over the age of forty, does not cause any symptoms at first, and progresses slowly.
Angle-closure glaucoma (narrow-angle glaucoma) constitutes a small portion of glaucoma seen in adults. In these patients with a narrow anterior chamber angle, eye fluid cannot be expelled because the iris root has formed in front of the trabecular network for various reasons. Narrow-angle glaucoma requires urgent intervention because there is a sudden increase in eye pressure. Such patients typically experience blurred vision, vomiting, and severe pain around the eyes and head.
What Causes Eye Pressure?
Glaucoma (eye pressure) , which is seen in 70 million people worldwide , is a disease whose cause is unknown as of today. According to research, although there are some factors that trigger glaucoma, it is impossible to say that any of them is the only reason that causes the disease.
The main risk factor for glaucoma (eye pressure) is the accumulation of intraocular fluid inside the eye and thus the increase in intraocular pressure. Apart from this, genetic predisposition, thin cornea, myopia, features of the optic disc, circulatory disorders, advancing age, uncontrolled drug use, blow to the eye, diabetes, etc. Factors can also lead to glaucoma.
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Relationship between intraocular pressure and Glaucoma (Eye Pressure Disease)
Intraocular pressure, which is created by the colorless liquid called aqueous humor located between the cornea and the intraocular lens and is normally expected to be between 9 and 22 mmHg, plays an important role in maintaining the health of the eye. The level of intraocular pressure varies from person to person and between times of day, parallel to health history.
It is important that the intraocular fluid is in balance (the balance between the amount of fluid remaining in the eye and being expelled), because disruption of the balance causes the fluid accumulated in the eye to increase, which leads to eye pressure . Glaucoma , as it is mentioned, is a disease of optic neuropathy (infection of the eye nerves) and may occur due to persistently high eye pressure.
However, it may be seen even if the intraocular pressure is at normal values, or it may not be seen even if the intraocular pressure is high. In other words, the effect of intraocular pressure varies from person to person. For example, in a person whose intraocular pressure is 18 mmHg, we can diagnose eye pressure by seeing that the optic nerves are affected during the examination and set the target as lowering the intraocular pressure to levels lower than 18 mmHg. However, pressure exceeding 20 mmHg is considered the biggest cause of glaucoma .
In summary , high eye pressure (ocular hypertension) is a condition in which the intraocular pressure rises for different reasons, but the optic nerves are not damaged (referred to as ocular hypertension in the medical literature). In order to be diagnosed with eye pressure disease (glaucoma), the optic nerves must be damaged.
* Although the intraocular pressure is within the normal range, if the optic nerves are damaged, there is a loss of vision not from the outside to the center, but in the opposite direction, from the center to the outside.
How to Diagnose Glaucoma?
Since glaucoma is an insidious disease that progresses without symptoms (asymptomatic), it is usually diagnosed during routine eye examinations.
Measuring the intraocular pressure level with a tonometry test and evaluating the optic nerves with an ophthalmoscope or biomicroscope, which are integral parts of routine eye examinations, are important steps in revealing the presence of glaucoma. Apart from these, the ophthalmologist may use different methods to evaluate the visual field and trabecular network.
Glaucoma Treatment
Glaucoma (eye pressure disease) , if not detected and treated, causes partial or complete and permanent loss of vision (13.5% of total blindness worldwide is caused by glaucoma).
In order to prevent blindness, it is extremely important for people to have regular full eye health screenings and to receive treatment if glaucoma is detected, without waiting for any symptoms to appear. Glaucoma , which is monitored by performing the necessary tests under the supervision of a specialist physician , is not expected to completely blind the patient.
Glaucoma (eye pressure disease) is one of the diseases that progresses insidiously, that is, it does not cause any complaints in the patient until the late stages. Glaucoma’s damage to nerve cells called ganglion increases day by day. The main problem is that the damaged nerve cells and ganglia have no possibility of recovery/renewal. Therefore, treatment is aimed at stopping the progression of the disease and maintaining the current state of eye health and should be continued throughout life.
Since there is no single type of glaucoma , there is no single type of treatment. Like the type of disease, the patient’s current condition also affects the treatment. For example, in some patients, due to a blockage that cannot be seen from the outside with the naked eye, the eye fluid increases, increasing the intraocular pressure, and this pressure leads to glaucoma. In some patients, glaucoma is detected even though the intraocular pressure is not high. Therefore, it can be said that glaucoma treatment varies from patient to patient. After the diagnosis, the physician decides the most appropriate treatment method.
The main goal of glaucoma treatment is to reduce intraocular pressure today, as in the past. Within the scope of glaucoma (eye pressure disease), patients are mostly treated with medication. Although this treatment appeals to the majority of patients, laser treatment and surgical methods can also be applied, depending on the type of glaucoma. In case of congenital glaucoma , surgical intervention is usually performed. Medication may also be preferred for some infant patients.
- It is essential to re-establish intraocular pressure balance within the scope of drug treatment. Therefore, medications (eye drops, pills and serum) have the ability to reduce the production of intraocular fluid or increase the excretion of fluid. Within the framework of drug treatment, the use of eye drops is generally preferred. Instead of using a single drop, some patients may need to use two or even three drops in rare cases. Pills and serum only contribute to lowering intraocular pressure for a short time and are applied in glaucoma attacks.
- The primary aim of laser treatment is to establish pressure balance. To prevent the increase in intraocular pressure, radiation is sent to the tissue where the fluid is produced. In order to allow the intraocular fluid to be expelled, a hole is made in the colored layer of the eye using a laser beam. Laser treatment is generally preferred in patients who are not suitable for surgery and in chronic simple glaucoma .
- When glaucoma is desired to be controlled through surgical intervention, a slit is made inside the eye to drain the intraocular fluid and maintain pressure balance. There is a possibility that the crack will close over time and the pressure will rise. In surgical treatment, the use of implants to transfer fluid to the outside may also be preferred. Surgical interventions stand out as the most effective method in reducing eye pressure compared to other treatment methods. Although it is possible that the surgery will be repeated in the future, it is difficult to achieve the success of the first surgery in the next surgery.
The aim of the treatment of patients whose intraocular pressure is at normal values but whose optic nerves are damaged is to reduce the blood pressure. Treatment of such patients may be relatively more difficult in terms of achieving results. For patients whose intraocular pressure is above 22 mmHg but whose optic nerves are not damaged, that is, they do not have glaucoma , drug treatment can be started as a precaution due to the risk they pose.
It would be beneficial for patients receiving treatment not to be active/passive smokers, not to use steroids as much as possible, to change their eating habits to healthy ones, and to exercise routinely. In addition, it should not be forgotten that no herbal treatment can reverse optic nerve damage that modern medicine cannot reverse.
Each of the treatments is aimed at preventing vision loss that is expected to occur in the future. The only way to prevent the situation from getting worse is to receive appropriate treatments in the form and duration deemed appropriate by the physicians. The absence of complaints should not make the patient decide to discontinue the treatment.
When glaucoma treatment is stopped, the patient is likely to experience partial or complete blindness. Compliance with the control date determined by the physician is also very important in order to detect the current situation; In some patients, the treatment method may need to be changed. In addition, during these checks, the current condition of the optic nerves should be examined by OCT and visual field tests, because – for example – although eye pressure can be reduced with current treatment, the progression of damage to the optic nerves may not be stopped.
Patients should not forget that no matter what treatment is applied, the damage already caused by glaucoma cannot be eliminated. In other words, even with surgery, it is certain that vision loss caused by glaucoma will continue.
As a result, early diagnosis and treatment is very important in glaucoma, as in every disease. It will be useful to consult an ophthalmologist for early diagnosis, even if there are no complaints.
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