The classification of glaucoma developed by specialists simplifies case management. Having correctly determined which type the pathology belongs to, the doctor will select a therapeutic course faster and better, more accurately formulate a prognosis. To identify belonging to a certain class, it is necessary to analyze the symptomatology of the case and its key features, as well as the root causes and complications observed in the patient.
Which are there?
All cases are divided into primary and secondary. An important criterion for dividing into groups is the open or closed corner of the camera. Assessing the pressure, the case is considered 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. Given the progress of pathology, they determine the belonging to the initial, developed, progressive, terminal.
Let's consider these types in more detail.
Congenital
In the current classification, glaucoma of this type is called a disease due to dysgenesis of the external chamber angle. Other factors are possible, but attributing a case to congenital is allowed only with genetic root causes or improper embryo formation. From medical statistics it is known: in the predominant number of patients with such a violation, concomitant abnormal nuances of the structure of the visual system are detected. 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 symptoms, which allows you to diagnose a juvenile or infantile form. With congenital pathology, the eyeball often exceeds the normal size of the patient. The phenomenon was called hydrophthalmus.
In the current classification, congenital type glaucoma is a pathological condition in which the outflow of fluid from the eye is impaired, since the mesenchyme in the anterior chamber corner 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 the congenital type is more often detected in males.
Congenital type: forms and mechanisms
In the current classification, congenital type glaucoma refers to a pathological condition caused by dysgenesis of the anterior chamber angle. With such a pathology, the process of formation of this region proceeds with violations. The iris is attached near the trabeculae, which is why the outflow of liquid ophthalmic substance is blocked. The impossibility of adequate circulation is explained by mesenchyme. In different cases, the volume of this tissue varies significantly.
A newborn can have a congenital type - then the disease is called that. Symptoms can be seen as soon as the baby is born. Glaucoma of newborns is detected if the primary symptoms are established before reaching the age of three months. Many born with pathology have hydrophthalmos. An increase in internal pressure provokes an overgrowth of the eye, a buftalm forms, the sclera becomes thinner, the cornea degenerates, and a corneal syndrome appears. The child has tears, red eyes, irritated condition. The patient does not sleep well and is inclined 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 considered infantile if the signs of pathology are formed at the age of more than three months, but less than ten. The clinical picture is quite blurry, if we compare the case with developing immediately after birth. Most patients with this disorder do not have a complex angular syndrome.
The 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 sore eyes, impaired ability to see. The headache is constantly worrying.
Status Progress
Since the classification of glaucoma takes into account not only the age of the patient, but also the features of 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 the characteristic symptom of the disease is observed every couple of months or every quarter of a year, mainly worries about angular syndrome, tears are released, eyes turn red, mucous membranes are irritated, a person is afraid of bright light.
There is a chance of a malignant type. Symptoms progress at high speed. Most patients with this form of the disease from birth suffer from hydrophthalmia. For many, the pressure inside the eye increases greatly in the first or second month of existence.
With a benign form of congenital glaucoma, symptoms can be noticed when the child reaches the age of one year or twice as much. The clinical picture is blurry, the disease is identified as part of a routine 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 in the first months of life. Further, the symptoms regress, the patient's condition spontaneously becomes better.
Terminal glaucoma
In all previously listed species, the terminal type of disease was mentioned in the classification of glaucoma. The term describes the final stage of the disease, the main sign of which is an irreversible loss of ability to see. Some patients retain the ability to distinguish between light and darkness. 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 deformity of the fundus. The nervous system atrophies, dystrophy encompasses the retina, and the ability to see is impaired. The progress of the disease in 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 severely exhaust the suffering person. Soreness spreads to the head, partially covers the face. Strength is similar to pain due to a tooth, neuralgia. Correction with medicines is possible with great difficulty. Most are shown to operate as the only method to stabilize pressure and eliminate pain.
Symptomatology
The existing classification system for glaucoma and its stages involves the 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. Typical for most manifestations is the active release of tears and redness of the eyes. All of them are explained by edema of corneal tissues, accompanied by local nervous irritation. Corneal tissues are easily infectious. In many, terminal glaucoma is accompanied by frequent keratitis, corneal perforation, iridocyclitis.
Is it possible to exclude?
The main problem of glaucoma is the relatively weak severity of the clinical picture. The patient is not bothered by unpleasant syndromes, so a person does not consult a doctor on time. Pathology is progressing, the ability to see is deteriorating. Experts advise to visit an ophthalmologist at least once a year to determine the characteristics of the eye condition. Such a measure is recommended even to those who consider themselves completely healthy.
If glaucoma is diagnosed, an eye doctor should be visited 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 checking of the condition are the main ways to exclude the progress of pathology and loss of vision.
If, based on the classification of glaucoma according to the fields of view, a terminal course is diagnosed, the prognosis is poor. Changes cannot be reversed; vision cannot be returned to the patient. The main objective of the therapeutic program is to relieve pain and maintain cosmetic eye functionality, if possible.
Primary glaucoma
In the domestic and foreign classification of glaucoma, this term is used to denote a condition in which the pressure inside the eye rises, despite the absence of organic eye pathologies. Several factors provoking such a disease have been identified. One of them is genetic, that is, burdened by heredity. Glaucoma is usually a polygenic disease. From generation to generation, features of the formation of a network of trabeculae, iris attachment, and the dimensions of individual areas within the eye are transmitted. A set of factors leads to the formation of glaucoma.
An important role is played by ocular anatomy. In the classification of glaucoma and its forms, it is specified: the primary form more often persecutes people with hyperopia, since the eye chamber is small in front and the angular dimensions are smaller than the standard ones. Of 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.
No less significant age. Over the years, local ocular blood flow is disturbed, drainage works worse. Such factors can trigger the formation of pathology.
Primary disease: what happens?
Classification of glaucoma according to IOP involves the division of all cases into those accompanied by high and normal internal pressure. Dynamics allows us to rank the pathology as a stabilized version or not being such. Primary glaucoma may be initial, as it progresses, it is ranked as a developed case or has gone far. The final stage is the terminal primary.
Three mechanisms of disease formation are known. 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 malfunction of the drainage eye system. The reason may be iris pigment deposition, affecting the apparatus of the trabeculae, a change in its structural features. The closed-angle shape is detected if the movement of aqueous humor, normally passing through the pupil, is disturbed. With the disease, the iris periphery is prone to prolapse. The iris root closes the anterior chamber eye angle. The circulation of the ophthalmic fluid goes astray.
Symptomatology
To determine what type of case the classification belongs to (angle-closure glaucoma, open angle, combined course), it is necessary to analyze the features of the manifestations. Glaucoma forms like a chronicle, accompanied by acute cases. Outside of these, clinical manifestations are insignificant. A person has a headache. Sight is deteriorating, including peripheral, soreness occurs near the eye, in the eyebrow. Pathology progresses, which affects the condition of the fundus and leads to a worsening of manifestations. If progress has reached the terminal stage, it will not work to reverse the loss of vision.
An acute attack is a serious condition that requires emergency qualified assistance. The patient feels a sharp cutting soreness in the eye, spreading to the face. A person vomits, feels sick. Pain occurs in the heart, stomach area. A veil is seen before the eyes or rainbow circles appear. The patient needs help to lower the pressure and prevent ischemia of the bottom of the eye. Shown drugs to stabilize the pressure, antioxidants, neuroprotectors. When the condition stabilizes, they can offer surgery to prevent relapse.
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 the stable normal pressure indices characteristic of a healthy person. In this case, the pathology covers the fundus, where unhealthy changes are localized, and the nervous system that provides the visual organs atrophies. Examination of the nerve ocular disk reveals hemorrhagic bands.
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 glaucoma of a normotensive type, 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 extremely weak tolerance to parameter growth is observed. Pathology often develops slowly, flows in the form of a chronicle, and 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 is no pronounced symptomatology, but degeneration still occurs, vision deteriorates, and it is impossible to reverse this process.
How to identify?
An extremely important problem of modern medicine is an adequate and timely diagnosis of glaucoma. Classification, which includes specific manifestations inherent in different cases, somewhat simplifies the refinement of a specific one. First of all, the doctor checks the pressure inside the eye, using specialized devices designed for this. Normal are considered indicators within 12-21 units. At the same time, it is necessary to determine the tolerant pressure, that is, the level at which pathological tissue deformations do not form. The next stage of diagnosis is gonioscopy. The method involves identifying the dimensions of the anterior ophthalmic chamber and its other important features. It is necessary to visualize the rake angle.
Diagnosis of glaucoma carried out taking into account the current classification involves ophthalmoscopy, that is, research measures to determine the features of the eye day. This method helps to detect complications in a timely manner and accurately determine 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 eye angle. It is believed that OAG is formed due to the inherent specificity of the structure of the ophthalmic system. External factors play a role. Mostly cases, polygenic mechanisms of transmission of pathology between generations are inherent.
Pathology is formed with a violation of ocular drainage. The areas near the limb suffer. Over the years, degeneration progresses, dystrophy is more pronounced, the symptoms of the disease worsen. The pathology covers the intratrabecular spaces, the network of trabeculae and the Schlemm's canal.
Pathology can form in a pigmented form. This is the name of the disease due to leaching 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 indicates the pathological condition of the ocular system, which has formed as a complication against a different pathology. According to the current classification, secondary glaucoma is a pathology that appears due to a person’s injury, an active inflammatory focus or surgery. The cause of the disease can be tumor processes, cataracts, tissue degeneration. There is a likelihood of vascular disorders as a root cause. Usually, the disease develops one-sided, often accompanied by an increase in local pressure in the evening. There is a chance of a crisis. Vision is rapidly deteriorating, potentially reducing it can be reversed if you start a therapeutic program in a timely manner.
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