chronic glaucoma

Chronic glaucoma is a frequent, sneaky and malignant disease, which can strike since presbyopia ; this is the reason why, after 40 years old, it is strongly advisable to consult an ophthalmologist medical doctor before buying new spectacles, especially for close vision.

This illness as frequent as hypertension is characterized by the slow and progressive destruction of the optic nerve exactly where it enters the eye, leading eventually to blindness ; this destruction is due to an excess of intra-ocular pressure, which causes no symptom. The statistical normal average of the intra-ocular pressure is 10 to 20 units (millimeters of mercury). This ocular hyper-pressure oculaire is itself caused by a kind of clogging of the natural filter of the eye, where escapes continuously its aqueous fluid.

Chronic glaucoma is therefore a serious sickness, that one does not notice, and which only a medical doctor specialized in ophthalmology can detect and diagnose by examining the state of the optic nerve at the fundus of the eye, and by measuring the intra-oculoar pressure ; for chronic glaucoma does not cause any visual defect before 90% of the optic disk (the socket of the optic nerve) is definitively destroyed. At this stage, blind areas appear in the visual field of each eye, which do not match right and left : the patient can notice them only when closing one eye, at the end of disease, just before blindness.

The treatment is simple and effective, beause, thanks to recent pharmaceutical progress, we dispose of powerfull eyedrops. The ophtalmologist evaluates the efficiency of this continuous treatment, by checking the patient regularly, at least each 6 months, examining the shape of the optic disk in the fundus of the eye, measuring the intra-ocular pressure, and testing the visual field of each eye. The medical treatment does not heal this chronic disease, but lowers the intra-ocular pressure, hence prevents ruination of the optic nerve ; it is demanding : one must never stop it, otherwise intra-ocular pressure rises again in less than a day.

Despite the treatment, year after year, the intra-ocular pressure tendency is to increase slowly, leading to increase the number of eyedrops ; in certain cases, the ophthalmologist can propose laser treatment.

When eyedrops are no longer efficient for keeping down the intra-ocular pressure, the ophtalmologist is constrained to propose surgery, which is the only means for healing the patient. This operation is performed under topical anesthesia, by eyedrops, without injection, plus a sedation with a tranquillizer, and lasts about 20 minutes. It consist in opening a small window, under a microscope, to slim the filter and facilitate the exit of the aqueous fluid. The rate of success is good, about 95%, then the patient recovers both normal life and intra-ocular pressure, without treatment. But, as every human undertaking, this surgery is necessarily a bit risky : here is the reason why one must not decide it hastily, but only when no other alternative exists. On principle, once operated glaucoma does not come back ; however one should submit in an annual follow-up, for detecting an unlikely relapse.

This surgery is usually ambulatory ; and the post-operative treatment is about two months.

If you need additionnal information during your short hospitalization, please do not hesitate to ask to your ophthalmologist surgeon, who thanks you for your confidence.

the aqueous fluid

optic disk in glaucoma    visual field in glaucoma

pictures of operated eyes : fistula #1    fistula #2

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