Non-pupillary block type: can be divided into peripheral iris hypertrophy type and ciliary body anterior type. The characteristics of peripheral iris hypertrophy are: The thick peripheral iris root is trapezoidal at the entrance of the chamber angle, forming a sharply turning narrow chamber. Some scholars call this type of patient a high iris fold type. ciliary body anterior position The characteristic is that the position of the ciliary body moves forward, pushing the peripheral iris toward the chamber angle, resulting in narrowing of the chamber angle or closure.

It is more common in people over 50 years old, and is more common in women. The ratio of men to women is about 1:2.

Clinical manifestations and disease stage

Diagnosis and differential diagnosis: Although acute iridocyclitis also has symptoms of eye pain, there is generally no corneal epithelial edema. The blood pressure is often low, the pupils are constricted, aqueous humor can be seen shining in the anterior chamber, and sometimes fibrinoid exudation can be seen. out so that it can be identified. Because acute angle-closure glaucoma attacks are often accompanied by nausea, vomiting, and severe headache, these symptoms Symptoms can even mask eye pain and vision loss. Clinical identification should be noted to avoid misdiagnosis of gastrointestinal disease. Delay in treatment due to tract disease, brain disease or migraine.

Diagnosis: The diagnosis of chronic angle-closure glaucoma should be based on the following points: ① The peripheral anterior chamber is shallow, the depth of the central anterior chamber is slightly shallow or close to normal, and the iris bulge is not obvious; ②The chamber angle is moderately narrow, and there are varying degrees of anterior synechiae around the iris; ③ accompanied by varying degrees of glaucomatous visual field defects. Chronic angle-closure glaucoma and open-angle glaucoma also have elevated intraocular pressure, optic disc pit atrophy, and visual field defects.

1. Symptoms: Most patients do not have any conscious symptoms.

2. Intraocular pressure: It appears unstable in the early stage, and sometimes it can be within the normal range. It is easier to detect intraocular pressure peaks and larger fluctuations by measuring 24-hour intraocular pressure. The overall intraocular pressure level is often slightly higher than normal.

3. Anterior segment: The depth of the anterior chamber is normal or deeper.

4. Fundus: The optic disc depression progressively expands and deepens.

5. Visual function: Changes in visual function, especially visual field defects. Typical early visual field defects in glaucoma visual field examination manifest as isolated paracentral scotoma. and nasal steps.

Visual field defect: Normal tension glaucoma (NTC) has characteristic glaucomatous optic disc damage and visual field defect, but the intraocular pressure is always within the statistically normal range. around. Even under normal intraocular pressure, the optic nerve is damaged.

1. Parasympathomimetic drugs (miotics): The most commonly used are 1% ~ 4% pilocarpine eye drops. Pilocarpine directly stimulates pupils Aperture sphincter, narrows the pupil and increases iris tension, releasing the peripheral iris from the trabecular meshwork It is the first-line medication for the treatment of angle-closure glaucoma.

2. Beta-adrenergic receptor blockers: commonly used are 0.25% ~ 0.5% timolol, 0.25% ~ 0.5% levobunolol hydrochloride and Eye drops such as 0.25% ~0.5% betaxolol can reduce intraocular pressure by inhibiting the production of aqueous humor. It does not affect pupil size and adjustment function, but its blood pressure lowering range is limited. The blood pressure lowering effect is weakened.

3. Prostaglandin derivatives: The preparations currently in clinical use include 0.005% latanoprost, 0.004% travoprost and 0.03% bemetoprost.

4. Carbonic anhydrase inhibitors: represented by acetazolamide, which reduces intraocular pressure by reducing the production of aqueous humor and is mostly used as a supplement for topical medications. Charge.

5. Hypertonic agent: 50% glycerin and 20% mannitol are commonly used. This type of drug can increase plasma osmotic pressure in the short term, causing eye tissue, especially In particular, the water in the vitreous body enters the blood, thereby reducing the intraocular volume and rapidly lowering intraocular pressure, but the antihypertensive effect It disappears after 2 to 3 hours. Hypertonic agents are mainly used to treat acute attacks of angle-closure glaucoma and certain acute Secondary glaucoma due to increased intraocular pressure.

1. Surgery to relieve the resistance of the trabecular meshwork: such as goniotomy, trabeculotomy, and selective laser trabeculoplasty (SLT). This type of surgery can often cure primary infantile glaucoma. healing effect.

2. Surgery to establish an external aqueous humor drainage channel (filtration surgery): aqueous humor drainage device implantation. This type of surgery is mainly suitable for For POAG and angle-closure type with extensive angle adhesions glaucoma.

1. Narrow pupils: During the aura stage, use 1% pilocarpine eye drops once every half hour. The reduction is usually achieved after 2 to 3 times. To narrow pupils and reduce intraocular pressure.

2. Combined medication: During an acute attack, in addition to local miotic drops, combined medication is often required, such as systemic application of hypertonic agents, carbonic acid Anhydrase inhibitors, local drops of beta-blockers to quickly reduce intraocular pressure.

3. Surgical treatment: Peripheral iridectomy can be used for pupillary block and the scope of angle adhesion is not limited. Mydriasis alone can be used. Early cases of intraocular pressure control.

Filtration surgery: Trabeculectomy is the most common procedure. It is generally believed that the indications for surgery are when medical treatment is ineffective or intolerable. Cases that are subject to long-term medication or are incapable of medical treatment.

1. Photophobia, tearing, and blepharospasm are the three characteristic symptoms of this disease.

2. The cornea is enlarged and the anterior chamber is deepened. The transverse diameter of the cornea exceeds 12mm (the normal transverse diameter of the cornea in infants generally does not exceed 10.5mm).