Trauma-related glaucoma

Introduction to trauma-related glaucoma Glaucoma associated with ocular trauma is an eye disease caused by multiple factors. Glaucoma can be caused by eye bruises, lacerations, chemical damage, electromagnetic radiation damage, or surgical damage. Elevated intraocular pressure can occur within a few days after the injury, or after several years. The corners can be opened or closed. Injuries can result in signs of significant damage or conditions that are highly disproportionate to clinical signs. basic knowledge The proportion of sickness: 0.0052% Susceptible people: no special people Mode of infection: non-infectious Complications: anterior chamber hemorrhage retinal detachment choroidal laceration

Traumatic related glaucoma etiology

Pathogenesis:

It is generally thought that the blunt injury is caused by the parallel movement of the blunt object on the axis of the eye. The impact of the object causes the cornea and the anterior sclera to be displaced backward. The eyeball is compressed back and forth, and the external force is transmitted to the eye, which is accompanied by the expansion of the equator of the eyeball. The vitreousness of the vitreous and the vitreous is very small, and the iris, the anterior chamber, the lens and its suspensory ligament lack strong support and cannot counteract the sudden impact force, thus causing these tissues to suddenly expand and tear. Campbell describes 7 tissues in front of the eye. Rings, lesions can occur after blunt injury, respectively:

1 pupil sphincter (pupil sphincter tear).

2 The peripheral iris (iris root) is connected to the ciliary body (the iris root is disconnected).

3 anterior ciliary body (the corner of the anterior chamber, the ciliary body surface tear between the ciliary body and the scleral process, often occurs between the ciliary body of the ring muscle and the longitudinal muscle).

4 The connection between the ciliary body and the sclera (the ciliary body is detached, allowing the aqueous humor to enter the choroidal superior cavity from the anterior chamber, resulting in temporary or permanent low intraocular pressure).

5 trabecular mesh (trabecular tear).

6 lens suspensory ligament (lens tremor, lens subluxation or total lens dislocation).

7 The retina is connected to the serrated edge (sawed edge dissociation).

Contusion can also cause damage to the back of the eye, such as retinal detachment, choroidal laceration, optic nerve injury, etc., anterior chamber hemorrhage, vitreous hemorrhage and endophthalmitis often accompanied by traumatic lesions in the anterior and posterior segments, intraocular pressure Elevation can occur immediately after injury or extended to months or years.

The retreat of the anterior chamber is mainly caused by tearing and separation between the ring muscle and the longitudinal muscle of the ciliary body. Because the ring muscle is connected with the iris, the contracture of the ring muscle will cause the iris root to move backward, while the longitudinal muscle remains attached. In situ sclera, so the angle of the anterior chamber becomes deeper. This change can occur in a certain area or all of the angle of the anterior chamber. At the same time, the trabecular tissue is damaged by inflammation, degeneration and absorption, and the trabecular changes are concealed. Slowly, after the contusion of the corner, the early and late changes are different, but the iris, the anterior chamber and the ciliary body are highly differentiated structures. After the trauma, the healing of these tissues is extremely limited, and only a small amount of non-specific tissue is repaired, forming a small amount. Non-functional scars generally retain the appearance of the original lesion as a permanent trace.

Causes:

Various forms of the eye and varying degrees of trauma.

Traumatic related glaucoma prevention

Under the action of trauma, it is easy to cause positional change. On the one hand, crystal dislocation causes blockage in the aqueous circulation pathway, and on the other hand, it causes an increase in aqueous humor secretion and causes an increase in intraocular pressure. The time to cause an increase in intraocular pressure after dislocation of the crystal is different. Some patients will immediately cause a sudden increase in intraocular pressure, while in some patients, the increase in intraocular pressure is slow, and some even increase after a long period of time after trauma. Therefore, after the eye injury in the elderly, regardless of whether there is visual acuity, they should go to the hospital for examination. Do not cause irreversible damage to the eyes due to temporary negligence, and pay attention to actively prevent trauma.

Traumatic-related glaucoma complications Complications, anterior chamber retinal detachment, choroidal laceration

Hemiplegia, retinal detachment, choroidal laceration, and optic nerve damage.

Traumatic-related glaucoma symptoms Common symptoms Iris defect Lens turbid tremor Iris heterochromic IOP increased iris root disconnection disappears light response

1. Characteristics of receding angle: The most important feature is that the distance from the scleral process to the root of the iris becomes larger, which makes the ciliary body band in the receding area widened, and the angle of the anterior retraction of the angle of 1 to 3 degrees in the gonioscopic examination , the specific performance:

1 The ciliary body band is widened, and there may be wide and deep cracks, or only shallow fissures.

2 corners become deeper.

3 The iris root moves back and inserts the corner in a more rearward position.

4 Ciliary body tear, light-colored tissue deep in the fissure, newly formed fibrous tissue, or exposed non-pigmented uveal tissue. Crystal detachment, typical angle changes can occur throughout the entire circumference of the angle of the room, or only limited to one area. In the early post-injury examination, the ciliary body band has a clear fissure boundary, shortly after injury, the ciliary body The tear can be scarred, and some of the retrograde lesions of the eye can not be seen clearly, forming a peripheral anterior adhesion. Therefore, in the subsequent examination, the depth and range of the corner of the corner that began to appear are changed and blurred. Find and discover features that accompany the cornerback, especially note:

1 scar on the face and eyelids.

2 excessive deep anterior chamber.

3 pupil sphincter laceration.

4 The iris suddenly disappears or tears.

5 iris defect.

6 iris and lens tremor.

7Vossius ring.

8 The trabecular meshwork is partially sunken or torn.

9 prominent scleral abnormalities turned white.

10 The lower corner of the room is dark brown or black, and the other clue is typical unilateral glaucoma, but the possibility of receding the bilateral angle must be considered.

2. Other damage performance accompanying the cornerback

(1) anterior chamber hemorrhage: anterior chamber hemorrhage often caused by iridocorneal corneal vascular tear, therefore, in the case of anterior chamber hemorrhage, most can detect different degrees of angle of the anterior chamber, including recurrent anterior chamber Hemorrhage can account for 18%, the corner of the corner is accompanied by Schlemm tube tear, the latter causes active recurrent anterior chamber hemorrhage, bed and binocular dressing only temporarily stop bleeding, after argon laser coagulation bleeding point, bleeding stops In most cases, the anterior chamber blood itself does not cause obvious visual impairment.

(2) corneal injury: corneal injury can occur in more than 12% of anterior contusion cases, including corneal superficial or full-thickness opacity, Descemet membrane rupture, corneal persistent edema, corneal endothelial pigmentation and corneal band degeneration.

(3) Iris and pupillary injury: In the anterior segment of the eye, the incidence of iris and pupil injury can reach 26% to 49%. The iris root is broken, the iris is torn, the pupil margin is notched, and the iris is partially or staged. , pupillary sphincter injury, permanent traumatic pupil dilation, loss of photoreaction, anterior adhesion around the iris, focal atrophy of the iris matrix, and iris tremor.

(4) opacity or dislocation of the lens: in the case of contusion of the anterior segment of the eye, there is about 30% of the lens opacity or dislocation. The mild injury is only in front of the lens, the local cortex is lobulated or petal-like opacity, or the lens capsule is small. Broken, moderate injury can form a significant cataract, or accompanied by lens dislocation, severe cataract, need to remove cataract or dislocation of the opacity lens, the reasons are mostly vision needs or elevated intraocular pressure.

(5) Contusion in the posterior segment of the eye: Contusion in the posterior segment of the eye is also common, including macular edema, cystoid macular degeneration, macular hole, pigmented scar formation, choroidal rupture, retinal serrated detachment, retinal tear and detachment, glass Volumetric blood, optic nerve contusion and atrophy, and thus cause significant visual impairment.

In addition, a small number of cases have a tibiofibular fracture or extraocular muscle paralysis.

3. Corner retreat and secondary glaucoma Dombrain reported the relationship between eye contusion and subsequent glaucoma in 1945. Wolff et al. described his relationship in histopathology in 1962 and provided a retreat for the corner. There has been evidence of trauma, but not the exact cause of glaucoma, which has been confirmed by subsequent clinical observations and animal tests.

After eye contusion, it is easy to cause the angle of the anterior chamber to retreat, accounting for 50% to 100% of cases of traumatic anterior chamber hemorrhage. The incidence of retrograde anterior chamber and glaucoma is directly related to the angle of the angle of the corner. If the angle of retreat is 240° Above, the risk of developing glaucoma is the greatest, and it is necessary to check the angle of the cornea to confirm the angle of the corner.

In addition, special attention should be paid to checking:

1 The face or eyelid skin has any scars that were originally traumatized.

2 Whether the front room is obviously deeper.

3 pupil sphincter laceration.

4 iris defect, iris tremor and lens tremor.

5Vossius ring (lens).

6 local trabecular mesh depression or laceration.

7 scleral abnormalities become white or clear.

The corner below the 8 shows dark brown deposits (ie residual anterior chamber blood).

Trauma-related glaucoma examination

The necessary laboratory tests, such as cerebrospinal fluid examination for severe craniocerebral trauma, can be performed depending on the extent and location of the injury.

Eye trauma in most cases need to use CT, MRI to rule out intracranial lesions, B-ultrasound, UBM can identify the important lesions in the ball and the anterior segment of the eye, especially in the presence of hemorrhage and affect observation.

Trauma-related glaucoma diagnosis

Diagnostic criteria

1. Medical history: The history of trauma has important value for diagnosis.

2. Iris corneal keratoscopy should be done early in the iris confolar keratoscopy.

3. Contusion angle abnormalities often accompanied by other lesions of the eye found iris sphincter laceration, iris heterochromia, trabecular pigmentation, iris root disconnection, iris adhesion, lens incomplete dislocation, traumatic retinal choroiditis, Choroidal rupture, tendon trauma, etc., should be thought of with the possibility of receding the corner.

4. anterior chamber hemorrhage: is one of the signs of retrograde anterior chamber. For patients with anterior chamber hemorrhage, once hemorrhage is absorbed, a gonioscopic examination is performed immediately, accompanied by cases of anterior chamber hemorrhage, for ultrasound biomicroscopy (UMB). ) Examination can reveal the retraction of the angle of the corner.

5. Long-term follow-up observation of cases with retrograde corners, regular measurement of intraocular pressure, visual field of view, and timely treatment when elevated intraocular pressure is found.

Differential diagnosis

At present, there is no relevant information to develop good living habits.

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