Increased intraocular pressure damages the
optic tissue. Glaucoma is of two types viz. (i) open angle
glaucoma and (ii) closed angle glaucoma.
Primary open angle glaucoma is often symptomless..
There is a gradual painless loss of vision along with constriction
of field of vision. Headache is occasional. Defective vision
with a sluggishly reacting pupil is diagnostic. In advanced
stages, there is gross defective vision, increased tension,
small and slowly reacting pupil. 2% pilocarpine 2-3 drops
instilled every 4-6 hrs is of immense use.
In closed angle glaucoma, there is sudden
redness of the eye, circumcorneal congestion, haziness of
cornea and the pupils are dilated, almost oval and do not
react briskly. Patients complain of rainbow haloes around
light, headache especially on entering dark, occasionally
vomiting, prostration and fever. The attacks are severe at
night and hence patients report first in the outpatient department.
Acute catarrhal conjunctivitis also presents
with redness of the eye and history of haloes around light.
When the eye is washed and the discharge washed away, haloes
disappear; congestion occurs in the lids too. Careful evaluation
is necessary before excluding any case of glaucoma as ACCO.
Development of retinopathy in diabetics depends
upon the age of the patient rather than the severity of diabetes.
Diabetic retinopathy is of two types viz.
(i) simple (ii) proliferative. Haemorrhages and exudates are
visualised in the fundus in the simple type. Prothrombin and
vasodilators help. In the proliferative type of retinopathy,
vitreous haemorrhage and retinal detachment also occur. Photocoagulation,
laser therapy and cryosurgery are found to be helpful. It
is always important to advise diabetics to have a review every
year to know the progress.
In hypertension with involu.tionary (senile)
arteriosclerosis occurring in older patients, the picture
of arteriosclerotic retinopathy appears. There are localised
constriction and dilatation of vessels with sheathing of the
vessels and the deposition of hard exudates and sometimes
of haemorrhages without any oedema. Although the vascular
changes are bilateral, the retinopathy is confined to one
eye and the ocular prognosis is relatively good. A diastolic
blood pressure above 100 mm of Hg can cause changes not unlike
diabetes mellitus; if hypertension is controlled the disease
process is arrested.
Central retinal arterial occlusion, central
retinal venous occlusion, vitreous haemorrhage and retinal
detachment are causes of sudden loss of vision. Senile macular
degeneration may require glasses.
This is a bilateral peripheral corneal degeneration
with a gutter like opacity, conjunctival congestion and severe
pain. Cornea melts from the periphery. Antibiotic drops along
with atropine instillation and padded bandage help. Some cases
may need corneal transplantation.