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Eye complaints and vasculitis: GlaucomaThis lecture was given in Brugge, by Dr B. Heintz, ophthalmologist in the Elisabeth Hospital in Sijsele-Damme
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| What is glaucoma and how does it develop? |
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Glaucoma is the term for various diseases that are characterised by an increase in eye pressure. It is very common and usually the result of the natural ageing process. It affects 1 to 2 % of the population older than 50.
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| What causes this increase in pressure? |
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The ciliary body continually produces a clear fluid, the aqueous humour, which supplies nutrients to the anterior eye chamber and maintains it. This fluid is secreted through small channels and the balance between production and secretion determines the eye pressure. If the secretion channels are narrowed or blocked, the fluid, of which the production continues like before, is unable to leave the eye. The intraocular eye pressure will automatically increase. The part of the eye most sensitive to it, is the optic nerve. It consists of multiple (a large amount) nerve fibres, surrounded by supporting tissue. Central in the optic nerve are the blood vessels that feed the retina. |
| What can be the consequences of an elevated eye pressure? |
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The nerve fibres die off very gradually so that the optic nerve on the outside is reduced to a small ring of nerve fibres, while the centre becomes more and more hollow. Once damage to nerves has occurred, it is irreversible (unchangeable). The retina picks up the light rays but the message does not reach the brain because the connection between the two is missing. As such, black spots occur in the range of vision, and the end result may be blindness. |
| How can glaucoma be treated? |
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As glaucoma affects the sight only gradually it is sometimes noticed in an advanced phase. Therefore, early diagnosis is extremely important and a three-yearly eye pressure examination is necessary for people of 45 and over. It is a small effort that can avoid many problems, especially because glaucoma is a disorder that can be treated. Two times a day the medication is administered to the eye to reduce the production of aqueous humour and to restore the balance between production and secretion. If this treatment proves inefficient, laser therapy or an operation can be considered. |
| How can corticosteroids be a possible cause of glaucoma? |
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It is not the most frequent cause, but someone taking corticosteroids- and especially someone likely to develop an elevated eye pressure- should be aware of the fact that these drugs may increase eye pressure. The susceptibility is individually determined: some patients will develop an elevated eye pressure with the smallest intake of corticosteroids, while others will never be troubled with this phenomenon. Individuals taking corticosteroids should be examined yearly. |
| Can the eye pressure of a patient with scleroderma be influenced and caused by oedema? |
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Not at all. Glaucoma occurs in the closed eye system and has nothing to do with the accumulation of fluid in the body.
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| Can typical eye problems of lupus and other CICTDs remain latent in a routine-check-up? Are there other eye examinations that need to be performed? |
| In a routine-check-up the visual acuity, the eye pressure, the retina and the anterior part of the eye are examined. Many problems are detected in these examinations, like the 'cotton wool'-spots in lupus. These white spots betray the dying off of blood vessels by inflammation but do not require treatment.
Patients taking Plaquenil (contains hydroxycloroquine) or Nivaquine (contains chloroquine) have to be examined for the first time after 3 months to check the visual acuity, the range of vision, the retina and the colour vision. Very exceptionally, the retina is clouded by the deposition of chloroquine or the macula is damaged. In this case, regular check-ups are also necessary: every six months when the patient takes Plaquenil or Nivaquine, unless the doctor decides otherwise.
If you have a CICTD, report it to your ophthalmologist. If necessary, additional examinations can be carried out for dry eyes. (see Sjogren's Syndrome) |
 Also read: Eye complaints and vasculitis: Cataract
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