Irizace

Deprecated: Function split() is deprecated in /home/users/dana/medicinman.cz/web/csf/kf.inc.php on line 67

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Deprecated: Function split() is deprecated in /home/users/dana/medicinman.cz/web/csf/kf.inc.php on line 67

Deprecated: Function split() is deprecated in /home/users/dana/medicinman.cz/web/csf/kf.inc.php on line 67

Deprecated: Function split() is deprecated in /home/users/dana/medicinman.cz/web/csf/kf.inc.php on line 67

Deprecated: Function split() is deprecated in /home/users/dana/medicinman.cz/web/csf/kf.inc.php on line 67

Deprecated: Function split() is deprecated in /home/users/dana/medicinman.cz/web/csf/kf.inc.php on line 67

Deprecated: Function split() is deprecated in /home/users/dana/medicinman.cz/web/csf/kf.inc.php on line 67

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Deprecated: Function split() is deprecated in /home/users/dana/medicinman.cz/web/csf/kf.inc.php on line 67

Deprecated: Function split() is deprecated in /home/users/dana/medicinman.cz/web/csf/kf.inc.php on line 67

Deprecated: Function split() is deprecated in /home/users/dana/medicinman.cz/web/csf/kf.inc.php on line 67

Deprecated: Function split() is deprecated in /home/users/dana/medicinman.cz/web/csf/kf.inc.php on line 67

Deprecated: Function split() is deprecated in /home/users/dana/medicinman.cz/web/csf/kf.inc.php on line 67

Deprecated: Function split() is deprecated in /home/users/dana/medicinman.cz/web/csf/kf.inc.php on line 67

Deprecated: Function split() is deprecated in /home/users/dana/medicinman.cz/web/csf/kf.inc.php on line 67

Deprecated: Function split() is deprecated in /home/users/dana/medicinman.cz/web/csf/kf.inc.php on line 67

Deprecated: Function split() is deprecated in /home/users/dana/medicinman.cz/web/csf/kf.inc.php on line 67

Deprecated: Function split() is deprecated in /home/users/dana/medicinman.cz/web/csf/kf.inc.php on line 67

Deprecated: Function split() is deprecated in /home/users/dana/medicinman.cz/web/csf/kf.inc.php on line 67

Deprecated: Function split() is deprecated in /home/users/dana/medicinman.cz/web/csf/kf.inc.php on line 67

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Deprecated: Function split() is deprecated in /home/users/dana/medicinman.cz/web/csf/kf.inc.php on line 67

Deprecated: Function split() is deprecated in /home/users/dana/medicinman.cz/web/csf/kf.inc.php on line 67

Deprecated: Function split() is deprecated in /home/users/dana/medicinman.cz/web/csf/kf.inc.php on line 67

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Deprecated: Function split() is deprecated in /home/users/dana/medicinman.cz/web/csf/kf.inc.php on line 67

Deprecated: Function split() is deprecated in /home/users/dana/medicinman.cz/web/csf/kf.inc.php on line 67

Deprecated: Function split() is deprecated in /home/users/dana/medicinman.cz/web/csf/kf.inc.php on line 67

Deprecated: Function split() is deprecated in /home/users/dana/medicinman.cz/web/csf/kf.inc.php on line 67

Deprecated: Function split() is deprecated in /home/users/dana/medicinman.cz/web/csf/kf.inc.php on line 67

Deprecated: Function split() is deprecated in /home/users/dana/medicinman.cz/web/csf/kf.inc.php on line 67

Deprecated: Function split() is deprecated in /home/users/dana/medicinman.cz/web/csf/kf.inc.php on line 67

Deprecated: Function split() is deprecated in /home/users/dana/medicinman.cz/web/csf/kf.inc.php on line 67

Deprecated: Function split() is deprecated in /home/users/dana/medicinman.cz/web/csf/kf.inc.php on line 67

Deprecated: Function split() is deprecated in /home/users/dana/medicinman.cz/web/csf/kf.inc.php on line 67

Deprecated: Function split() is deprecated in /home/users/dana/medicinman.cz/web/csf/kf.inc.php on line 67

Deprecated: Function split() is deprecated in /home/users/dana/medicinman.cz/web/csf/kf.inc.php on line 67

Deprecated: Function split() is deprecated in /home/users/dana/medicinman.cz/web/csf/kf.inc.php on line 67

Deprecated: Function split() is deprecated in /home/users/dana/medicinman.cz/web/csf/kf.inc.php on line 67

Deprecated: Function split() is deprecated in /home/users/dana/medicinman.cz/web/csf/kf.inc.php on line 67

Deprecated: Function split() is deprecated in /home/users/dana/medicinman.cz/web/csf/kf.inc.php on line 67

Deprecated: Function split() is deprecated in /home/users/dana/medicinman.cz/web/csf/kf.inc.php on line 67

Deprecated: Function split() is deprecated in /home/users/dana/medicinman.cz/web/csf/kf.inc.php on line 67

Deprecated: Function split() is deprecated in /home/users/dana/medicinman.cz/web/csf/kf.inc.php on line 67

Deprecated: Function split() is deprecated in /home/users/dana/medicinman.cz/web/csf/kf.inc.php on line 67

Deprecated: Function split() is deprecated in /home/users/dana/medicinman.cz/web/csf/kf.inc.php on line 67

Deprecated: Function split() is deprecated in /home/users/dana/medicinman.cz/web/csf/kf.inc.php on line 67

Deprecated: Function split() is deprecated in /home/users/dana/medicinman.cz/web/csf/kf.inc.php on line 67

Deprecated: Function split() is deprecated in /home/users/dana/medicinman.cz/web/csf/kf.inc.php on line 67

Deprecated: Function split() is deprecated in /home/users/dana/medicinman.cz/web/csf/kf.inc.php on line 67

Deprecated: Function split() is deprecated in /home/users/dana/medicinman.cz/web/csf/kf.inc.php on line 67

Deprecated: Function split() is deprecated in /home/users/dana/medicinman.cz/web/csf/kf.inc.php on line 67

Deprecated: Function split() is deprecated in /home/users/dana/medicinman.cz/web/csf/kf.inc.php on line 67

Deprecated: Function split() is deprecated in /home/users/dana/medicinman.cz/web/csf/kf.inc.php on line 67

Deprecated: Function split() is deprecated in /home/users/dana/medicinman.cz/web/csf/kf.inc.php on line 67

Deprecated: Function split() is deprecated in /home/users/dana/medicinman.cz/web/csf/kf.inc.php on line 67

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Deprecated: Function split() is deprecated in /home/users/dana/medicinman.cz/web/csf/kf.inc.php on line 67

Deprecated: Function split() is deprecated in /home/users/dana/medicinman.cz/web/csf/kf.inc.php on line 67

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Deprecated: Function split() is deprecated in /home/users/dana/medicinman.cz/web/csf/kf.inc.php on line 67

Deprecated: Function split() is deprecated in /home/users/dana/medicinman.cz/web/csf/kf.inc.php on line 67

Deprecated: Function split() is deprecated in /home/users/dana/medicinman.cz/web/csf/kf.inc.php on line 67

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Deprecated: Function split() is deprecated in /home/users/dana/medicinman.cz/web/csf/kf.inc.php on line 67

Deprecated: Function split() is deprecated in /home/users/dana/medicinman.cz/web/csf/kf.inc.php on line 67

Deprecated: Function split() is deprecated in /home/users/dana/medicinman.cz/web/csf/kf.inc.php on line 67

Deprecated: Function split() is deprecated in /home/users/dana/medicinman.cz/web/csf/kf.inc.php on line 67

Deprecated: Function split() is deprecated in /home/users/dana/medicinman.cz/web/csf/kf.inc.php on line 67

Deprecated: Function split() is deprecated in /home/users/dana/medicinman.cz/web/csf/kf.inc.php on line 67

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Deprecated: Function split() is deprecated in /home/users/dana/medicinman.cz/web/csf/kf.inc.php on line 67

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Deprecated: Function split() is deprecated in /home/users/dana/medicinman.cz/web/csf/kf.inc.php on line 67

Deprecated: Function split() is deprecated in /home/users/dana/medicinman.cz/web/csf/kf.inc.php on line 67

Deprecated: Function split() is deprecated in /home/users/dana/medicinman.cz/web/csf/kf.inc.php on line 67

Deprecated: Function split() is deprecated in /home/users/dana/medicinman.cz/web/csf/kf.inc.php on line 67

Deprecated: Function split() is deprecated in /home/users/dana/medicinman.cz/web/csf/kf.inc.php on line 67

Deprecated: Function split() is deprecated in /home/users/dana/medicinman.cz/web/csf/kf.inc.php on line 67

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Deprecated: Function split() is deprecated in /home/users/dana/medicinman.cz/web/csf/kf.inc.php on line 67

Deprecated: Function split() is deprecated in /home/users/dana/medicinman.cz/web/csf/kf.inc.php on line 67

Deprecated: Function split() is deprecated in /home/users/dana/medicinman.cz/web/csf/kf.inc.php on line 67

Deprecated: Function split() is deprecated in /home/users/dana/medicinman.cz/web/csf/kf.inc.php on line 67

Deprecated: Function split() is deprecated in /home/users/dana/medicinman.cz/web/csf/kf.inc.php on line 67

Deprecated: Function split() is deprecated in /home/users/dana/medicinman.cz/web/csf/kf.inc.php on line 67

Deprecated: Function split() is deprecated in /home/users/dana/medicinman.cz/web/csf/kf.inc.php on line 67

Deprecated: Function split() is deprecated in /home/users/dana/medicinman.cz/web/csf/kf.inc.php on line 67

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Deprecated: Function split() is deprecated in /home/users/dana/medicinman.cz/web/csf/kf.inc.php on line 67

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Definice

• Irizace = barevné spektrum kolem světel [1] (Newtonovy kroužky)

Příčiny irizace

Edém epitelu rohovky vlivem hypoxie [kontaktní čočky]

• často spojen s keratitis superficialis punctata
• Porušením integrity epitelu
• V.s. při hypoxii nastává redistribuce tekutiny uvnitř epitelu
• Laktát
• Akumuluje se mezi bazálními buňkami epitelu
• Osmoticky dehydratuje buňky
• Vznik okrsků mezi buňkami s nižším index lomu světla než epitel
• Jiný rozptyl světla [1]

Glaukom

Prodromalni stavy = „malé záchvaty“ - stavy pred vznikem akutniho záchvatu

• Subjektivní obtíže nejsou tak výrazné
• Mírná bolest v očnici
• Zamlžené vidění
• Typická je tzv. irizace [1] [3]
• Tlak nad 30 torr vyvolává edém rohovky
• Kolem bodových zdrojů světla se vytvářejí ohybem světla Newtonovy kroužky [4]
• Mírné prodromy
• Přicházejí večer po fyzické či psychické námaze [5]
• Lehce snížený visus
• Duhové kruhy kol světel (irizace)
• Neurčitá bolest v oku a o čnici na postižené straně
• únava, podrážděnost
• Zmizí do druhého dne
• Později se objeví znovu
• Stavaji se silnějšími
• Opakování může vyústit v ac. záchvat glaukomu [5]

Chronický primární glaukom

• Téměř žádné subjektivní příznaky [2]

Chronický primární glaukom s uzavřeným úhlem

• Velmi mírné příznaky
• Tlak v očích
• Bolesti hlavy (podráždění n. V z nitrooční tenze kolem 30 torr) [4]
• Irizace kolem světel
• Mlhavé vidění po probuzení
• Potíţe s nočním viděním [2]

Exacerbace - akutní záchvat glaukomu

• Náhlé zvýšení nitroočního tlaku
• V případe glaukomu s uzavřeným úhlem většinou dobře snášeno, pokud je rychle odstraněna příčina a tím snížen nitrooční tlak [2]
• Zhoršené, zamlžené vidění
• Tlak kolem 50 torr snižuje perfúzi sítnice a tím i její funkci [4]
• Fotofobie
• Ochrnutí svěrače zornice vede k reaktivní mydriáze [4]
• Patrná smíšená injekce
• Rohovka zašedlá, ztluštělá, nerovný povrch
• Duhovka je překrvená, smazané kresby
• Zornice mydriatická!, oválná
• NOT: 40 mmHg a více [3] až 70 torrů [4]
• Nauzea a zvracení (připomíná náhlou příhodu břišní)
• Z podráždění parasympatiku [4]s
• Bělavě edematózní rohovka [4]
• Zarudnutí spojivky [4]
• Nitrooční tlak až 60 torr (8,00 kPa), oko je « tvrdé jako kámen» [5]

• Kritické pro oko:
• Chronické zvýšení NOT
• Veliké výchylky tlaku během dne [2]

• Glaukom s uzavřeným úhlem
• Odtokové cesty = uzávěr komorového úhlu
• Nitrooční tekutina se nedostává do trabekulární tkáně.
• Uzávěr naléhající duhovkou
• Vznik u „predisponovaných očí“
• Vyvolávajícím momentem je mydriáza !!!
• I po očním vyšetření
• Tma
• Stres [3]

Terapie akutního glaukomového záchvatu s uzavřeným úhlem

• 1. 1% pilokarpin
• Ke zúžení zornice a vytažení kořene duhovky z úhlu, čímž přerušíme okluzi odtokových cest
• Opakovaně po 15 minutách
• V nouzi dostupnější 2% roztok [4]
• 2. celkově farmaka ke snížení nitroočního tlaku
• Osmotické preparáty:
• 50ml glycerol per os
• 100ml 20% Manitol iv.
• Diuretikum Diluran per os [4]
• 3. ke zlepšení vidění a vizualizaci duhovky při laserové iridotomii
• Lokálně v kapkách 20% roztok glukózy z ampulky pro iv. podání
• Lokálně inhibitory karboanhydrázy – Acetazolamid
• Snižují produkci komorové tekutiny řasnatým tělískem [4]
• betablokátory - Timolol [4]
• Laserová iridotomie ke zrušení pupilárního bloku a tím okluze úhlu,
• Chirurgická bazální iridektomie
• Pokud stav rohovky nedovolí laserový výkon
• Otevře přímo vstup do odtokových cest [4]