Glaucoma de ángulo cerrado: actualización de conocimientos en Atención Primaria de Salud
Resumen
El glaucoma es una neuropatía que involucra una atrofia de la cabeza del nervio óptico, acompañada de alteraciones visuales características. Corresponde a la segunda causa de ceguera a nivel mundial, y la primera que causa ceguera irreversible. La clasificación del glaucoma es bastante amplia, actualmente las formas más frecuentes a nivel mundial son el glaucoma primario de ángulo abierto, el glaucoma primario crónico de ángulo cerrado, y glaucoma de exfoliación.
El glaucoma de ángulo cerrado se caracteriza por el cierre del ángulo iridocorneal de la cámara anterior, y puede ser primario o secundario dependiendo la presencia o ausencia de factores asociados que contribuyan al aumento de la presión. Los factores de riesgo asociado a glaucoma de ángulo cerrado incluyen la genética, la edad, sexo femenino, hipermetropía, algunos medicamentos, la raza y factores anatómicos. El mecanismo fisiopatológico más frecuente en el glaucoma de ángulo cerrado corresponde al bloqueo pupilar, que impide el flujo adecuado del humor acuoso a través de la pupila, aumentando la presión intraocular. La clínica varía dependiendo de la rapidez de instalación y del grado de elevación de la presión intraocular, pudiendo presentar desde una disminución de la visión, cefalea, dolor ocular severo, hasta incluso ser asintomático. Se considera una emergencia oftalmológica cuando es de rápida progresión. El oftalmólogo debe evaluar ambos ojos, y realizar el diagnóstico mediante gonioscopia. Existen tratamientos médicos y quirúrgicos, sin embargo el de elección es la iridotomía periférica con láser. El pronóstico visual depende del manejo inicial y de la rápida derivación.
Palabras clave:
glaucoma ángulo cerrado, tratamiento, epidemiología, fisiopatologíaReferencias
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