Fluids Hypertension Syndromes: Migraines, Headaches, Normal ...

Fluids Hypertension Syndromes – Dr. Leonardo Izecksohn – page 83
Caffeine and Glaucomatocyclitic crisis; relapse caused by cola drinks: We noticed a strong
Brazilian white mulatto, nutrition student, 1.75 meter (5 feet and 9 inches) tall, 20-year-old, 68 kilograms
(150 pounds) of weight. He was presenting typical Glaucomatocyclitic crisis at his right eye,
with intraocular pressure of 55 mmHg at the crisis, and other signs of this Posner-Schlossman Syndrome,
as right eye aches, little hyperemia, keratic precipitates, deep anterior chamber, pupil dilatation
and blurred vision. What attracted our attention was the coincidence that he was a drinker of beer,
caffeinated cola drinks, coffee and 3,300 milliliter (three quarters of a gallon) of water daily. He also
presented in both eyes Optic Nerve’s disks with 0.1/1/0/0.75 (cup diameter/ cup depth/ lamina cribosa’s
pores visibility/ borders edema), which is characteristic of the Cerebrospinal Fluid Hypertension
Syndrome. With proper ocular medication and stopping all the caffeinated drinks, he became better
in one week, presenting the right intraocular pressure of only 10 mmHg, and normal visual acuity.
After 4 months, he came again with another Glaucomatocyclitic crisis in the same right eye, and this
time the crisis was caused only by 600 milliliter of daily cola soft drinks he drank in order to study better.
It was evident that the caffeine etiology added to his personal susceptibility caused the Glaucomatocyclitic
crisis. Do you have any doubt?
VII - C - Angle-closure Glaucoma: The patient that presents shallow anterior chamber at bio-microscopy,
actually presents simultaneously two ocular pathophysiologies:
1- Increased resistance to the outflow of the intraocular Aqueous Humor, which is one risk factor to
suffer from the Ocular Hypertension Syndrome, every day that the patient drinks other etiologies.
After many years, the patient can present Optic Nerve’s damage of a Low-tension (Peak-tension)
glaucoma, or a Chronic High-pressure glaucoma.
2- When not medicated nor advised to shorten or withdraw those etiologies, as beer, wine, caffeine
and excessive water, this patient can suffer a sudden Acute Angle-closure Glaucoma crisis.
During the more than 40 years of ophthalmology, with more than 100,000 patients oriented, we never
had even one patient under our care who presented the acute Angle-closure glaucoma crisis. All patients
who came with this crisis had it before our orientation and were drinking some of those etiologies.
Those rare patients that had very shallow anterior chambers, and even when medicated and withdrawn
from other etiologies nevertheless presented peaks of ocular hypertension, were oriented to laser
iridectomy or cataract surgery, which deepened the anterior chamber and consequently cured this risk
factor, and simultaneously cured the eventual cataract.
We conclude that the acute Angle-closure glaucoma is one of the many signs, symptoms and
sicknesses from the Ocular Hypertension Syndrome in some eyes prone to it, and it is preventable
as all the other glaucomas.
“Among adults 50 and older Chinese in an urban area of southern China, data from 1248 right eyes
were available for analysis. The mean anterior chamber depth values for men and women were 2.59
mm and 2.42 mm. Mean anterior chamber depth declined by 0.09 mm per decade (adjusted for gender)
and was 0.18 mm shallower in women than men (adjusted for age). The anterior chamber depth was
found to be monotonically associated with gonioscopic angle width, decreasing from 2.73 mm in Shaffer
grade 4 to 1.94 mm in Shaffer grade 0. There was also a relationship between anterior chamber
depth and refractive error; mean spherical equivalent decreased by 0.030 mm anterior chamber depth
per diopter.” (He M, and others).
We conclude that the ophthalmological examination of gonioscopy, which discriminate whether
the eye is a “wide-angle” or a “closed-angle” glaucoma is useless, and we no more perform it.
VII - D – Congenital and Infantile Glaucoma: They are rare and preventable.