LUCRARE DE DIPLOMA

GLAUCOMUL GLAUCOMUL
COORDONATORI :
Prof. Nurs. THEER EMILIA
ABSOLVENT :
FLESERU RICA
- 1999 -

C U P R I N S
CAPITOLUL I
ANALIZORUL VIZUAL - ANATOMIE SI FIZIOLOGIE PAG. 2


CAPITOLUL II PAG. 8
PATOLOGIA TENSIUNII OCULARE
PARTICULARITATI FIZIOLOGICE
MASURAREA TENSIUNII OCULARE
SINDROMUL DE HIPERTENSIUNE OCULARA
CAPITOLUL III PAG. 15
GLAUCOMUL
DEFINITIE
CLASIFICARE
DESCRIERE
PROFILAXIA GLAUCOMULUI
CAPITOLUL IV PAG. 24
ROLUL ASISTENTEI IN INGRIJIREA BOLNAVULUI CU GLAUCOM
BIBLIOGRAFIE

- 2 -
CAPITOLUL I
ANALIZATORUL VIZUAL
1.1 ANATOMIA ANALIZATORULUI VIZUAL
Analizatorl !izal "#t" al$atit %in tr"i #"&'"nt" (
)* S"&'"ntl +"ri,"ri$ #a r"$"+tor $ar" +ri'"#t" "-$itatiil" "-t"rn"
#+"$i,i$" "#t" ,or'at %in(
a* Glo.l o$lar*
.* Or&an"l" an"-" al" &lo.li o$lar*
a* Glo.l o$lar - ,or'iaza a+aratl o+ti$ al or&anli
!izal* Ar" ,or'a a+roa+" #,"ri$a #i "#t" al$atit %in
tr"i tni$i #+ra+#" $ar" ,or'iaza +"r"t"l" li*
- o tni$a "-t"rna $on/n$ti!a ,i.roa#a*
- o tni$a 'i/lo$i" !a#$lara 0UVEE12 .o&ata in
+i&'"nt*
- o tni$a int"rna n"r!oa#a2 r"tina*
Tni$a "-t"rna ,i.roa#a #" i'+art" in %oa +ortini in"&al"(
-na +o#t"rioara o+a$a2 al.-#i%",i" n'ita #$l"ro- ti$a2
-o +ortin" ant"rioara2 .o'.ata #i tran#+ar"nta n'ita
$orn""*
S$l"roti$a "#t" ,or'ata %intr-o i'+l"titra %"n#a %" ,i.r" $ola&"n"2 %i#+#"
ra%ial #i $ir$lar $ar" o ,a$ r"zi#t"nta* E#t" %ra #i in"-t"n#i.ila la a%lt2
a!in% rol %" +rot"$ti"* In &ro#i'"a "i #" ra'i,i$a !a#" %" #in&" #i n"r!i2
+r"$' #i $anall li S$3l"''2 !"$in li'.li #$l"ro-$orn"an $ar" ar" rol
,iziolo&i$ in $ir$latia li$3i%"lor %in int"riorl o$3ili* La +oll +o#t"rior
#$l"roti$a +r"zinta o +ortin" +"r,orata n'ita 4la'a $irita552+rin $ar" tr"$
,i.r"l" n"r!li o+ti$*
Corn""a "#t" +art"a ant"rioara a #tratli ,i.ro#* E o '"'.rana
tran#+ar"nta2 'ai #.tir" in +ortin"a #a 'i/lo$i"* E#t" al$atita %in ,i.r"
$on/n$ti!" $ola&"n" a#"zat" #. ,or'" %" la'"l" +aral"l" intr" "l" #i $
#+ra,ata $orn""i* Corn"a n +o#"%a !a#" %" #in&"2 %ar $ontin" n'"roa#"
ra'i,i$atii n"r!oa#"* Ntritia "#t" a#i&rata +rin i'.i.iti" %" !a#" #an&in"
%" la ni!"ll li'.li #$l"ro-$orn""an* Zona %" tr"$"r" %intr" $orn"" #i
#$l"ra #" n'"#t" 4li'. #$l"ro-$orn""an*
- 6 -
Tni$a 'i/lo$i" #a !a#$lara 0UVEE12 $a+t#"#t" ,ata int"rna a
#$l"roti$ii +ina la n 'ili'"tr %" $orn""2 %" n%" "a n #" 'ai $ontina +"
,ata +o#t"rioara a a$"#t"ia $i l-a o %ir"$ti" !"rti$ala +" a-l o$3ili #i
,or'iaza $ $orn""a n&3il $a'"rlar #a iri%o-$orn""an* Tni$a 'i/lo$i"
"#t" $o'+#a %in tr"i +ortini (
-$oroi%a
-$or+l $iliar
-iri#l
Coroi%a "#t" o '"'.rana int"n# !a#$larizata2 "a ,iin% in!"li#l
3ranitor al &lo.li o$lar* Part"a "-t"rna a%"ra la #$l"roti$a #i "#t" al$atita
%intr-o +atra #.tir" $on/n$ti!a .o&ata in $"ll" +i&'"ntar"2 +rin $ar"
$ontri.i" la ,or'ar"a $a'"r"i o.#$r"* La +oll +o#t"rior $oroi%a
+r"zintan ori,i$i $ar" $or"#+n%" la'"i $irit" a #$l"r+ti$ii2 +rin $ar" tr"$
,i.r"l" n"r!li o+ti$*
In +ortin"a ant"rioara $oroi%a ,or'"aza $or+l $iliar2 $ar" "#t" o
,or'atin" $on/$ti!- '#$lara $" #" intin%" +ina la ra%a$ina iri#li* In
&ro#i'"a a$"#t"ia #" &a#"#$ '#$3il $iliar 7 ,or'at %in ,i.r" n"t"%" #i
+ro$"#"l" $iliar" 7 $ar" #nt ni#t" $r"#t" ,or'at" %in &3"'ri !a#$lar"2
,oart" ana#to'ozat" intr" "l" $+rin#" intr-n t"#t $on/$ti! in $ar" "-i#ta #i
n'"roa#" $"ll" +i&'"ntar" #i t"#t "la#ti$* Cor+l $iliar +rin '#$3il #a
ar" rol in a$o'o%ar"a !izala la %i#tanta2 iar +ro$"#"l" $iliar" #"$r"ta
'oar"a a+oa#a $ar" 3ran"#t" t"#tril" li+#it" %" !a#" 0$orn""a #i
$ri#talinl1*
Tni$a int"rna #a r"tina "#t" o '"'.rana %" natra n"r!oa#a #i
$+rin%" r"$"+torii +"ntr l'ina* In ,ata "i int"rna +r"zinta %oa r"&ini
i'+ortant" ( +a+ila o+ti$a 0+ata oar.a1 #i +ata &al."na 0'a$la lt"a1*
Pa+ila o+ti$a $or"#+n%" lo$li in $ar" #" $on$"ntr"aza ,i.r"l"
n"r!oa#" $" al$ati"#$ n"r!l o+ti$2 lo$ in $ar" n #" &a#"#$ r"$"+tori2 a!in%
,or'a ni %i#$ o!alar #a $ir$lar %in $"ntrl $aria +l"a$a !a#"l" $"ntral"
al" r"tin"i*
Pata &al."na #" a,la in lo$l n%" a-l !izal intaln"#t" r"tina* In
$"ntrl "i #" &a#"#t" o %"+r"#in" in $ar" #" a,la $"l" 'ai 'lt" "l"'"nt"
r"$"+toar"2 ai$i r"alizan%-#" $"a 'ai $or"$ta #i 'ai $lara i'a&in" a
o.i"$t"lor +ri!it"*
R"tina "#t" al$atita %in )8 #tratri $"llar"*
-#tratl $"ll"lor +i&'"ntar" 7 $ $a+a$itat"a %"
a "'it" +#"%o+o%"*
- 9 -
- #tratl $"ll"lor !izal" 7 $on#tit" nl %in "l"'"nt"l"
r"$"+toar"*
Un"l" tri'it #+r" +atra +i&'"ntara +r"ln&iri in ,or'a %" .a#tona#"2
alt"l" tri'it +r"ln&iri $oni$"2 $"ll" $ $onri*
C"ll"l" $ .a#tona#" #nt in n'ar %" 2:*888 #i #nt $"ll" n"r!oa#"
'o%i,i$at"; .a#tona#"l" $ontin r"%o#+ina-+i&'"nt ,oto#"n#i.il $ rol %" a
tran#,or'a "n"r&ia l'inoa#a in i'+l#ri n"r!oa#"*
C"ll"l" $ $onri #nt in n'ar %" <*888*8882 $onril" +"r'itin%
!"%"r"a %irna $olorata2 in l'ina 'ai int"n#a*
Stratl n"ronilor .i+olari $+rin%" n"roni #"nziti!i +"ri,"ri$i2
n"ronl .i+olar r"+r"z"ntin% +ri'l n"ron al $aii o+ti$"*
Stratl n"ronilor 'lti+olari 7 al" $aror %"n%rit" ,a$ o #ina+#a $
a-onii n"ronilor .i+olari2 iar a-onii lor ,or'in% n"r!l o+ti$* N"ronl
'lti+olar r"+r"zinta al %oil"a n"ron al $aii o+ti$"*
M"%iil" tran#+ar"nt" in a,ara %" $orn"" 'ai $+rin% (
- 'oar"a a+oa#a
- $ri#talinl2
- $or+l !itro#2
"l" a roll %" a r",ra$ta raz"l" %" l'ina2 %"$i #nt '"%ii
r",rin&"nt" #a #i#t"' %io+tri$ al o$3ili*
U'oar"a a+oa#a2 "#t" n li$3i% $lar2 in$olor2 tran#+ar"nt 0in $antitat" %"
826-82912 #"$r"tat %" +ro$"#"l" $iliar"2 %" $o'+oziti" a#"'anatoar"
li$3i%li $",alora3i%ian #i #" &a#"#t" in #+atil $+rin# intr" $orn"" #i
$ri#talin2 %"n'it $a'"ra ant"rioara* Ca'"ra ant"rioara "#t" 'ai 'ar" %"$it
$"a +o#t"rioara $ar" " %"li'itata ant"rior %" iri#2 +o#t"rior %" $ri#talin #i %"
li&a'"ntl #a ##+"n#or2 +"ri,"ri$ %" $or+l $iliar* C"l" %oa $a'"r"
$o'ni$a +rin ori,i$il ++ilar +rin $ar" tr"$" #i 'oar"a a+oa#a %intr-o
$a'"ra in $"alalta* Printr-n $anal a,lat in &ro#i'"a #$l"roti$ii n'it
4$anall li S$3l"''=2 'oar"a a+oa#a "#t" "li'inata $ontin in !"n"l"
#$l"roti$ii*
Cri#talinl "#t" o ,or'atin" l"ti$lara .i$on!"-a a#"zata +o#t"rior
iri#li ,iin% $+rin#a intr-o $a+#la $on/$ti!a al" $ar"i 'ar&ini #nt ,i-at"
+rin li&a'"ntl ##+"n#or 0zonla Zinn1 %" +ro$"#"l" $iliar"* La rin%l lor
+ro$"#"l" $iliar" a$tionat" %" '#$3il $iliar*
Cor+l !itro# "#t" o #.#tanta tran#+ar"nta &"latinoa#a #"$r"tata %"
+ro$"#"l" $iliar" ,iin% in!"lit intr-o '"'.rana #.tir" n'ita 43ialoi%a= #i
o$+a tot #+atil $+rin# intr" $ri#talin #i +"r"t"l" &lo.li o$lar2 n'it
$a'"ra +o#t"rioara*
- : -
Or&an"l" an"-" al" &lo.li o$lar*
Sitat" in i'"%iata !"$inatat" a &lo.li o$lar #" i'+art in %oa
$at"&orii(
- or&an" %" 'i#$ar" 'otilitat"
- or&an" %" +rot"$ti"
Or&an"l" %" 'i#$ar" #nt r"+r"z"ntat" %" '#$3ii "-t"rni ai &lo.li
o$lar-9 %r"+ti #i 2 o.li$i* Ei rot"#$ o$3il in toat" %ir"$tiil"* C"i +atr
'#$3i %r"+ti #" in#"ra $ n $a+at +" #$l"roti$a iar $ $"lalalt $a+at %" n
in"l ,i.ro# 0t"n%onl li Zinn1 %" +" ,n%l or.it"i2 iar $"i %oi '#$3i o.li$i
$ n $a+at +" oa#"l" $" al$ati"#$ or.ita #i $ $"lalalt $a+at +" #$l"r+ti$a*
Or&an"l" %" +rot"$ti" #nt ( #+ran$"n"l"2 +l"oa+"l"2 $on/n$ti!a #i
a+aratl la$ri'ar*
S+ran$"n"l" #nt ,or'atini '#$lo-$tanat" a$o+"rit" %" +"ri2 $ar" a
rol %" a o+ri #%oar"a #a $r&a in o$3i*
Pl"oa+"l" #nt %oa +liri t"&'"ntar"2 in &ro#i'"a $arora #" a,la o
'"'.rana ri&i%a2 iar +" 'ar&in" +r"zinta ni#t" +"ri n'iti $ili 0&"n"1 $"
r"tin +arti$l"l" %" +ra,* La .aza $ililor #" &a#"#$ &lan%" #".a$"" 'o%i,i$at"
$" #"$r"ta o &ra#i'" $ar" n&" $ili #i i'+i"%i$a #$r&"r"a la$ri'ilor*
Con/n$ti!a "#t" o '"'.rana #.tir" #i tran#+ar"nta $ar" $a+t#"#t"
,ata int"rna a +l"oa+"lor #i ,ata ant"rioara a &lo.li o$lar +ana la
+"ri,"ria $orn""i2 %" n%" #" $ontina $ "+it"lil ant"rior al a$"#t"ia*
A+aratl la$ri'al #" $o'+n" %in( &lan%a la$ri'ala #i $ail" la$ri'al"*
Glan%a la$ri'ala %" 'ari'"a n"i 'i&%al"2 %" #tr$tra t.lo-
a$inoa#a "#t" a#"zata in +art"a #+"rioara #i lat"rala a or.it"i* S"$r"ta
la$ri'il" $ar" #" "li'ina +rin 'ai 'lt" $anali$l" +" #+ra,ata &lo.li
o$lar*
Cail" la$ri'al" #nt %oa $anali$l" a#"zat" in &ro#i'"a $"lor %oa
+l"oa+" #i $on%$ la$ri'il" %in ,n%l %" #a$ $onn/n$ti!al #+"rior 7 #itat
in n&3il int"rn al or.it"i; %" ai$i +rin $anall la$ri'o-nazal2 la$ri'il"
#nt "li'inat" in ,o#"l" nazal"*
S"$r"tia la$ri'ala +rin $li+ir" in%"+art"aza +arti$l"l" #train" $ar" a/n& +"
$orn"" #i +rin #tratl ,in $" a$o+"ra $on/n$ti!a #i $orn""a #" '"ntin"
+"r'an"nt '"z"ala lor*
S"&'"ntl %" $on%$"r" al o$3ili "#t" r"+r"z"ntat +rin $al"a o+ti$a*
A$"a#ta in$"+" $3iar %" la r"tina n%" #" &a#"#$ +ri'l #i al %oil"a n"ro .i-
#i 'lti+olar* A-onii $"li %" al %oil"a n"ron intra in al$atir"a n"r!li
o+ti$*
- > -
C"i %oi n"r!ii o+ti$i2 %+a $" intra in $tia $raniana +rin ori,i$il
$ranian al &arii o+ti$"2 #" intaln"#$0%"a#+ra 3i+o,iz"i1 %an% na#t"r" n"i
in$r$i#ari $ar" #" n'"#t" $3ia#'a o+ti$a* La ni!"ll a$"#t"ia ,i.r"l" $ar"
!in %in /'atat"a nazala a r"tin"i #" in$r$i#"aza 0,i.r"l" int"rn"12 $"l"
"-t"rn" $ontinan%-#i %r'l* Din$olo %" $3ia#'a2 $al"a %" $on%$"r" #"
$ontina #. n'"l" %" 4tra$tri o+ti$"=2 ,i"$ar" tra$t $on#titin% ,i.r"
n"r!oa#" %" la o$3il %" a$"a#i +art" #i ,i.r" %" la o$3il %" +art"a o+#a*
A$"#t" ,i.r" la n n$l" #+"$ial %in tala'# n%" ,a$ #ina+#a $ $"l %"-al
tr"il"a n"ron al $aii o+ti$"* A-onii a$"#ti lti' n"ron #" in%r"a+ta #+r"
#$oarta $"r".rala #i #" t"r'ina in lo.l o$$i+ital n%" #" a,la #"&'"ntl
$"ntral*
S"&'"ntl $"ntral #a $orti$al 0%" +"r$"+ti"1 "#t" r"+r"z"ntat %" aria
!izala $ar" #" &a#"#t" la lo.l o$$i+ital2 in /rl #$izrii $al$arin"2
$a'+ril" )<-)?-)@ Aro%'an* Ai$i ar" lo$ +ro$"#l %" tran#,or'ar" a
"-$itati"i l'inoa#" in #"nzati" !izala*

1.2. FIZIOLOGIA ANALIZATORULUI VIZUAL
Si'tl !"%"rii n" +"r'it" #a r"$noa#t"' o.i"$t"l" $ar" n" in$on/oara2
#a a+r"$i"' $alitatil" lor2 ,or'a2 'ari'"a2 $loar"a2 l'inozitat"a2
'o.ilitat"a 7 $a #i %i#tanta $ar" n" #"+ara %" "l" #i %i#tanta %intr" o.i"$t"*
Pro$"#l +rin $ar" #" r"aliz"aza !"%"r"a $+rin%" r'atoar"l" "ta+"
#$$"#i!" (
a* For'ar"a i'a&inii +" r"tina2 +rin int"r'"%il ni #i#t"' %io+ti$2
in $ar" $ri#talinl in%"+lin"#t" roll n"i l"ntil" .i$on!"-"*
.* Sti'lar"a $"ll"lor r"$"+toar" %in r"tina2 #"n#i.il" la l'ina2
%"$i a $"ll"lor $ $onri #i a $"lor $ .a#tona#"* D"o#".iril" %"
$o'+orta'"nt a .a#tona#"lor l" r"!in" roll +rin$i+al in !"%"r"a
no$trna2 'ono$ro'ati$a2 iar $onrilor in !"%"r"a %irna2
$ro'ati$a*
$* R"+r"z"ntar"a i'a&inii la ni!"ll #$oart"i $"r".ral" ( i'a&in"a
r"ala #i ra#trnata2 ,or'ata +" r"tina "#t" +roi"$tata +rin
int"r'"%il $aii o+ti$" #+r" aria !izi.ila %in r"&in"a o$$i+itala*
A$"a#ta ar" o $ito-ar3it"$toni$a #+"$iala2 %" n%" #i %"n'ir"a
%" ari" #triata* R"tina #" +roi"$t"aza +n$t $ +n$t in aria
#triata* Fi.r"l" $or"#+nzatoar" %in +ata &al."na a in zona
- < -
!izala n t"ritori 'lt 'ai 'ar" $o'+arati! $ r"#tl r"tin"i*
Din $aza in$r$i#arii +artial" $ $3ia#'a o+ti$a2 ,i.r"l" ,i"$ar-
ia %in $"i %oi n"r!i o+ti$i #" +roi"$t"aza +" a'."l" "'i#,"r"*
Datorita a$"#ti ,a+t "-$itatiil" $l"#" %" $"l" %oa r"tin" a/n#"
in "'i#,"r"l" $"r".ral" +rintr-n ,"no'"n %" ,zin" $orti$ala
%$ la ,or'ar"a n"i #in&r" i'a&ini $ar" "#t" in !"%"r"a
.ino$lara 0a'.ii o$3i ,i-"aza a$"la#i +n$t1*

- ? -
CAPITOLUL II
PATOLOGIA TENSIUNII OCULARE
2.1 PARTICULARITATI FIZIOLOGICE
T"n#in"a o$lara #a o,tal'oton#l "#t" r"zltat al #tarii %" "$3ili.r
%intr" $ontintl o$3ili #i "la#ti$itat"a +"r"tilor #ai2 %"$i "a a#i&ra
$o'+on"nt"lor int"rn" al" &lo.li o$lar $on%itiil" n"$"#ar" .n"i
,n$tionari* Pr"#in"a intra-o$lara !ariaza intr" an'it" li'it" ,iziolo&i$"2
$ar" %a$a #nt %"+a#it" a r"+"r$#ini a#+ra a+aratli o+ti$ #i a#+ra
'"ta.oli#'li o$lar +"rtr.an% ,n$tionar"a nor'ala a !"%"rii*
In r"&lar"a t"n#inii o$lar" n rol "#"ntial il a %oi ,a$tori (
- 'oar"a a+oa#a #i $ir$latia "i
- #i#t"'l !a#$lar !"al*
U'oar"a a+oa#a $ir$lan% +"r'an"nt in int"riorl o$3ili "#t"
"l"'"ntl $"l 'ai i'+ortant al r"&larii t"n#ional"* A$"a#ta "#t" n li$3i%
tran#+ar"nt2 $ontin" #.#tant" al.'inoa#" )8-68 '&*B2 #arri 0Na Cl2 a$i%
a#$or.i$1*
Ea #" ,or'iaza in int"riorl $a'"r"i +o#t"rioar"2 +rintr-n +ro$"# %"
#"$r"ti" al "+it"lili $iliar2 tr"$" +rin ++ila in $a'"ra ant"rioara #i %+a $"
#i-a in%"+linit roll #a '"ta.oli$ "#t" "!a$ata in a,ara o$3ili +" la
ni!"ll n&3ili iri%o-$orn"an2 #" #$r&" +rin +orii tra."$li in $anall li
S$3"l'' #i in !"n"l" a+oa#" a/n&an% a#t,"l in $ir$latia !"noa#a
"+i#$l"rala* O alta $al" %" "!a$ar" "#t" $"a !"o-#$l"rala #+ra$oroi%iana*
Prin a$"a#ta $al" #" #$r&" o $antitat" %" 'oar" a+oa#a +rin #+atiil" $iliar"
int"r'#$lar"2 #+r" $oroi%a2 #$l"ra #i t"#t or.itar*
T"n#in"a o$lara %"+in%" %" $ir$latia #an&ina o$lara $ar" intr"tin"
n ton# %" .aza r"lati! #ta.il* R"latiil" %intr" t"n#in"a #an&ina #i
t"n#in"a o$lara #,"ra !ariatii n"in#"'nat" %atorita n"i r"&lari n"r!oa#"
",i$a$"*
Mo%i,i$ar"a t"n#inii art"rial" ar" o in,li"nta #la.a #i tr"$atoar"2 %"
$at"!a or" a#+ra t"n#inii o$lar" 0'o%i,i$ar"a t"n#inii o$lar" "#t"
a+ro-i'ati! )C)8 %in 'o%i,i$ar"a T*A* 1 #i #" %ator"aza in +rin$i+al
#$3i'.arii %" !ol' a #an&"li %in int"riorl o$3ili #i in al %oil"a ran%
'o%i,i$arii %".itli $iliar 0$ar" "#t" ra+i% $o'+"n#at %" !ariatia $antitatii %"
- @ -
'oar" a+oa#a "li'inata $""a $" r"%$" +r"#in"a intra-o$lara la ni!"ll
#a initial1*
Cr"#t"r"a t"n#inii !"noa#" "+i#$l"ral" 0$ar" ar" !aloar" nor'ala %"
)8'' H&12 "#t" r"#+on#a.ila %" an'it" ,or'" %" 3i+"rt"n#ini o$lar"
0&la$o' #"$n%ar1*
Ni!"ll t"n#ional "#t" $on%itionat #i %" #i#t"'l n"r!o#2 $ar" %"#i
,oart" $o'+l"- ar" n rol #"$n%ar*
Da$a #" +ro%$" +r"a 'lta 'oar" a+oa#a2 #a %a$a "li'inar"a "i "#t"
in&r"nata2 a$"a#ta #" "&al"aza +" $al" r",l"-a 03o'"o#tazia t"n#ionala a
a%ltli1*
R"&lar"a t"n#inii o$lar" #-ar ,a$" +rin '"$ani#'" lo$al" #i ar ,i #.
%"+"n%"nta #i#t"'li #i'+ati$ #i +ara#i'+ati$ +rin int"r'"%il n"r!ilor
$iliari ln&i #i #$rti* E-$itatia #i'+ati$li $"r!i$al +ro!oa$a o #$a%"r" a
t"n#inii o$lar"2 iar "-$itatia +ara#i'+ati$li +ro!oa$a o 3i+otoni" $ #$a-
%"r"a %" #$r&"r" a 'orii a+oa#"* Datorita $ontra$ti"i '#$3ili $iliar2
$ar" t"r$" +int"nl #$l"ral #i lar&"#t" +orii tra."$lari2 "-$itatia tri&"'"nli
+ro%$" o $r"#t"r" ra+i%a a t"n#inii o$lar" a#o$iata $ 'ioza*Si#t"'l
n"r!o# $"ntral ar" o oar"$ar" a$tin" a#+ra ton#li %" .aza al o$3ili +rin
'o%i,i$aril" $ir$latorii +" $ar" l" %"t"r'ina*
Fa$torii "'otionali #i +#i3i$i a o 'ar" in,li"nta a#+ra #"$r"ti"i
$iliar"2 #" a%'it" %" a#"'"n"a "-$itatia ni $"ntr r"&lator %i"n$",ali$ al
t"n#inii intrao$lar"*
Li'it"l" nor'al" al" t"n#inii intrao$lar" #nt 28 ''H& DE :''H&2
$ n 'a-i' %i'in"ata #i n 'ini' $atr" #"ara* Cr"#t"r"a t"n#inii o$lar"
P"#t" 29 ''H&2 $on#titi" #i'+to'l +ri'or%ial in &la$o'*

- )8 -
EXAMINAREA OCIULUI IN GLAUCOM
E-a'inar"a #" ,a$" +rin(
)* E-a'inar"a $a'+li !izal 7 +"ntr a %"#$o+"ri la ti'+
"!"ntal"l" %",i$it" a+art" 0 #$otoa'" ar$i,or'"2 in&#tari
+"ri,"ri$" 1* Ca'+l !izal #a !"%"r"a +"ri,"ri$a "#t" #+atil +"
$ar" il $+rin%" o$3il in ti'+ $" +ri!"#t" n +n$t ,i-* S"
'a#oara $ ar$ril" +"ri'"tri$" #i'+l" #a #,"ri$"* R"tina ar"
$a+a$itat"a %" a +"r$"+" o.i"$t"l" a#"zat" lat"ral2 iar +"ntr
%"#$o+"rir"a nor "!"ntal" %","$tini al" a$"#t"ia #" ,olo#"#t" n
a+arat %"n'it +"ri'"tr 2 ,or'at %intr-n #"'i$"r$ * Aolna!l
i#i #+ri/ina .ar.ia +" n #+ort al a+aratli #i ,i-"aza $ +ri!ir"a
n +n$t #itat in 'i/o$l #"'i$"r$li* Din#+r" +"ri,"ri" #+r"
+n$tl +" $ar" il +ri!"#t" .olna!l #" +li'.a n 'i$ +atrat al.*
Cin% +atratl "#t" !azt %" .olna! 2 in#"a'na $a a intrat in $a'+l
!izal 0+" +ortin"a +"ri,"ri$a a r"tin"i #" $it"#t" +" la'a
+"ri'"trli &ra%atia $or"#+nzatoar" 1* E-a'inar"a #" ,a$" in
tr"i %ir"$tii ( !"rti$ala2 orizontala #i int"r'"%iara* S" r"n"#$
+n$t"l" #ta.ilit" #i #" o.tin" $a'+l !izal $ar" ,olo#in% o
#$3"'a ti+ %" !"%"r" nor'ala r"l"!a %a$a .olna!l +r"zinta #a
n %",i$i"nt" al" $a'+li !izal*
2* E-+lorar"a int"riorli o$3ili #" ,a$" $ o,tal'o#$o+l 2 $ar"
'a#oara ,n%l %" o$3i 2 n"r!l o+ti$ 2 !a#"l" #an&in" #i r"tina*
O,tal'o#$o+ia "#t" %ir"$ta $an% i'a&in"a ,n%li %" o$3i #"
!"%" %ir"$t 2 a+ro+iin% o,tal'o#$o+l %" o$3i #i in%ir"$ta $an%
,n%l %" o$3i "#t" !azt ra#trnat*O,tal'o#$o+l #" tin" la 98
$'* %" .olna! #i i #" a%r"#"aza in ,ata o$3ili o l"ntila .i$on!"-a
%" 28D2 il'inan% o$3il $ o&lin%a +rin l"ntila2 i'a&in"a
,n%li %" o$3i a+ar" a"riana #i in!"r#a* E-a'inar"a #" ,a$"
intr-o $a'"ra o.#$ra*
M!"#$!$%! &%'"(#'(( ('&$!)*#+!$%.
Contintl %" li$3i% al &lo.li o$lar 0#an&"2 'oar" a+oa#a2!itro#1
"-$ita a#+ra +"r"tilor #ai o t"n#in" $ar" $on#titi" t"n#in"a o$lara #a
o,tal'oton#l*D"t"r'inar"a o,tal'oton#li #a tono'"tria ar" i'+ortan-
ta in %ia&no#ti$ar"a &la$o'li*
- )) -
T"n#in"a o$lara #" 'a#oara +rin %oa '"to%" (
- %i&itala
- in#tr'"ntala
M%&),! ,(-(&!+!. S" $"r" .olna!li #a +ri!"a#$a in /o# #i $ a'."l"
%"&"t" in%i$atoar" al" 'ainilor a+li$at" +" &lo. 2 +rin int"r'"%il +l"oa+"i
#+"rioar" #" "-"r$ita o +r"#in" alt"rnati!a 0$an% n %"&"t #ta ,i- 2 $"lalalt
a+a#a +" &lo. 1* Nor'al "-i#ta o #oara ,l$t"nta 2 $ar" %i#+ar" in $az %"
3i+"rto'i"* T"n#in"a #" +oat" nota (nor'ala T8 FD) 2 D2 2 D6*
M%&),! ('"&$#.%'&!+!. S" tiliz"aza %oa +ro$"%"" (
a* M"to%a +rin i%"ntati" 0In,n%ar"-S$3iiotz 1*
.* M"to%a +rin a+lanati" 0Gol%'ann2 MaGlaGo! 1*
M"to%"l" a la .aza n +rin$i+i $o'n ( 'a#rar"a %",or'arii
$orn""n" #. a$tin"a n"i ,ort" "-t"rn"*
a* M"to%a +rin i%"ntati" 7 'a#oara +ro,nzi'"a %"+r"#inii $orn""i
+ro%#a %" o an'ita &r"tat" intr-n +n$t %at* D"+r"#in"a !a ,i
$ atat 'ai 'ar" $ $at T8 "#t" 'ai 'i$*C"l 'ai ,r"$!"nt #"
tiliz"aza Tono'"trl S$3iotz*Aolna!l "#t" $l$at $ ,ata in ## #i
+ri!"#t" %r"+t inaint"a #a2 +" $orn""a an"#t"ziata $ in#tilatii2 %+a
in%"+artar"a ,ara +r"#ini a +l"oa+"lor $ +oli$"l" #i in%i$"l" 'ainii
#tan&i2 #" a+li$a !"rti$al tono'"trl +" $"ntrl $orn""i #i #" $it"#t"
+" $a%ran %"!iatia a$li*Ci,ra o.tinta "#t" tran#,or'ata in ''H&2
$ a/torl ni ta."l #+"$ial2 tinan% $ont %" &r"tat"a +la#ata +"
+i#ton*
.* Tono'"tria +rin a+lanati" 7 %"t"r'ina ,orta n"$"#ara +"ntr a
a+latiza o #+ra,ata $orn""ana*E-i#ta %oa ti+ri %" tono'"tri" +rin
a+lanati"2 n"l" $ar" tiliz"aza o #+ra,ata $on#tanta #i 'a#oara
+r"#in"a n"$"#ara +"ntr a o a+latiza 0Gol%'an1 #i alt"l" $ar"
tiliz"aza o +r"#in" $on#tanta #i 'a#oara #+ra,ata a+latizata
0MaGlaGo!1*
Aolna!l #" a#"aza in ,ata n"i la'+i $ ,anta +r"!azta $ n
a+lano'"tr #i $ n ,iltr %" $o.alt2a+oi i #" in#til"aza n an"#t"zi$
%" #+ra,ata 0no!"#in1 #i o #olti" %" ,lor"#$"ina*S" $"r" .olna!li
#a +ri!"a#$a inaint" ,ara a $li+i2 #" l'in"aza o$3il +rin int"r'"%il
,iltrli %" $o.alt %+a $ar" #" r"&l"aza +r"#in"a "-t"rna la )8
''H&* #i #" i'+in&" $ %"li$at"t" $onl %" +r"#in"2 +ana a/n&" in
$onta$t $ $orn""a*

- )2 -
E-a'"nl .io'i$ro#$o+i$ +n" in "!i%"nta %oa 'i$i #"'i$"r$ri
al.a#tr"2 'ar&init" %" n liz"r" !"r%"2 #" r"&l"aza la'+a a#t,"l in$at $"l"
%oa #"'i$"r$ri #a ,i" %" 'ari'" "&ala*Da$a $"l" %oa #"'i$"r$ri #"
in$al"$a P8 "#t" 'ai 'i$ %" )8 ''H&2 iar $an% #nt la %i#tanta nl %" altl
P8 "#t" 'ai 'ar" %"$at )8 ''H&*S" 'ar"#t" a$tin"a $onli %" +r"#in"
+ana la 'ar&inil" int"rn" al" $"lor %oa #"'i$"r$ri $ar" !in in $onta$t2 %an%
i'&in"a ni S $l$at2 a+oi #" $it"#t" t"n#in"a o$lara in ''H&*
C a/torl tono'"trli #" +oat" o.tin" o $r.a ni$t"'"rala a t"n#inii
o$lar"2 ,iin% na %in $"l" 'ai .n" '"to%" %" %"#$o+"rir" a n"i
3i+"rt"n#ini o$lar" in$i+i"nt"*
Tono'"tria #" ","$tiaza la ,i"$ar" 6 or" %" la ora 8>AM la 29PM*La
+"#oan"l" nor'al" !ariatiil" ni$t"'"ral" al" t"n#inii o$lar" n %"+a#"#$ :
''H& * La .olna!ii %" &la$o' !ariatiil" #nt 'lt 'ai 'ari2 +ana la 2:
''H& #a $3iar 'ai 'lt*
Tono&ra,ia 'a#oara $antitat"a %" 'oar"a a+oa#a "!a$ata in a,ara
o$3ili2 intr-o nitat" %" ti'+ #i #. o +r"#in" $no#$ta* Ar" #$o+l #a
%"t"r'in" #rinta %" #$r&"r" a 'orii a+oa#" %in o$3i* Cin% #" la#a +"
$orn"" n tono'"tr S$3iotz $ &r"tat"a %" <2: & ti'+ %" 9 'in2 &r"tat"a
#a "!a$iaza %in o$3i o $antitat" %" 'oar" a+oa#a $ar" "#t" in ,n$ti" %"
$a+a$itat"a %" %r"na/ a n&3ili iri%o$orn""an*
P"ntr "-"$tar"a n"i tono&ra,i #" 'a#oara 'ai intai +r"#in"a initiala
in +ozitia $l$at2 a+oi #" a%a&a o &r"tat" %" )8&2 o.tinin%-#" o +r"#in"
0Pt1 'ai 'ar" %"$at +r"#in"a initiala2 $ar"a I #" inr"&i#tr"aza $a%"r"a %"
ti'+ %" 9 'in* 0C1* Valoar"a li C "#t" o.tinta $ a/torl ni ta."l in
,n$ti" %" Pl #i Pt* P"ntr o$3il nor'al CF 822?D828) H )C'nC''H&*
Gonio#$o+ia2 #" tiliz"aza +"ntr "-a'inar"a o$3ilor 3i+"rt"n#i!i; "a
+"r'it" "-a'inar"a n&3ili iri%o-$orn"an +rin ,olo#ir"a ","$tli
+ri#'ati$ al nor l"ntil" %" $onta$t2 in $ar" "#t" o o&lin%a in$linata $ar"
r",l"$ta i'a&in"a n&3ili** E-a'inar"a #" ,a$" in $a'"ra o.#$ra la
la'+a $ ,anta2 %+a a+li$ar"a +" $orn"" a l"ntil"i %" $onta$t* Ra#$in%
l"ntila %" $onta$t a+ar in o&lin%a toat" r"&inil" n&3ili $a'"rlar2 a#t,"l
in$at #" +oat" "-+lora tot r"li",l a$"#ti n&3i*
In &la$o' "#t" n"$"#ar #a #" a+r"$i"z" lar&i'"a n&3ili iri%o-
$orn""an; 'ari'"a li #" "!aliaza %+a %i#tanta $ar" #"+ara in"ll li
S$3Ial." %" iri#*
Da$a n&3il "#t" in$3i#2 n #" !"%" ni$i o ,or'atin"*
Da$a n #" !"%" %"$at in"ll li S$3Ial."2 n&3il "#t"
'ai +tin in$3i# %" )8 0n&3i nr*)1
- )6 -
Da$a #" !"%" in"ll li S$3aIl." #i $anall li S$3l"''
in$3i%"r"a n&3ili in $r#l 'i%riaz"i "#t" +o#i.ila
0n&3i %" )8J 728J1*
Da$a #" !"%" in"ll li S$3aIl."2 $anall li S$3l"''
#i +int"nl #$l"ral2 %"#$3i%"r"a n&3ili "#t" %" 28J-68J2
iar in$3i%"r"a #a "#t" +o#i.ila %ar n #i&ra*
Da$a #" !"%" %n&a $iliara2 n&3il "#t" lar& %"#$3i# 68J-
9:J*
S" +ot $on#tata in"&alitatil" ,iziolo&i$" al" +ro,nzi'ii n&3ili
$a'"rlar 0n&3il #+"rior 'ai in&#t %"$it $"l in,"rior 1 #a +atolo&i$"*
P"ntr #t%i"r"a 'orii a+oa#" #nt n"$"#ar" +r"!"%"ril" #i
'i$roanaliz"l" %" 'oar" a+oa#a 'ai al"# in an'it" a,"$tini $' ar ,i
&la$oa'"l" #"$n%ar"( +n$tiona $a'"ra ant"rioara 0%" +art"a t"'+orala la
82:'' inlantrl li'.li 1 #i #" !a #$oat" 828:- 822'l 'oar" a+oa#a intr-
o "+r."ta #t"rila +"ntr a ,i "-a'inata %in +n$t %" !"%"r" .io$3i'i$ #i
$itolo&i$*

SINDROMUL DE IPERTENSIUNE OCULARA

Tl.raril" $azat" %" $r"#t"r"a t"n#inii o$lar" $on#titi" #in%ro'l
&la$o'ato# #-ar %atora nor tl.rari a $ir$lati"i 'orii a+oa#"*T"n#in"a
o$lara ar ,i in ,n$ti" %"( %".itl #"$r"tor al +ro$"#"lor $iliar"2 %" r"zi#t"nta
la $r&"r" a 'orii a+oa#" #i %" !aloar"a +r"#inii !"noa#" "+i#$l"ral" 2 or$"
$r"#t"r" a t"n#inii o$lar" a+ar" $a r'ar" a %"r"&larii nia %intr" $"i %oi
,a$tori r"#+on#a.ili %" '"ntin"r"a #a in li'it"l" ,iziolo&i$"*
Cr"#t"r"a %" !ol' a #"$r"ti"i 'orii a+oa#" +" 'int +ro%$" n
&la$o' +rin 3i+"r#"$r"ti"* Cr"#t"r"a r"zi#t"nt"i la #$r&"r" +rin o.#tr$ti"
la ni!"ll tra."$li #$l"ral al $analli li S$3l"'' #a !"n"lor a+oa#"
0$ail" #al" a,"r"nt" 1 i'+i"%i$an% #$r&"r"a 'orii a+oa#" %in $a'"ra
ant"rioara #+r" $ir$latia !"noa#a "+i#$l"rala $on#titi" $aza +rin$i+ala a
$"lor 'ai 'lt" ,or'" %" &la$o'* Cr"#t"r"a +r"#inii !"noa#" "#t" "-tr"'
%" rara #i #" +ro%$" in &la$o'l #"$n%ar*
Gla$o'l %"+in%" #i %" n ,a$tor &"n"ti$ #i in &"n"ral "#t" .ilat"ral
0+arinti $on#an&!ini #i +r"z"nta a,"$tinii la 'ai 'lti '"'.rii in a$"a#i
,a'ili" 1*
In a,ara %" $r"#t"r"a t"n#inii o$lar" +"#t" o an'ita li'ita 022
''H&1 !ariatiil" t"n#ional" +"#t" :-> ''H& in $r#l zil"i $a #i %i,"r"nt"
- )9 -
%" :->''H& intr" $"i %oi o$3i2 $3iar %a$a t"n#in"a ,i"$aria %intr" "i "#t"
in li'it" nor'al"2 #nt #o$otit" +atolo&i$"*
A,"$tin"a n",a#ta a 3i+"rt"n#inii o$lar" a#+ra r"tin"i #i n"r!li
o+ti$ ,a$ %in .oala &la$o'atoa#a $"a 'ai &ra!a %intr" 'ala%iil" o$lar"*
Gla$o'l $on#titi" na %intr" $az"l" $"l" 'ai ,r"$!"nt" %" or.ir" la
a%lti*





- ): -
CAPITOLUL III
GLAUCOMUL
D",initi"
Prin &la$o' #" int"l"& o #"ri" %" $on%itii +atolo&i$" al $aror #i'+to'
$o'n "#t" $r"#t"r"a t"n#inii o$lar" #i $ar" %$ la a,"$tar"a !"%"rii*
Cla#i,i$ar"
Gla$o'l +ri'ar - $ n&3i in$3i# #a $on&"#ti! 7a$t
-$roni$
-$ n&3i %"#$3i# #a $oni$ #i'+l
Gla$o'l 'al,or'ati! %a %i#&"n"ti$
Gla$o' #"$n%ar
Gla$o' a.#olt

Gla$o'l +ri'ar
D+a a#+"$tl $lini$ #i "!oltia #a2 &la$o'l +ri'ar #" i'+art" in
%oa $at"&orii(
Gla$o'l #i'+l #a $ n&3i %"#$3i#
Gla$o'l $on&"#ti! #a $ n&3i in$3i#
Gla$o'l $ n&3i %"#$3i# "#t" o .oala $roni$a .ilat"rala 2$ o
"!olti" in#i%ioa#a2 +ro&r"#i!a2 $ar" #" 'ani,"#ta +rintr-o $r"#t"r" l"nta a
t"n#inii intrao$lar"2$ar" %"t"r'ina #"$n%ar alt"ratii anato'i$" 0atro,ia
n"r!li o+ti$ $ "-$a!ati"1 #i tl.rarii ,n$tional" 0%",i$itl !"%"rii
$"ntral"1* S" $ara$t"riz"aza +rin a.#"nta or$ar"i a,"$tini #a ano'alii
o$lar"2 #"'n" %" $on&"#ti" #i n&3i $a'"rlar %"#$3i#*
S" intaln"#t" %+a !ar#ta %" ::->8 ani2 la a'."l" #"-"* Datorita
a.#"nt"i #i'+to'"lor #.i"$ti!"2 &la$o'l $roni$ #i'+l "#t" ,or'a $"a
'ai +"ri$loa#a* Aoala "#t" %"#$o+"rita a$$i%"ntal $ o$azia n"i +r"#$ri+tii
%" o$3"lari*
Si'+to'"l" o.i"$ti!" #nt r"%#"* O$3il "#t" lini#tit 2 ++ila "#t" +tin
'ai lar&a #i r"a$tiil" ++ilar" 'ai l"n"#"22 t"n#in"a o$lara $r"#$ta
'o%"rat intr" 2:-6: ''H&* La ,n%l %" o$3i #" $on#tata o "-$a!ati"
+a+ilara $ara$t"rizata +rintr-o in,n%ar" in ,or'a %" $al%ar" a %i#$li
+a+ilar* Va#"l" r"tini"n" $"ntral" #" !a% +" +ro,nzi'"a +a+il"i2 a+oi %i#+ar
#i r"a+ar la ni!"ll 'ar&inilor +a+ilar" %"+la#at" nazal*In /rl +a+il"i #"
o.#"r!a n"ori in"l" al.-&al.i %" atro,i" a r"t"l"i $oroi%i"n"*
- )> -
Mo%i,i$aril" $a'+li !izal a+ar la in$"+t #. ,or'a %" 'i$i
#$otoa'" izolat" 2 iar 'ai tarzi #.. ,or'a ni #$oto' ar$i,or'' 0#$oto'
AKERUM1* Intr-o ,aza 'ai a!an#ata $a'+l !izal #" in&#t"aza in,"ronaza*
Ori&in"a alt"ratiilor $a'+li !izal "#t" l"&ata %" %",i$i"nt"l"
$ir$latorii al"+a+il"i n"r!li o+ti$ #i al" r"tin"i* Tr"+tat $a'+l !izal #"
'i$#or"aza $on$"ntri$ 2 in ,aza +ri'ara a%a+tar"a la intn"ri$ "#t" alt"rata2
!"%"r"a $"ntrala #" +i"r%" 'ai tarzi*
E!oltia &la$o'li #" ,a$" l"nt2 #+r" $"$itat" .ilat"rala +rin #$a%"r"a
tr"+tata a !"%"rii*
P!&)-%'(%
Gla$o'l $roni$ #i'+l #" %ator"#t" $r"#t"rii r"zi#t"nt"i la #$r&"r" a
'orii a+oa#" la ni!"ll #i#t"'li tra."$lar #$l"rozat* O alta $aza %"
$r"#t"r"a r"zi#t"nt"i %" #$r&"r" a 'orii a+oa#" "#t" #$l"roza !a#"lor
#"$tinii %" %r"na/* N " %o!"%it in$a %a$a a$"a#ta .lo$ar" a n&3ili %"
,iltrati" "#t" initiala #a "#t" r'ar" a .olii &la$o'atoa#"*
A'!&).(% /!&)+)-(*!
In n&3il $a'"rlar2 la ni!"ll tra."$li #" $on#tata #$l"roza #i
+roli,"rar" $"llara $ar" %$ la in$3i%"r"a #+atiilor tra."$lar"* R"tina
+r"zinta o %"&"n"r"#$"nta a ,i.r"lor n"r!oa#" #i a $"lor &an&lionar" $ o
&lioza 0n"ror"tiniana2 +roli,"rar" %" t"#t &lial in r"tina #i n"r!l o+ti$2
$on#"$ti!a ni +ro$"# in,la'ator #a %in na#t"r" 1 #"$n%ara2 !""a
+r"zinta ,"no'"n" %" #$l"roza !a#$lara* N"r!l o+ti$ #,"ra o %"&"n"r"# 7
$"nta $a!"rnoa#a*
Con/n$ti!a2 $orn""a #i #$l"ra a a#+"$t nor'al* Un"ori in #ta%il
a!an#at iri#l +r"zinta zon" intin#" %" atro,i" 2 "l" #" 'ani,"#ta +rintr-o
rar",i"r" %i,za a #tro'"i ant"rio"r"* In ,aza ,inala a .oli in $or+l !itro#
a+ar 'o%i,i$ari %"&"n"rati!"*
Dia&no#ti$
Dia&no#ti$l #" .az"aza +"( 3i+"rt"n#in" intrao$lara
tl.rari %" $a'+ !izal
"-$a!atia &l$o'atoa#a a ++il"i
In ,aza %" in$"+t2 $an% %ia&no#ti$l n "#t" #i&r2 #" r"$r&" la +ro."l"
%" +ro!o$ar"( in&"rar" %" li$3i%"2 in#tilar"a 'i%ria$"lor2 $ar" %$ la $r"#t"r"a
t"n#inii intrao$lar" in o$3il &la$o'ato#* S" !a ,a$" "-a'"nl $r."i ni$-
t"'"ral"2 !aloril" $on,ir'an% %ia&no#ti$l*
La "-a'inar"a 'ai at"nta #" +oat" o.#"r!a $a'"ra ant"rioara 'ai 'i$a2
++ila 'ai %ilatata ,ata %" $"lalalt o$3i2n&3il $a'"rlar ra'anan% %"#$3i#*
- )< -
D(!-')"&(*#+ ,(0%$%'&(!+* S" ,a$" $ ( $atara$ta #"nila in$i+i"nta $
$ar" "#t" a%"#"a $on,n%at*
In $atara$ta li+#"#$( 3i+"rt"n#in"a o$lara2 'o%i,i$ar"a $a'+li !izal
2 atro,ia n"r!li o+ti$*
In &la$o' "-i#ta( o 'i#$ar" a $a'+li !izal2 "-$a!atia +a+ilara "#t"
$"ntrala #i +lata*
In #ta%il in$i+i"nt al .olii2 $ t"n#in"a o$lara #or $r"#$ta2
#ta.ilir"a %ia&no#ti$li " %i,i$ila n"ori* D" a$""a #" a+li$a +ro.a %"
+ro!o$ar" 3i%ri$a* Can% "li'inar"a 'orii a+oa#" "#t" #,i$i"nta2 %a$a
#"in$ar$a or&ani#'l $ li$3i% 0$"ai12 +t"' $on$l%" la #tar"a li +ato-
lo&i$a* Pro.a "#t" +oziti!a %a$a %i,"r"nta %" t"n#in" o$lara inaint" #i %+a
+ro.a "#t" %" : ''H&2 #a $3iar 'ai 'lt* R"zltatl +oziti! $on,ir'a %ia&-
no#ti$l %" &la$o' $roni$ #i'+l*
P$)-')"&(*#+ "#t" r"z"r!at #i "#t" in ,n$ti" %" +"rioa%a in $ar" a ,o#t
%"#$o+"rit* Da$a .oala a ,o#t #r+rin#a intr-o ,aza in$i+i"nta2 +rin trata'"nt
$or"#+nzator #i ##tint #" +oat" #al!a ,n$tia !izala* Pro&no#ti$l
,n$tional "#t" in ra+ort $ "$3ili.r %intr" t"n#in"a o$lara #i !a#$lariza-
tia n"r!li o+ti$*
T$!&!.%'&#+ &la$o'li $roni$ #i'+l "#t" (
- #i'+to'ati$2 $ar" r'ar"#t" #$a%"r"a t"n#inii intrao$lar"*
- lo$al #i &"n"ral ( #" tiliz"aza #.#tant" $ a$tin" +ara#i'-
+ati$o'i'"ti$a*
M"%i$a'"nt"l" +ara#i'+ati$o'i'"ti$" #a 'ioti$" a ","$t 3i+otoni-
zant a#+ra o$3ili +rin 'i$#orar"a r"zi#t"nt"i la #$r&"r"a 'orii a+oa#"*
P"ntr nor'alizar"a t"n#inii o$lar" #" a%'ini#tr"aza +ilo$ar+ina in
#olti" %" )-98B* A$tin"a "i %r"aza > or"* Ar" a$tin" a#+ra ,i.r"lor
'#$lar" n"t"%"* S" +oat" intr".inta #i #"ara #. ,or'a %" n&"nt 2B2 $
","$t2 'ai %ra.il %"$at $"l al +i$atrilor*Ez"rina #a ,izo#ti&'ina #" tili-
z"aza in #olti" )C)8882 "a a$tionan% +rin in3i.ar"a a$tinii $olin"#t"raz"i*
A$tin" #i'ilara o a Minta$oll 0#olti" )C>88812 To#'il"nl08222:- )B1
La +"r#oan"l" in !ar#ta '"%i$a'"nt"l" $ ","$t 'ioti$ #nt n",a!ora-
.il" +"ntr $a a,"$t"aza !"%"r"a +rin 'i$#orar"a ++il"i2 in $azri %" o+a$i-
tat" in$i+i"nta $"ntrala a $ri#talinli*
Si'+ati$o'i'"ti$"l" a$tion"aza +rin %i'inar"a #"$r"ti"i $iliar" #i +rin
#rar"a #$r&"rii 'orii a+oa#"* S" tiliz"aza in#tilatii $ E+in",rina )-9B
#i N"o#in",rina )-:B*
Para#i'+ati$o'i'"ti$"l" +ot ,i a%'ini#trat" in a#o$i"r" $ #i'+ati$o-
'i'"ti$"l"* Fr"$!"nta in#tilatiilor "#t" %"t"r'inata %" ,or'a &la$o'li #i
- )? -
%" &ra%l t"n#inii o$lar"* In n"l" $azri "#t" #,i$i"nt #a #" in#til"z" %" 6-
9 ori +" zi2 alt"ori in#tilatii ,r"$!"nt" #i a#o$i"r"a '"%i$a'"nt"lor %" 'ai
##*
Da$a trata'"ntl lo$al "#t" in#,i$i"nt 2 #" !a ,a$" trata'"nt &"n"ral
$ar" in3i.a #"$r"tia $iliara #i r"%$" "-$ita.ilitat"a #$oart"i $"r".ral"*P"ntr
in3i.ar"a #"$r"t"i $iliar" #" tiliz"aza ( A$"tazola'ina 0E%"r"n 2 Dia'o-2
Dira'i%12 %"ri!at #l,a'i%i$2 a%'ini#trat 4+"r o#=*
A"ta.lo$ant"l" 0Ti'orol2 Ti'o+ti$1#$a% t"n#in"a o$lara*N $az"aza
'ioza2 #" +ot a#o$ia $ alt" '"%i$a'"nt" anti&la$o'atoa#"*
In #$o+l r"%$"rii "-$ita.ilitatii #$oart"i $"r".ral" #i a 3i+otala-
'#li #" tiliz"aza L'inall2 Lar&a$till2 Aro'ril"*
S" 'ai tiliz"aza a&"nti o#'oti$i $ar" +ro%$ o %"#3i%ratar" a $or-
+li !itrio#( r""2 'anitol2 &li$"rol* Trata'"ntl '"%i$a'"nto# in &la-
$o'l $roni$ #i'+l #" $ontina atata ti'+ $at ar" ","$t 3i+otonizat2
'"ntinan% t"n#in"a intrao$lara in li'it" nor'al"* Da$a n #" 'ai o.tin"
a$"#t ","$t2 #" a+li$a trata'"nt $3irr&i$al*

G+!#*).#+ *)'-%"&(1 2*# #'-3( ('*3("4
A$"a#ta ,or'a %" &la$o' #r!in" in r'a in$3i%"rii n&3ili iri%o-
$orn""an* E-i#a %oa ti+ri %" &la$o' $on&"#ti!( a$t #i $roni$*
In r"alitat" "#t" !or.a %" a$""a#i ,or'a2 $ar" in#a "!ol"aza %i,"rit %" la
n an'it #ta%i* Gla$o'l $on&"#ti! a,"$t"aza in #+"$ial ,"'"il" intr" 9:-
>8 ani*
S&!,(( ,% %1)+#&(% :
Sta%il +ro%ro'al 0+"rioa%a %" in!azi"1 #" 'ani,"#ta +rin tl.rari
!izal" tranzitorii2 $" $on#ta in (
!"%"r"a in $"r$ri $olorat" 0$r$."1 in /rl #r#"lor %" l'i-
na*A$"#t #i'+to' a+ar" %in $aza "%"'li $orn""an +ro!o$at
la $r"#t"r"a t"n#inii o$lar" ;
int"to#ari +"rio%i$" al" !"%"rii ;
%r"ri o$lar" #i +"rio$lar"2 'ai al"# %i'in"ata*
Si'+to'"l" a$"#t"a %r"aza $at"!a 'int" #i a+oi %i#+ar ,ara r'"*La
in$"+t +ro%roa'"l" #nt rar"2 a+oi %"!in %in $" in $" 'ai ,r"$!"nt"*
Mo%i,i$ari o$lar" o.i"$ti!" al" a$"#ti #ta%i #nt +tin 'ar$at" #i
$on#ta in (
- 'itriaza 'o%"rata
- %i'inar"a $a'"r"i ant"rioar"
- o+al"#$"nta $orn""i %atorita "%"'li
- )@ -
Si'+to'" $ar" #nt +r"z"nt" in ti'+l +ro%roa'"lor $an% #i t"n#in"a
o$alara "#t" $r"#$ta*
Si'+to'" +r"$o$"
- alt"rar"a a%a+tarii la intn"ri$
- a+aritia ni #$oto' $ar" +l"a$a %in +ata oar.a
in$on/ran%2 in #"$torl nazal +n$tl %"
,i-ati" 0#$oto' A/"rr'1
Pri'"l" #"'n" %" .oala 0+ro%roa'"l"1 #nt +ro%#" %"#"ori %"
in#o'ni"2 %" +r"#in" +#i3i$a2 o.o#"ala2 "n"r!ari2 ali'"ntati" a.n%"nta2
tilizar"a lo$ala #a &"n"rala %" atro+ina*A$"#t #ta%i +oat" %ra lni #a
ani*
Sta%il %" &la$o' "!olat #" 'ani,"#ta #. ,or'a %" &la$o'
$on&"#ti!2 a$t #i $roni$*
Gla$o'l $on&"#ti! a$t #" 'ani,"#ta +rintr-o $riza 0ata$1 %"
3i+"rt"n#in" o$lara*Ata$l "#t" %"zlantit %" a$"l"a#i $az" $a #i
+ro%roa'"l"*Aolna!ii #" +lan& %" %r"ri a$$"ntat" $ $ara$t"r %"
3"'i$rani"2 in#otit" %" &r"ata2 !ar#atri #i #$a%"r"a a$$"ntata a !"%"rii*El"
#r!in %" o.i$"i #"ara in $az %" o.o#"ala2 "'otii*
Dintr" ,a$torii %"$lan#atori ai &la$o'li $on&"#ti! a$t #" +ot "n'"-
ra ( #tr"#l2 in#o'nia2 '"%i$a'"nt"l" $ $ontint %" atro+ina2 #$3i'.ar"a %"
$li'a2 &r"#"lil" %i"t"ti$"2 $on#' "-a&"rat %" li$3i%"*
La "-a'"nl o.i"$ti! #" $on#tata (
$r"#t"r"a a$$"ntata a t"n#inii o$lar" ;
"%"'l +loa+"lor #i $on/$ti!"lor ;
o+al"#$"nta $orn""i ;
in,"$ti" +"riG"rati$a ;
$a'"ra ant"rioara 'i$a ;
++ila 'ar"2 o!alara2 i'o.ila2 !"rzi";
t"n#in" intrao$lara +"#t" :8 ''H& ;
Din $aza "%"'li $orn""an2"-a'"nl o,tal'o#$o+i$ #" ,a$"
&r"*O+al"#$"nta $orn""i #" %ator"aza "%"'li $or""an2 $ar" la "-a'"nl
.io'i$ro#$o+i$ a+ar" ,or'at %in n'"roa#" !"zi$l" +lin" $ li$3i%2 #itat"
in "+it"lil +ar"n$3i'li $orn""an*
La ni!"ll n&3ili $a'"rlar #" o.#"r!a $a ra%i$ina iri#li "#t" in
$ota$t $ ,ata +o#t"riora a $orn""i2 in$3izan% $o'+l"$t $o'ni$ar"a %intr"
$a'"ra ant"rioara #i $anall S$3l"''*Mo%i,i$aril" la ni!"ll n&3ili
$a'"rlar #" +ot !"%"a +rin &onio#$o+i"*
- 28 -
Dia&no#ti$l &la$o'li a$t #" ,a$" +" #i'+to'"l" o$lar" D +ri'"l"
#"'n" %" .oala*
Din $aza $",al""i2 &r"trilor #i !ar#atrilor +oat" ,i $on,n%at $
a,"$tini a$t" &a#tro-int"#tinal"2&r"#"ala $" %$" la +i"r%"r"a totala a !"%"-
rii*
D(!-')"&(*#+ ,(0%$%'&(!+ #" ,a$" $ (
iri%o$i$lita a$ta 0"%"' 'ai r"%#2 tl.rar"a 'orii a+oa#" %in $a'"ra
ant"rioara2 +r"$i+itata1;
$on/n$ti!ita a$ta ;
!"ita 3i+"rt"n#i!a a$ta ;
&la$o' #"$n%ar ;
Fara trata'"nt %+a $at"!a zil" #a #a+ta'ani ata$l %" &la$o' #"
+otol"#t"*F"no'"n"l" o.i"$ti!" %i#+ar in +art"*A$itat"a !izala #" +i"r%"
tr"+tat #a .r#$*
E%"'l $orn""an #i an"'ia r"tiniana +ot %i#+ar" $o'+l"t*Iri#l ra'an"
atro,i$ $ zon" %"$olorat"2 iar ++ila 'ai %ilatata*D"+i&'"ntatia iri#li
a+ar" in r'a i#$3"'i"i $azata %" t"n#in"a o$lara $r"#$ta 'lt*
G+!#*).#+ *)'-%"&(1 *$)'(*.
S" a/n&" tr"+tat %" la ,aza +ro%ro'ala la o #tar" %" +"r'an"nta
$on&"#ti" o$lara in#otita %" 3i+"rt"n#in" o$lara $ontina2 $ o !aloar"
'ai 'i$a %"$at in ata$l %" &la$o'*
Si'+to'"l" #.i"$ti!" al" +ro&roa'"lor (
in$"to#ar"a tr"$atoar" a !"%"rii ;
%r"r" o$lara #i +"rio$lara #oara ;
!"%"r"a nor $"r$ri $olorat" in /rl #r#"lor %" l'ina ;
Si'+to'"l" $" a+ar in (
'o'"nt" #tr"#ant" ;
&r"#"li %i"t"ti$" ;
o.o#"ala
Corn""a "#t" #or o+al"#$"nta2 $ #"n#i.ilitat" #$azta2 iri#l atro,i$2
++ila %ilatata o!alara2 %" $loar" !"rzi"2 $a'"ra ant"rioara "#t" 'ai 'i$a2
n&3il $a'"rlar in&#tat*
E-a'"nl o,tal'o#$o+i$ arata o "-$a!ati" +a+ilara &la$o'atoa#a
$ar"ia ii $or"#+n%" #$a%"r"a 'ar$ata a !"%"rii*
La "-a'"nl +"ri'"tri$ #" $on#tata la in$"+t o $r"#t"r" a +"t"i oar."
a+oi a+ar #$otoa'" +ara$"ntral"2 $ar" +l"a$a %in +ata oar.a #i in$on/oara
+n$tl %" ,i-ati"*
- 2) -
In ,aza r'atoar" #" in#tal"aza o a'+tar" a $a'+li !izal #i 'ai
tarzi #" +ro%$" o in&#tar" $on$"ntri$a a intr"&li $a'+ !izal*
P!&)-%'(%. Gla$o'l $on&"#ti! #r!in" +" n o$3i $ o $on,or'ati"
+arti$lara2 'ai al"# 3i+"r'"tro+2 la $ar" "-i#ta o %i#+ro+orti"
intr" 'ari'"a $ri#talinli #i $"l"lalt" #"&'"nt"
ant"rioar"*Ca'"ra ant"rioara #i n&3il $a'"rlar #nt in&#t"*
E-i#ta $azri $an% in&#tar"a n&3ili $a'"rlar "#t" %ata %" o ano 7
'ali" %" %"z!oltar" "r"%itara*
In&#tar"a n&3ili $a'"rlar ,ran"aza $ir$latia 'orii a+oa#"*An-
'iti ,a$tori int"r$r"nti 0%ilatar"a '"%i$a'"ntoa#a a ++il"i2 #o$ "'otional2
r"t"nti" %" li$3i%"12 +ot i'+in&" ra%a$ina iri#li2 la n o$3i +r"%i#+# #i
n&3il $a'"rlar #" !a in$3i%"*
T$!&!.%'& 7 C3irr&i$al - $ roll %" a #+ri'a ri#$l nor +#"" noi
#i #" !a a+li$a %" r&"nta*
- M"%i$al 7 +"ntr #+ri'ar"a %r"rilor a%"#"a in#+orta.i-
l" #" ,a$ in/"$tii r"tro.lar" $ No!o$aina2 #" a%'ini#tr"aza #"%ati!"
0Clor%"lazin2Diaz"+a'1 lo$al in#tilatii $ Pilo$ar+ina <B 2 $ o ,r"$!"nta $"
!ariaza in ,n$ti" %" &ra!itat"a +#"li*
- Trata'"nt '"%i$al &"n"ral 7 #" !or a%'ini#tra a&"nti
o#'oti$i 3i+"rtoni$i 0 Gli$"rol ) &rCG& $or+2 +"r,zi" !"noa#a %" r"" 66B-2
&rCG& $or+12%" a#"'"ni '"%i$a'"nt" $" r"%$ #"$r"tia %" 'oar" a+oa#a(
A$"tazola'i%a2 "%"r"n in/"$tii #a ta.l"t"*
S" ,a$ .ai $al%" la +i$ioar"2 #" a%'ini#tr"aza la-ta!i"*D+a $" o$3il
%"!in" $al'2 $ t"n#in"a nor'alizata #" r"$r&" la trata'"nt $3irr&i$al (
iri%"$to'i" .azala +"ri,"ri$a 7 $ar" ,a$ l"&atra intr" $"l" %oa $a'"r" al"
o$3ili2 a#i&ran% a#t,"l %"#$3i%"r"a $on#tanta a o$3ili*S" 'ai +oat"
tiliza tr"+anatia Elliot #i iri%"n$l"zi#l 0o+"ratii ,i#tlizant"12 &oniotr"+ana-
tia2 &onio+n$tra $ la#"r $ar" inl"#n"#t" #$r&"r"a 'orii a+oa#"*
Da$a n #" o.tin" n "$3ili.r t"n#ional +"r,"$t2 trata'"ntl $3irr&i$al
!a ,i r'at %" n trata'"nt '"%i$a'"nto#*
Pro,ila-ia o$3ili $on&"n"r $on#ta in "-"$tar"a +r"!"nti!a a n"i
iri%"$to'ii +"ri,"ri$"*
G+!#*).#+ .!+0)$.!&(1 "!# ,("-%'%&(** E#t" o 3i+"rt"n#in" #"$n-
%ara a n"i ano'alii %" %"z!oltar" "'.rionara a n&3ili iri%o$orn""an
$ar" i'+i"%i$a #$r&"r"a a'orii a+oa#" %in $a'"ra ant"rioara*Poat" ,i
$on&"nital #a #" in#tal"aza %+a na#t"r" in +ri'ii ani %" !iata*T"n#in"a
o$lara $r"#$ta %$" la %ilatar"a o$3ili a,lat in ,aza %" %"z!oltar"2 +tan%
a/n&" la %i'"n#ini 'ari 03i%o,tal'i"1*
- 22 -
Gla$o'l in,antil #" %"o#"."#t" %" &la$o'l +ri'ar al a%ltli +rin
$on%itiil" %" a+ariti" #i +rin ,a+tl $a 3i+"rt"n#in"a o$lara a$tion"za
a#+ra nor t"#tri in$a %i#t"n#i.il"2$""a $" %"t"r'ina a#+"$tl li
$lini$*A,"$tin"a "#t" .ilat"rala #i $on#titi" na %in $az"l" %" or.ir" la
$o+ii*A+ar" %" %oa ori 'ai %"# la .ai"tii %"$at la ,"t" #i #" 'ani,"#ta +rin (
O+a$i,i"r" a $orn""i +" n o$3i 'arit %" !ol' ;
Sin%ro' a$t $ %r"ri o$lar"2,oto,o.i"2.l",aro#+a#' #a +rintr-o
"!olti" l"nta*
Corn""a "#t" 'arita in toat" %ir"$tiil" %in $aza r+trilor '"'.ran"i
D"#$"'"t* Li'.l #$l"ro-$orn""an "#t" lar&it2 #$l"ra #.tiata2 $a'"ra
ant"rioara ,oart" +ro,n%a #i in n&3i $a'"rlar +rin &onio#$o+i" #" +oat"
!"%"a o '"'.rana tran#l$i%a $ar" 'a#$3"aza tra."$li #$l"ral*
Iri#l "#t" atro,iat iar in r'a %i#t"n#i"i &lo.li o$lar #i r+"rii
zonl"i Zinn2 a+ar" #.l-atia $ri#talinli $ar" #" +oat" o+a$i,ia*
Prin o,tal'o#$o+i" in r"tina #" !a% ,"no'"n"l" %"&"n"rati!"* E-$a!atia
&la$o'atoa#a a +a+il"i a+ar" 'ai tarzi2 t"n#in"a ,iin% $o'+"n#ata in
+art" %" %"#tin%"r"a #$l"ro-$orn""ana*
T"n#in"a o$lara "#t" $r"#$ta 68-:8 ''H&2 "-a'"nl r",ra$ti"i arata
n &ra% !aria.il %" 'io+i" %atorita %"z!oltarii &lo.li o$lar* In ,or'a
tar%i!a 0&la$o'l /!"nil12 +ri'l #"'n a+ar" la n $o+il 'ai 'ar"2 .oala
#" 'ani,"#ta $ #$a%"r"a tr"+tata a a$itati !izal"2 ,oto,o.i"2 .l",aro#+a#'2
#a +rin %r"ri o$lar"* Cr"#t"r"a .r#$a a t"n#inii intrao$lar" +oat" ,i
r'ata %" o 3"'ora&i" in $a'"ra ant"rioara2 in#otit" %" %r"ri o$lar"
+t"rni$"* Co+ill %"!in" a&itat2 +lan&"2 n ar" +o,ta %" 'an$ar"*
Trata'"nrl '"%i$a'"nto# ,iin% ,ara r"zltat2 iar $"l $3irr&i$al n %a
r"zltat" in toat" ,or'"l"2 .oala "!ol"aza #+r" $"$itat"* S" tiliz"aza
a%r"nalina )B in in#tilatii o$lar" 'ai al"# +r"o+"rator +"ntr $a "a
%i'in"aza %".itl #"$r"tor al 'orii a+oa#"*
Trata'"ntl $3irr&i$al in ,az"l" initial" %a r"zltat" +rin
tra."$l"$to'i"2 iar in ,az"l" a!an#at" int"r!"ntiil" ,i#tlizant" %a r"zltat"
tranzitorii*
G+!#*).#+ "%*#',!$
In &la$o'l #"$n%ar "-i#ta o $aza o$lara #a "-trao$lara $ar"
%"t"r'ina $r"#t"r"a t"n#inii o$lar"*
A,"$tin"a $ar" ,a$" %i,i$ila #$r&"r"a 'orii a+oa#" +oat" %"$lan#a
&la$o'l #"$n%ar*
- 26 -
Gla$o'l #"$n%ar "#t" %" o.i$"i nilat"ral #i "!ol"aza in 'o%
#.a$t2 $ ,"no'"n"l" #.i"$ti!" alar'ant"2 alt"ori "!oltia "i +oat" ,i
in#i%ioa#a2 $roni$a*
Dia&no#ti$l #" +n" in r'a $"r$"tarii #i#t"'ati$" a t"n#inii o$lar"2
a n&3ili $a'"rlar2 a ,n%li %" o$3i*
Clini$ "l +oat" ,i #"$n%ar nor a,"$tini %" ori&in" in,la'atori"2
!a#$lara2 tra'ati$a2 t'orala2 +o#to+"ratori"* Mai "-i#ta &la$oa'"
#"$n%ar" nor !"it"2 nor l"zini r"tini"n"2 &la$oa'" al"r&i$"2 %" natra
$ri#taliniana2 0&la$o' +rin int'"#$"nta $ri#talinli2 +rin 3i+"r'atritat"a
$atara$t"i1*
Dia&no#ti$l #" ,a$" +rin $"r$"tar"a #i#t"'i$a a t"n#inii intrao$lar"2 a
n&3ili $a'"rlar2 a ,n%li %" o$3i*
Trata'"ntl &la$oa'"lor #"$n%ar" "#t" $azal* Trata'"ntl lo$al
"#t" $"l al &la$o'li +ri'ar2 %ar in iri%o$i$lit" #" !or tiliza 'i%riati$"*
G+!#*).#+ !5")+#&* Con#titi" ,aza initiala a &la$o'li n"tratat #a
in#,i$i"nt tratat* El #" $ara$t"riz"aza +rin a.#"nta totala a !"%"rii #i o
t"n#in" o$lara $r"#$ta #i ir"%$ti.ila* La "-a'"nl o.i"$ti!2 in /rl
$orn""i !a#"l" a a#+"$t %" 4$a+ %" 'a%za= 2 %atorita /"n"i $ir$latorii
!a#$lar"2 $orn""a +r"zinta n "%"' "+it"lial 2 $a'"ra ant"rioara "#t" 'i$a2
++ila %ilatata #i ri&i%a2 $ri#talinl o+a$i,iat*
T"ra+"ti$a "#t" ilzori"2 'ioti$"l" #i ."ta.lo$ant"l" n a ",i$a$itat"2
in3i.itorii an3i%raza $ar.oni$a #i $3iar +"r,ziil" $ #.#tant" 3i+"r#o'ati$"
n a/ta la nor'alizar"a t"n#inii intrao$lar"* Int"r!"ntiil" ,i#tlizant" +ot ,i
til" %ar in#,i$i"nt"*
Trata'"ntl r'ar"#t" #$a%"r"a %r"rilor +rint-o in/"$ti" r"tro.l.ara
$ al$ool <8B* In $azril" r"."l" #" ,a$" "n$l"ar"a &lo.li o$lar*

P$)0(+!6(! -+!#*).#+#(.
Con#ta in %"+i#tar"a +r"$o$" a .olii2 +rin 'i/loa$" %" in!"#ti&ati" #i
+rin in#titir"a ni trata'"nt a%"$!at in ,az"l" in$i+i"nt"* S" !a r"$r&" la
n "-a'"n +ro,ila$ti$ #i#t"'ati$2 tono'"tri$ al ttror +"r#oan"lor $" a
%"+a#it !ar#ta %" 98 ani* Cazril" %" &la$o' $on,ir'at $a #i $azril"
##+"$t" #" %i#+"n#ariz"aza #i #" "-a'in"aza +"rio%i$ +rin $ontroll
t"n#inii o$lar"2 a ,n%li %" o$3i #i al ,n$tiilor !izal"*
- 29 -
CAPITOLUL IV
ROLUL ASISTENTEI IN INGRIJIREA BOLNAVILOR
CU GLAUCOM
Aolna!ii $arora li #" ","$t"aza o+"ratii $3irr&i$al" o,ta'olo&i$" 2 a
n"!oi" %" in&ri/iri #+"$ial"* Ma/oritat"a a$"#tor .olna!i a o #tar" %"
an-i"tat" %"o#".ita 2 t"'an%-#" $a int"r!"ntia n !a r"#iii #i $a #tar"a
+r"z"nta a !"%"rii lor #" !a a&ra!a * Di,i$ltat"a in&ri/irilor $on#ta in ,a+tl
$a .olna!ii a!in% a'.ii o$3i a$o+"riti #nt $o'+l"t %"zori"ntati*
I'-$(7($(+% /$%)/%$!&)$((.
E#t" .in" $a .olna!l #a $noa#$a inaint" %" o+"rati" +"r#onall +"ntr
a-l r"$noa#t" %+a o+"rati" $3iar %a$a ar" o$3ii a$o+"riti2 #a $noa#$a
,oart" .in" to+olo&ia $a'"r"i #i a #+atiilor %in /r2 a &r+li #anitar2 'o%l
%" a#"zar" a 'o.ili"rli #i a o.i"$t"lor %in $a'"ra* Inaint" %" o+"rati"
a#i#t"nta !a o$lziona o$3ii +a$i"ntli #i !a ,a$" i'+r"na $ a$"#ta
"-"r$itii %" %"+la#ar" +rin $a'"ra #i in #+atiil" a,"r"nt"2 !a "-"r#a tilizar"a
,ara a l" !"%"a a o.i"$t"lor +"r#onal"2 a !"#"l"i2 ii !a arata $' #"
a$tion"aza .tonl %" $3"'ar"*
Toat" a$"#t"a #" ,a$ in #$o+l %" a a%a+ta .olna!l la #itatia %" %+a
o+"rati" #i +"ntr a-l ,a$" #a +ri!"a#$a 'ai #or a$"a#ta o+"rati"*
C)',(&((+% ,% .%,(#.
Ca'"ra .olna!li tr".i" #a ai.a /alz"l" +"ntr a #" +t"a $r"a in
$a'"ra #"'i-o.#$ritat"2 +"ntr a-l o.i#ni $ #itatia in $ar" #" !a a,la
i'"%iat %+a o+"rati"2 %" alt,"l #i %+a #$oat"r"a +an#a'"nt"lor o$lar"
.olna!l tr".i" #a #t"a 'ai intai in #"'i-o.#$ritat" $a'"ra ,iin% l'inata
tr"+tat in zil"l" r'atoar"*
Patl .olna!li !a ,i a#"zat a#t,"l in$at l'ina #a !ina lat"ral; +atl
tr".i" #a ai.a 'ar&ini lat"ral" $ar" #" +ot ri%i$a +"ntr a "!ita ri#$l $a%"rii
%in +at* Aolna!l tr".i" #a ai.a o la'+a la $a+atl +atli $ #ti$la 'ata*
M"na/ar"a .olna!li %" tra'ati#'"l" +#i3i$" #i a#i&rar"a .olna!li
$a totl #" !a %"#,a#ra in $on%itii +"r,"$t"2 $a "$3i+a o+"ratori" !a ,a$" totl
$a int"r!"ntia $3irr&i$ala #a #" %"#,a#oar" .in"*
In #$o+l "-+lorarii $a+a$itatii %" a+arar" a or&ani#'li #i a &ra%li
%" r"zi#t"nta ,ata %" #o$l o+"rator #" !a "-"$ta $at"!a "-a'"n" o.li&atorii(
ra%io#$o+i" +l'onara +"ntr a %"+i#ta o "!"ntala .oala
+l'onara $ar" +oat" $o'+li$a int"r!"ntia $3irr&i$ala ;
- 2: -
#" !a ,a$" o "l"$tro$ar%io&ra'a2 #" !a 'a#ra t"n#in"a art"riala2
#" !a n'ara ,r"$!"nta +l#li #i in $az %" tl.rari #" !a ,a$"
trata'"nt a%"$!at ;
a#i#t"nta #" !a int"r"#a %"#+r" #$an"l" #i 'i$tinil" .olna!ilor2
%"#+r" rit'l #i a#+"$tl a$"#tora #i ori$" tl.rari !or ,i #"'nalat"
'"%i$li ;
#" !a $ontrola zilni$ t"'+"ratra .olna!li ;
#" !or ,a$" analiz" +"ntr "-a'"nl $o'+l"t %" rina $ar" !or %a
in,or'atii a#+ra #tarii ,n$tional" a rini$3ilor2 +r"z"nta %" &l$oza
in rina $ar" +oat" #"#iza n %ia."t2 .oala $" !a ,i tratata inaint" #i
in ti'+l int"r!"nti"i $3irr&i$al"2 a$"a#ta a,"$tin" +oat" ,i
%"+i#tata #i +rin "-a'"nl #an&"li 0&li$"'ia1 ;
#" !or ,a$" r"$oltari %" #an&" +"ntr "-a'"nl $o'+l"t ( n'arl
&lo.l"lor ro#ii2 3"'o&lo.ina2 3"'ato$rit2 ,or'la #an&ina2
l"$o&ra'a2 ti'+ %" #an&"rar"2 ti'+ %" $oa&lar"2 ti'+ii Li$G #i
HoI"ll2 V*D*R*L* 2 "-a'"n L*C*R* 0al.'ina2&lo.lin"2+r"#in"1(
In $azl +r"z"nt"i n"i an"'ii a$"a#ta #" !a $or"$ta +rin tran#,zii
%" #an&" #a +r"+arat" %" ,i"r ;
#" !a %"t"r'ina &r+a #an&ina #i ,a$torl R3 ;
+"ntr +"r#oan"l" tr"$t" %" :8 ani #" !or ,a$" +ro." 3"+ati$" (
TM'ol2 ,o#,ataza al$alina #i tran#a'inaz" 0TGO2 TGP1 ;
#" !a t"#ta %a$a .olna!l ar" al"r&i" la n"l" '"%i$a'"nt" #a
#.#tant" $" #" !or tiliza +"ntr an"#t"zi" ;
intarir"a r"zi#t"nt"i or&ani#'li %a$a "#t" $azl +rin r""$3ili.rar"
3i%ro"l"$troliti$a2 nor'alizar"a +rot"in"'i"i2 !ita'inizar" #i la
n"!oi" ali'"ntati" #+"$iala ;
C o zi inaint" %" o+"rati" .olna!l !a ,i i'.aiat #$3i'.an%i-#"
l"n/"ria %" $or+ #i %" +at2 r"&i'l ali'"ntar !a ,i $o'+# %in li$3i%"2 iar in
zia int"r!"nti"i n !a 'an$a %" lo$*So'nl .olna!l %in noa+t"a
+r"'"r&atoar" o+"rati"i !a ,i a#i&rat %" '"%i$a'"nt" 3i+noti$"
0Ci$lo.ar.ital #a F"no.ar.ital "!"ntal Ro'"r&an $at" o ta.l"ta1*
Inaint" %" a %$" .olna!l in #ala %" o+"rati" #" !a ,a$" n #"'n $ n
$r"ion %"r'ato&ra, +" ,rnt"a .olna!li2 %" +art"a o$3ili $" r'"aza a ,i
o+"rat2 +"ntr "!itar"a nor $on,zii*

- 2> -
I'-$(7($%! /)"&)/%$!&)$(%.
A$"a#ta "#t" ,oart" &r" %" ","$tat2 %atorita n"lini#tii .olna!ilor2 a
%r"rii +" $ar" a$"#tia o r"#i't2 a intn"ri$li $o'+l"t in $ar" #" &a#"#$2 a
,a+tli $a +an#a'"ntl tr".i" #a #t"a n"'i#$at +" o$3i2 n"ori &r" %"
r"alizat %in $aza 'i#$arilor in!olntar"2 in #+"$ial in ti'+l #o'nli*S" !a
r"$r&" la $al'ant" #i #o'ni,"r" ori %" $at" ori o+"ratl n +oat" #ta
lini#tit*D+a o+"rati" .olna!l tr".i" tr".i" #a #t"a $ $a+l $o'+l"t
n"'i#$at2 n tr".i" #a t#"a#$a2 #a #trant"2 #a !o'it"2 n ar" !oi" #a ,a$a
'i#$ari .r#t"2 #a !or."a#$a tar"2 +"ntr $a toat" a$"#t"a +ot +ro!o$a
tra$tini +" r"&in"a o+"arata $ar" +ot $o'+ro'it" o+"ratia*Aolna!l !a #ta
$l$at +" +art"a n"o+"rata2 $a #a i'+"i%i$" ori$" +r"#ini a#+ra o$3ili
o+"rat #a i'.i.ar"a +an#a'"ntli $ #"$r"tii nazal" #a $ li$3i%l n"i
"!"ntal" !o'"*
D+a 29 %" or" $a+atl +atli #" ri%i$a tr"+tat #i .olna!l +oat" #ta
$l$at #i +" #+at"2 #" !a r'ari $a +an#a'"ntl #a n #" 'i#t" %" +" o$3i in
tot a$"#t ti'+* El !a +ri'i rinarl ori %" $at" ori ar" n"!oi"*
Ri%i$ar"a .olna!li %in +at #" +"r'it" %" $3irr&l o,ta'olo& 'ai
%"!r"'" #a 'ai tarzi2 in ,n$ti" %" ti+l o+"rati"i ","$tat"* D+a $" "#t"
+"r'i#a ri%i$ar"a2 'i#$aril" .olna!li #" ,a$ n'ai $ #+ri/inl #i
in%r'ar"a a#i#t"nt"i '"%i$al"* D+a $" o$3il #anato# n 'ai "#t" a$o+"rit
.olna!l +oat" ,a$" #i #in&r n"l" 'i#$ari 2 in#a %oar %+a $" a#i#t"nta #-a
$on!in# $a "l #" +oat" 'i#$a #in&r $or"$t*
S" !a a!"a &ri/a $a .olna!l #a n #" a+l"$" $"l +tin 6-9 #a+ta'ani2
%"oar"$" a$"#t"a $r"#$ t"n#in"a intrao$lara #i +ot $o'+ro'it" int"r!"ntia
$3irr&i$ala2 'oti! +"ntr $ar" .olna!l !a tr".i #a ai.a in$alta'int" ,ara
#ir"tri* E#t" ,oart" in%i$at $a .olna!l #a ai.a la %i#+oziti" n a+arat %"
ra%io2 $ar"-l !a a/ta #a tr"a$a 'ai #or +"rioa%a +o#to+"ratori"2 %"
a#"'"n"a ,iin% tila +r"z"nta ,a'ili"i #i a +ri"t"nilor +"ntr a-I ,a$"
$or"#+on%"nta #i a l" $iti $arti #i ziar"*
R"&i'l ali'"ntar !a ,i in$"+t n'ai $ li$3i%2 a+oi %" $on#i#t"nta
'oal" +"ntr a n #oli$ita '#$3i 'a#ti$atori $ar" ar +t"a "-"r$ita tra$tini
in r"&in"a o+"rata* Din a$"l"a#i 'oti!" .olna!l tr".i" #a ai.a #$an" 'oi
0la n"!oi" a%'ini#tran%-#" la-ati!"1*
S#/$!1%-3%$%! "&!$(( -%'%$!+%.
A#i#t"nta !a tr".i #a o.#"r!" +l#l2 t"'+"ratra2 #" !a int"r"#a %"
#tar"a r"&inii o+"rat"2 #"nzatii %" +r"#in" a$$"ntat" in o$3i in%i$an%
+o#i.ilitat"a n"i 3"'ora&ii* Dr"ril" !ii in%i$a a+aritia n"i 3"'ora&ii #a
in,"$tii #i'+to'" $" tr".i"#$ #"'nalat" '"%i$li i'"%iat*
- 2< -
La %"#,a$"r"a +an#a'"ntli #" +oat" $on#tata $a r"zltatl a$itatii
!izal" #a n ,i" $"l a#t"+tat %" .olna! 2 ,i" $a &ra%l %" a$itat" %orit %"
.olna! n !a +t"a ,i r"alizat 2 ,i" $a +"ntr atin&"r"a ni &ra% .n %"
!"%"r" !a tr".i #a tr"a$a 'ai 'lt ti'+*
A#i#t"nta n'ai la in%i$atia '"%i$li !a %i#$ta $ .olna!l a$"#t
l$r2 $atan% #a-I $r""z" #tar"a %" #+irit $or"#+nzatoar" +"ntr $a "l #a +ri-
'"a#$a lini#tit r"zltatl o+"rati"i* In $o!al"#$"nta a#i#t"nta !a r'arii
"!oltia .olna!li #i-l !a #,ati #a r"#+"$t" +r"#$ri+tiil" '"%i$al" #i #a #"
+r"zint" +"rio%i$ la $on#ltati"*
E,#*!&(! "!'(&!$!.
A#i#t"nta ii !a r"$o'an%a ni .olna! %" &la$o' o !iata or%onata2
li+#ita %" "'otii +t"rni$"2 #tr"##2 ,ara #r'"na/ ,izi$ #a o$lar* M"#"l"
tr".i" #a ,i" 'o%"rat" li+#it" %" "-$itant" 0$a,"a2 $io$olata12 "!itan%
"-$"#l %" .rannz"tri2 &ra#i'i2 #ar"2 za3ar* Aatril" al$ooli$" #nt
int"rzi#"2 in #+"$ial ."r"a2 %"alt,"l ori$" li$3i% $on#'at in $antitat" 'ar"
,iin% %anator* S" int"rzi$" $at"&ori$ ,'atl2 %" a#"'"n"a la .olna!ii $
&la$o' n #" a%'ini#tr"aza atro+ina $3iar %a$a "#t" in%i$ata +"ntr alt"
.oli* Ni$i ,r$t"l" n tr".i" $on#'at" "-$"#i!2 ,iin% in%i$at #a #" $on#'"
$at 'ai 'lt" !"r%"tri +roa#+"t"* Dintr" ,r$t"l" $"l" 'ai ."n",i$" #nt
a,in"l" iar %intr" l"&'" 'or$o!l #i $"a+a*
S" r"$o'an%a in,ziil" %in ,rnz" %" a,in 02 $ani +" zi1 #a $"ai ,or'at
%in r'atorl a'"#t"$ ( rzi$a D !"ntili$a D &al."n"l" D $oa%a #ori$"lli2
02-6 $ani +" zi12 $ra %" #$ +roa#+at %" 'or$o!i %i'in"ata +" n"'an$at"
#a $ra %" &ra in$oltit*
Aolna!l 'ai +oat" ,a$" .ai %" a.r o$lar" $ ,lori %" #o$ #i
'#"t"l*O$3ii !or ,i ,"riti %" raz"l" ltra!iol"t" +rin o$3"lari %" #oar" $
l"ntil" %" $loar" !"r%" #a &ri2 "-$lzan% l"ntil"l" %" $loar"
in$3i#a*Aolna!l n tr".i" #a +oart" i'.ra$a'int" +r"a #tran#a +" $or+2 n
tr".i" #a ri%i$" &r"tati 'ari2 tr".i" #a "!it" $on#ti+atia #i #" !a +r"z"nta
+"rio%i$ la $ontrol in +oli$lini$a2 $on,or' in%i$atiilor '"%i$al"*
- 2? -
SPITALUL KUDETEAN DEVA Aolna!a ( P"tr"#$ Ro%i$a
SECTIA OFTALMOLOGIE Dia&no#ti$(AO &la$o' +rin in-
Salonl )2 +at ) $3i%"r"a n&3ili2 a$t OD2
+ot"ntial OS
PREZENTARE DE CAZ
Aolna!a P"tr"#$ Ro%i$a2 na#$ta la 2>*8@*)@62 in !ar#ta %" >> ani2
+"n#ionara $ %o'i$ilil in D"!a2 #" +r"zinta in %i'in"ata zil"i %"
28*8)*)@@@ la Poli$lini$a D"!a2 a$zin% int"n#" %r"ri in a'.ii o$3i2 $",al""2
la$ri'ar"2 #$a%"r"a a$$"ntata a !"%"rii2 $on&"#ti"* La "-a'"nl o.i"$ti!
o$lar #" $on#tata TOODF>8 ''H& ; OS F )9 ''H&2 "-a'"n in r'a
$aria .olna!a "#t" int"rnata in #"$tia o,ta'olo&i" a S+italli K%"tian
D"!a*
In ant"$"%"nt" .olna!a n"a&a .oli in,"$to-$onta&ioa#" in ,a'ili"2 %ar
r"alat"aza $a in r'a $ 6 lni a a!t n a#t' in,"$to-al"r&i$ 'i-t*
Con%itii %" !iata #i 'n$a ( $or"#+nzatoar"*
Co'+ortar" ,ata %" '"%i ( nor'ala*
Aoala a$tala a %".tat in r'a $ o zi %" la %ata int"rnarii 2 .olna!a
a$zan% %r"ri !iol"nt" la AO 2 $",al"" 2 $on&"#ti"2 la$ri'ar"2 #$a%"r"a
a$$"ntata a !"%"rii 2 #tar" &"n"rala alt"rata*
La "-a'"nl $lini$ &"n"ral #" $on#tata (
t"&'"nt" #i '$a#" nor'al $olorat" $ "-$"+tia '$a#"i $on/n$ti-
!al" $ar" "#t" $on&"#tionata ;
t"#t $"llar #.$tanat #la. r"+r"z"ntat ;
#i#t"' &an&lionar n"+al+a.il ;
#i#t"' o#t"o-arti$lar int"&r ;
a+arat r"#+irator2 tora$" nor'al $on,or'at2 #onoritat" +l'onara nor-
'ala2 'r'r !"zi$lar +r"z"nt ;
a+arat $ar%io!a#$lar2 #o$ a+"-ian in #+atil V2 int"r$o#tal #tan&2
z&o'ot" $ar%ia$" rit'i$"2 .in" .att"2 TA F )28C<8 ''H&2 AV F )88
.C'in*
a+arat %i&"#ti!2 a.%o'"n #+l #i 'oal"2 n"%r"ro# la +al+ar"2,i$at #i
#+lina in li'it" nor'al"2 tranzit int"#tinal +r"z"nt ;
a+arat ro-&"nital2 lo/i r"nal" li."r"2 'i$tini #+ontan" n"%r"roa#"2
Gior%ano 0n"&ati!1;
#i#t"' n"r!o# $"ntral ( ROT +r"z"nt"2 r",l"- ++ilar +r"z"nt *
- 2@ -
La "-a'"nl o$lar o.i"$ti! #" $on#tata ( TOOD F 692> ''H&2
OSF)92> ''H& 2 VOD F N2 VOS F 2C6 ,$*In r'a "-a'"nli o$lar
#.i"$ti! #i o.i"$ti! #" +n" %ia&no#ti$l %" &la$o' +ri'ar +rin in$3i%"-r"a
n&3ili la a'.ii o$3i2 ata$ OD #i #" r"$o'an%a int"r!"nti" $3irr&i$ala*In
!"%"r"a int"r!"nti"i $3irr&i$al" #" !a ,a$" "-a'"n +l'onar2$ar%io2 ECHO*
Analiz" %" la.orator ( H. F )22@ B; L F >988 C''$; VSH F < ''Cora;
&li$"'i" F @8 '& B ; VDRL n"&ati! ; TS F 268 'in ; TC F ? 'in; "-a'"n
rina ( D F )8)< ; +H a$i% 0>1; A2P2G Fa.#"nt"; "+it"lii +lat" rar"*
La "-* Car%iolo&i$ ( $lini$ $ar%io!a#$lar nor'al ( AVF>8C'in*
ECHO ( ,i$at %" %i'"n#ini nor'al"2 "$3o#tr$tral2 CAP nor'al #itat
2 %" %i'"n#ini #i "$o#tr$tra nor'ala2 rini$3il #tan& "$onor'al2 #+lina
nor'ala*
Ana'n"za a#i#t"nt"i ( .olna!a a!an% n #o$ "'otional in r'a ni a$-
$i%"nt al nia %intr" '"'.rii ,a'ili"i 2 "#t" tr"zita in noa+t"a
+r"'"r&atoar" int"rnarii %" o %r"r" !iol"nta in a'.ii o$3i2 $",al""2 la$ri-
'ar"2 $on&"#ti"2 #$a%"r"a a$$"ntata a !"%"rii 2 ++ila %ilatata * In +ri'"l"
zil" %" la int"rnar" .olna!!a "#t" n"lini#tita #i +r"zinta o #tar" &"n"rala
alt"rata #i o TO $r"#$ta* Aolna!a "#t" a'+la#ata intr-o $a'"ra #"'i-
o.#$ra2 i #" in%i$a r"+a# la +at2 #i i #" !a a+li$a n trata'"nt %" r&"nta2
Car" !iz"aza #$a%"r"a TIO* A$"a#ta $on#ta %in ( in#tilatii $ Pilo$ar+ina %in
9-9 or" #i E%"r"n +ana la #$a%"r"a t"n#inii o$lar"2 r'an% $at"!a zil" %"
+r"&atir" +"ntr o+"rati"* In +r"-zia int"r!"nti"i i #" "-+li$a .olna!"i
n"$"#itat"a int"r!"nti"i $3irr&i$al" $a #in&ra '"to%a ",i$a$" %" trata'"nt 2
i #" i'+n" a.#tin"nta ali'"ntaraaa2 iar #"ara i #" ,a$" $li#'a "!a$atoar"
#i'+la2 i #" a%'ini#tr"aza Nitraz"+a' 2 $+ +"ntr +r"ln&ir"a #o'nli
,iziolo&i$* In %i'in"ata int"r!"nti"i $3irr&i$al" i #" tai" &"n"l"2 #" #+ala +"
,ata $ #a+n #t"ril2 #" %"zin,"$t"aza $ io% #i #" $on%$" la #ala n%" i #"
+r"zinta "$3i+a o+"ratori"2 i #" ,a$" an"#t"zi" lo$ala #i &"n"rala*
Po#t-o+"rator in +ri'"l" 29 %" or" .olna!l !a #ta $l$at +" +art"a
n"o+"rata #+ra!"&3in%-i-#" ,n$tiil" !ital" 0 T2 P2 TA2 $loar"a t"&'"n-
t"lor 1 #i r'arin% $a +an#a'"ntl #a n #" 'i#t" %" +" o$3i* S" !a
r"$o'an%a .olna!li #a #t"a $ $a+l $o'+l"t n"'i#$at2 #a n t#"a#$a 2 #a
n #trant"2 #a n ,a$a 'i#$ari .r#t"2 #a !or.ia#$a in #oa+taa* In +ri'"l" 29
%" or" ali'"ntatia !a ,i li$3i%a2 iar in r'atoar"l" zil" %" $on#i#t"nta 'oal"*
D+a 29 %" or" #" ri%i$a tr"+tat "-tr"'itat"a +ro-i'ala a +atli #i .olna!l
!a #ta in %"$.itt %or#al*
Pan#a'"ntl !a ,i #$3i'.at o %ata +" zi in +ri'"l" 9-: zil"* Da$a ar" o
"!olti" .na in zia a >- a #" !a la#a o$3il ,ara +an#a'"nt zia iar #"ara #"
- 68 -
a$o+"ra %in no* S" !a a#i&ra n $li'at ,a!ora.il2 #" !a $o'.at"
$on#ti+atia $ Cio$ola- #a #+ozitoar" %" Gli$"rina* Dr"r"a o$lara "#t"
$o'.atta $ Xilina )B #i 2B in +ri'a zi %+a o+"rati" 2 in,"$tia #" +r"!in"
$ P"ni$ilina 0988*8881 la 9 or" 2 i #" 'ai a%'ini#tr"aza Hi%ro$ortizon a$"tat
) ,* D+a $" i #" +"r'it" ri%i$ar"a %in +at .olna!a !a in$"+" 'o.ilizar"a
a$ti!a $ #+ri/inl a#i#t"nt"i +"ntr a "!ita +"ri$oll $a%"rii $" $on#taa %in
+li'.ari #$rt" +rin #alon #i i'+r"/ri'i* D+a $" o$3il n 'ai "#t"
a$o+"rit .olna!l !a ,a$" #in&r 'i#$ari2 n #" !a a+l"$a 6-9 #a+ta'ani*
Aolna!a !a ,i a/tata #a #" i'.ra$" #i #a #" %"z.ra$" 2 #a 'anan$"2 i #"
!a ,a$" toal"ta +" +ortini in +ri'"l" zil" +ana i#i !a +t"a +a#tra #in&ra
t"&'"nt"l" #i '$oa#"l" $rat"* D" a#"'"ni i #" !or $iti $arti2 ziar" 2
$or"#+on%"nta * In r"latiil" $ #"'"nii .olna!a "#t" $o'ni$ati!a iar $
+"r#onall '"%i$al $oo+"ranta2 %orin% $a in#anato#ir"aa #a %"$r&aa $at 'ai
r"+"%" #i 'ai .in"*

- 6) -
SPITALUL KUDETIAN DEVA Aolna!a ( Ni$oara L"titia
SECTIA OFTAMOLOGIE Dia&no#ti$(&la$o' +#" a$t
Salonl 22 +at 6 OS &la$o' $o'+"n#at OD

PREZENTARE DE CAZ
Aolna!a Ni$oara L"titia2 na#$ta la 2@* 8:* )@68 in !ar#ta %" >? %" ani2
$a#ni$a $ %o'i$ili in D"!a2 #" +r"zinta in %ata %" 2<*8)*)@@? la
Poli$lini$a D"!a2 a$zan% #$a%"r"a !"%"rii la AO2 'ai a$$"ntat la OS2
,oto,o.i"2 la$ri'ar"2 $on&"#tia o$3ilor2 %r"r" !iol"nta $ 3"'i$rani"*
In ant"$"%"nt" .olna!a n"a&a .oli $onta&ioa#" in ,a'ili"2 in #$3i'. a
+r"z"ntat &la$o' AO %in )@@: +r"$' #i r"'ati#' arti$lar $roni$*Aol-
na!a ar" $on%itii %" !iata .na2 iar ,ata %" '"%i o $o'+ortar" nor'ala*
Aoala a$tala a %".tat in r'a $ > lni $an% .olna!a a o.#"r!at o
#$a%"r" a !"%"rii la OS $ar" #" a$$"ntiaza tr"+tat* Din a$"#t" 'oti!" "#t"
int"rnata la #"$tia %" o,ta'olo&i" a S+italli D"!a2 n%" i #" +n"
%ia&no#ti$l %" &la$o' OS* In lti'l ti'+ o.#"r!a o #$a%"r" a !"%"rii #i la
OD* S" +r"zinta la Poli$lini$a D"!a2 %" n%" "#t" tri'i#a +"ntr int"rnar" la
#"$tia o,tal'olo&i"*
In r'a "-a'"nli o.i"$ti! #i #.i"$ti! o,tal'olo&i$ la $ar" #"
$on#tata ( .l",aro#+a#'2 ,oto,o.i" 2 la$ri'ar"2 $on&"#tia &lo.ilor 2
3"'i$rani"2 $orn"" tran#+ar"nta2 $a'"ra ant"rioara 'i$a2 iri# %" a#+"$t
nor'al2 $ri#talin tran#+ar"nt2 AVODF :C): $$2 OS F +l2 #" +n" %ia&no#ti$l
%" &la$o' a$t OS2 &la$o' $o'+"n#at OD*
La "-* Clini$ &"n"ral #" $on#tata (
t"&'"nt" #i '$oa#" nor'al $olorat" $ "-$"+tia '$oa#"i $on/$ti!al"
$ar" "#t" $on&"#tionata #i ro#i";
t"#t '#$lo-a%i+o# #la. r"+r"z"ntat;
#i#t"' o#t"o-arti$lar int"&r;
a+arat r"#+irator2 tora$" nor'al $on,or'at2 #onoritat" +l'onara
nor'ala2 'r'r !"zi$lar +r"z"nt;
a+arat $ar%io!a#$lar2 #o$ a+"-ian in #+atil V int"r$o#tal #tan& 2 z&o'ot"
$ar%ia$" rit'i$"2 .in" .att"2 'atitat" $ar%ia$a nor'ala TAF)):C>8
''H&2 AVF <8 .C'in*
a+arat %i&"#ti!2 a.%o'"n #+l #i 'oal"2 n"%r"ro# la +al+ar"2 ,i$at #i
#+lina in li'it" nor'al"2 tranzit int"#tinal +r"z"nt;
- a+arat ro-&"nital2 lo/i r"nal" li."r"2 'i$tini #+ontan" n"%r"roa#"2
- Gior%ano 0 n"&ati! 1;
- 62 -
#i#t"' n"r!o# "$3ili.rat ( ROT +r"z"nt"2 r",l"- ++ilar +r"z"nt;
In !"%"r"a int"r!"nti"i $3irr&i$al" #" ,a$" "-a'"nl $ar%iolo&i$ ( ECG
$lini$ nor'al2+r"$' #i r'atoar"l" analiz" %" la.orator in r'a $arora #"
$on#tata ( 3"'o&lo.ina F))2: &r B2 l"$o$it" F9888C ''$2 VSHF@''Cora2
Gli$"'i" F ?:'&B2 VDRL Fn"&ati!2 TS F2268 'in2 TC F? 'in2 "-a'"n
rina D F )8)@2 +H F:2: a$i% 2A*P*G* a.#"nt2 "+it"li +lat" rar"*
Ana'n"za a#i#t"nt"i ( .olna!a +r"zinta o #tar" &"n"rala alt"rata2 %r"ri
int"n#"2 #$a%"r"a !"%"rii AO2 'ai a$$"ntat" la OS2 ,oto,o.i"2 la$ri'ar"2 OS
ro# $on&"#ti!2 .l",aro#+a#'2 $orn"" tl.r" ++ila %ilatata* In +ri'"l" zil"
%" la int"rnar" .olna!a "#t" n"lini#tita2 a!an% o PIO $r"#$ta* Aolna!a !a #ta
intr-n #alon $ +tina l'ina #i !a #ta in r"+a# total la +at2 i #" !a a+li$a
n trata'"nt %" r&"nta $ar" !iz"aza #$a%"r"a TO #i in a$"la#i ti'+
+r"&atir"a +"ntr int"r!"ntia $3irr&i$ala*
In a$"#t #$o+ #" a%'ini#tr"aza ( E%"r"n ) $+C> or"2 in#tilatii lo$al" $
Pilo$ar+ina la 2 or"2 +"ntr $al'ar"a %r"rii #i #"%ar" in r'atoar"a zi i #"
a%'ini#tr"aza ) , Mial&in* Aolna!a #" ali'"nt"aza $or"#+nzator n"!oilor
or&ani#'li2 i#i +oat" +a#tra t"&'"nt"l" #i '$oa#"l" $rat" #i
t"'+"ratra in li'it" nor'al"* Can% &lo.ii %"!in n"%r"ro#i2 ++ila 'ioti$a
#i #$a%" TO2 #" ,a$" +r"&atir"a +"ntr o+"rati"* In zia int"r!"nti"i .olna!"i i
#" i'+n" a.#tin"nta ali'"ntara iar #"ara i #" ,a$" o $li#'a "!a$atoar"
#i'+la* Inaint" %" $l$ar" i #" a%'ini#tr"aza ) $+* M"+ro.a'at +"ntr
#$a%"r"a SN #i +"ntr a o.tin" n #o'n ,iziolo&i$ * In %i'in"ata zil"i #" !a
,a$" t"#tl la Xilina #i toal"ta $" $on#ta %in tai"r"a &"n"lor 2 #+alar"a +" ,ata
$ #a+n #t"ril2 %"zin,"$ti" $ io% 2 %+a $ar" #" $on%$" .olna!a la #ala
n%" i #" +r"zinta "$3i+a %" '"%i$i*
Po#to+"rator in +ri'"l" 29 %" or" .olna!l !a #ta $l$at +" +art"a
n"o+"rata2 #+ra!"&3in%i-#" ,n$tiil" !ital" 0 T2 P2 TA2 $loar"a
t"&'"nt"lor1 #i r'arin% $a +an#a'"ntl #a n #" 'i#t" %" +" o$3i* S" !a
r"$o'an%a .olna!li #a #t"a $ $a+l $o'+l"t n"'i#$at2 #a n t#"a#$a2 #a
n #trant"2 #a n ,a$a 'i#$ari .r#t"2 #a !or.ia#$a in #oa+ta* In +ri'"l" 29
%" or" ali'"ntatia !a ,i li$3i%a 2 iar in r'atoar"l" zil" %" $on#i#t"nta 'oal"*
D+a 29 %" or" #" ri%i$a tr"+tat "-tr"'itat"a +ro-i'ala a +atli #i .olna!l
!a #ta in %"$.it %or#al*
Pan#a'"ntl !a ,i #$3i'.at o %ata +" zi in +ri'"l" 9-: zil"* Da$a ar" o
"!olti" .na in zia a >- a #" la#a o$3il ,ara +an#a'"nt zia iar #"ara #"
a$o+"ra %in no* S" !a a#i&ra n $li'at ,a!ora.il2 #" !a $o'.at" $on#ti+atia
$ Cio$ola- #a #+ozitoar" %" Gli$"rina* Dr"r"a o$lara "#t" $o'.atta $
Xilina )B #i 2B in +ri'a zi %+a o+"rati" 2 in,"$tia #" +r"!in" $ P"ni$ilina
- 66 -
0 ?88*8881 la 9 or"2 i #" 'ai a%'ini#tr"aza E%"r"n la > or"* D+a $" #"
+"r'it" ri%i$ar"a %in +at 2 .olna!a !a in$"+" 'o.ilizar"a a$ti!a $ #+ri/inl
a#i#t"nt"i +"ntr a "!ita +"ri$oll $a%"rii $" $on#ta %in +li'.arii #$rt" +rin
#alon #i i'+r"/ri'i* D+a $" o$3il n 'ai "#t" a$o+"rit .olna!l !a ,a$"
#in&r 'i#$ari2 n #" !a a+l"$a 6-9 #a+ta'ani*
Aolna!a !a ,i a/tata #a #" i'.ra$" #i #a #" %"z.ra$" 2 #a 'anan$"2 i #"
!a ,a$" toal"ta +" +ortini in +ri'"l" zil" +ana i#i !a +t"a +a#tra #in&ra
t"&'"nt"l" #i '$oa#"l" $rat" * D" a#"'"ni i #" !or $iti $arti2 ziar" 2
$or"#+on%"nta* In r"latiil" $ #"'"nii .olna!a "#t" $o'ni$ati!a iar $ +"r-
Sonall '"%i$al $oo+"ranta2 %orin% $a in#anato#ir"a #a %"$r&a $at 'ai
r"+"%" #i 'ai .in"*
La "-t"rnar" .olna!"i i #" r"$o'an%a o !iata lini#tita2 li+#ita %" #tr"##2
%" ",,ort ,izi$ #i o$lar2 #a n ri%i$" &r"tati2 #a n $on#'" "-$itant"2
.atri al$ooli$"2 #a n ,'"z"2 #a r'"z" trata'"ntl $on,or' r"t"t"i
+r"#$ri#"2 #a #" +r"zint" +"rio%i$ la $ontrol +rin +oli$lini$a2 iar la o lna #a #"
+r"zint" la #+ital +"ntr a i #" #$oat" ,ir"l"*
SPITALUL KUDETIAN DEVA Aolna!l ( Da'ian Va#il"
SECTIA OFTALMOLOGIE Dia&no#ti$(&la$o' O!a#i a.#olt
Salonl 2 2 +at 9 #"$n%ar $atara$ta int'"#$"nta

PREZENTARE DE CAZ

Aolna!l Da'ian Va#il" 2 na#$t la )<* 8<* )@6? in !ar#ta %" >8 %" ani2
+"n#ionar $ %o'i$ilil in D"!a2 #" +r"zinta in %ata %" 2@* 8)* )@@? la
Poli$lini$a2 %" n%" "#t" int"rnat in #"$tia O,ta'olo&i" a S+italli K%"tian
D"!a2 in r'a #$a%"rii 'a#i!" a !"%"rii la OS* Aolna!l trai"#t" #i
'n$"#t" in $on%itii .n" iar ,ata %" '"%i #" $o'+orta nor'al*
Aoala a$tala a %".tat in#i%io# in r'a $ $at"!a lni $an% .olna!l a
O.#"r!at o #$a%"r" a !"%"rii la OS* Aolna!l n"&li/"aza a #" a%r"#a
'"%i$li #+"$iali#t +ana in +r"z"nt*
La "-* Clini$ &"n"ral #" $on#tata (
t"&'"nt" #i '$oa#" nor'al $olorat" $ "-$"+tia '$oa#"i
$on/n$ti!al" $ar" "#t" $on&"#tionata;
t"#t '#$lo-a%i+o# #la. r"+r"z"ntat;
#i#t"' o#to-arti$lar int"&r;
a+arat r"#+irator2 tora$" nor'al $on,or'at2 #onoritat" +l'onara
nor'ala2 'r'r !"zi$lar +r"z"t;
a+arat $ar%io!a#$lar2 #o$ a+"-ian in #+atil V int"r$o#tal #tan& 2
z&o'ot" $ar%ia$" rit'i$"2 .in" .att"2 'atitat" $ar%ia$a nor'ala
TAF)):C>8''H&2 AVF ?8.C'in;
a+arat %i&"#ti!2 a.%o'"n #+l #i 'oal"2 n"%r"ro# la +al+ar"2
,i$at #i #+lina in li'it" nor'al"2 tranzit int"#tinal +r"z"nt;
a+arat ro-&"nital2 lo/i r"nal" li."r"2 'i$tini #+ontan"
n"%r"roa#"2 Gior%ano 0n"&ati!1;
#i#t"' n"r!o# "$3ili.rat ( ROT +r"z"nt"2 r",l"- ++ilar +r"z"nt;
La "-a'"nl o$lar #" $on#tata ( OD- +oll ant"rior #i +o#t"rior nor'al*
La "-a'inar"a $a'+li !izal #" $on#tata V*OD F )2 V*OS n%' 0n'ara
%"&"t"l" %" la o 'ana12 $orn""a #or in%rata* Int'"#$"nta2 CA 'i$a2
$ri#talin $atara$t2 FO n #" !izaliz"aza* Tono'"tri$ ( TIOD F:C:2: 2 TIOS F
2C <2:*
P" .aza "-a'"nli o.i"$ti! #i #.i"$ti! #" +n" %ia&no#ti$l %"
&la$o' #"$n%ar2 $atara$ta int'"#$"nta #i #" r"$o'an%a +"#t" 6 zil" int"r-
!"ntia $3irr&i$ala*
In !"%"r"a int"r!"nti"i $3irr&i$al" #" ","$tiaza "-a'"n" %" la.orator
#i +ara$lini$"*
- 6: -
E-a'"n" %" la.orator in r'a $arora #" $on#tata ( 3"'o&lo.ina F )229
&rB2 l"$o$it" 9688C''$2 VSH F@ ''Cora2 &li$"'i" F ?: '& B 2 VDRL
n"&ati!2 TS F2'in*2 TC F ?'in*2 "-a'"n rina D F )8)?2 +H F > a$i%2
A*P*G* a.#"nt2 "+it"lii +lat" rar"*
Ana'n"za a#i#t"nt"i ( .olna!l +r"zinta o #tar" &"n"rala alt"rata2 %r"ri
int"n#"2 #$a%"r"a 'a#i!a a !"%"rii OS2 $orn"" #or in%rata int'"#$"nta*
In +ri'"l" zil" %" la int"rnar" .olna!l "#t" n"lini#tit a!an% o PIO $r"#$ta*
Aolna!l !a #ta intr-n #alon $ +tina l'ina #i !a #ta in r"+ao# total la +at2
i #" !a a+li$a n trata'"nt %" r&"nta $ar" !iz"aza #$a%"r"a TO #i in a$"la#i
ti'+ +r"&atir"a +"ntr int"r!"ntia $3irr&i$ala*
In a$"#t #$o+ #" a%'ini#tr"aza ( E%"r"n )$+C>or"2 Gli$"rol2 PC )226Czi
in#tilatii lo$al" $ Gla$o#tat2 +"ntr $al'ar"a %r"rii #i #"%ar" in
r'atoar"a zi i #" a%'ini#tr"aza ) , Mial&in* Aolna!l #" ali'"nt"aza
$or"#+nzator n"!oilor or&ani#'li2 i#i +oat" +a#tra t"&'"nt"l" #i
'$oa#"l" $rat" #i t"'+"ratra in li'it" nor'al"*
S" ,a$" +r"&atir"a +"ntr o+"rati"* In zia int"r!"nti"i .olna!li i #"
i'+n" a.#tin"nta ali'"ntara2 iar #"ara i #" !a ,a$" o $li#'a "!a$atoar"
#i'+la* Inaint" %" $l$ar" i #" a%'ini#tr"aza ) $+* M"+ro.a'at +"ntr
#"%ar"a SN #i +"ntr a o.tin" n #o'n ,iziolo&i$ * In %i'in"ata zil"i2 #" !a
,a$" t"#tl la Xilina #i toal"ta $" $on#ta %in tai"r"a &"n"lor2 #+alar"a +" ,ata
$ #a+n li$3i%2 %"zin,"$ti" $ io%2 %+a $ar" #" $on%$" .olna!l la #ala2
n%" i #" +r"zinta "$3i+a %" '"%i$i*
Po#to+"rator in +ri'"l" 29 %" or"2 .olna!l !a #ta $l$at +" +art"a n"
o+"rata #+ra!"&3in%i-#" ,n$tiil" !ital" 0 T2P2TA2 $loar"a t"&'"nt"lor1 #i
r'an% $a +an#a'"ntl #a n #" 'i#t" %" +" o$3i* S" !a r"$o'an%a
.olna!li #a #t"a $ $a+l $o'+l"t n"'i#$at2 #a n t#"a#$a2 #a n #trant"2
#a n ,a$a 'i#$ari .r#t" 2 #a !or.ia#$a in #oa+t"* In +ri'"l" 29 %" or"2
ali'"ntatia !a ,i li$3i%a 2 iar in r'atoar"l" zil" %" $on#i#t"nta 'oal"* D+a
29 %" or" #" ri%i$a tr"+tat "-tr"'itat"a +ro-i'ala a +atli #i .olna!l $a #ta
in %"$.it %or#al*
Pan#a'"ntl !a ,i #$3i'.at o %ata +" zi i +ri'"l" 9-: zil"* Da$a ar" o
"!olti" 'ai .na in zia a >-a #" la#a o$3il ,ara +an#a'"nt zia iar #"ara
#" a$o+"ra %in no*S" !a a#i&ra n $li'at ,a!ora.il2 #" !a $o'.at"
$on#ti+atia $ Cio$ola- #a #+ozitoar" %" Gli$"rina* Dr"r"a o$lara "#t"
$o'.atta $ Xilina )B #i 2B in +ri'a zi %+a o+"rati"2 in,"$tia #" +r"!in"
$ P"ni$ilina 0 988*8881 la 9 or"2 I #" 'ai a%'ini#tr"aza E%"r"n Q la > or"*
D+a $" #" +"r'it" ri%i$ar"a %in +at2 .olna!l !a in$"+" 'o.ilizar"a a$ti!a
$ #+ri/inl a#i#t"nt"i +"ntr a "!ita +"ri$oll $a%"rii $" $on#ta %in +li'.arii
- 6> -
#$rt" +rin #alon #i i'+r"/ri'i* D+a $" o$3il n 'ai "#t" a$o+"rit
.olna!l !a ,a$" #in&r 'i#$ari2 n #" !a a+l"$a 6-9 #a+ta'ani*
Aolna!l !a ,i a/tat #a #" i'.ra$" #i #a #" %"z.ra$" 2 #a 'anan$"2 i #"
!a ,a$" toal"ta +" +ortini in +ri'"l" zil" +ana i#i !a +t"a +a#tra #in&ra
t"&'"nt"l" #i '$oa#"l" $rat" * D" a#"'"ni i #" !or $iti $arti2 ziar" 2
$or"#+on%"nta* In r"latiil" $ #"'"nii .olna!a "#t" $o'ni$ati!a iar $ +"r-
Sonall '"%i$al $oo+"ranta2 %orin% $a in#anato#ir"a #a %"$r&a $at 'ai
r"+"%" #i 'ai .in"*
La "-t"rnar" .olna!li i #"r"$o'an%a o !iata lini#tita2 li+#ita %" #tr"##2
%" ",,ort ,izi$ #i o$lar2 #a n ri%i$" &r"tati2 #a n $on#'" "-$itant"2
.atri al$ooli$"2 #a n ,'"z"2 #a r'"z" trata'"ntl $on,or' r"t"t"i
+r"#$ri#"2 #a #" +r"zint" +"rio%i$ la $ontrol +rin +oli$lini$a2 iar la o lna #a #"
+r"zint" la #+ital +"ntr a i #" #$oat" ,ir"l"*

BIBLIOGRAFIE
ANATOMIA SI FIZIOLOGIA OMULUI I*C VOICULESCU
OFTALMOLOGIE PRACTICA S*AUIUC
L*KOLOACACEASTAI
OFTAMOLOGIE FODOR
POP* D* POPA

CHIRURGIE PENTRU CADRE MEDII M*MIHAILESCU
TEHNICA INGRIKIRII AOLNAVULUI MOZES