Two major forms: Acute Glaucoma

Results when the angle between the iris and the cornea becomes narrowed, restricting or blocking the drainage of aqueous humor through the trabecular network and the canal of Schlemn. This causes IOP to increase suddenly. It may result from trauma, stress, or any process that pushes the iris forward against the inside of the cornea when there is already an anatomically shallow anterior or chamber. It is an acute, painful condition that can cause permanent eye damage within several hours.

Chronic (open-angle)

Results from the gradual deterioration of the trabecular network that, as in the acute form, blocks drainage of aqueous humor and causes IOP to increase. If untreated, may result in degeneration of the optic nerve and visual field loss. It is the most common form of glaucoma, and its incidence increases with age. Genetics and conditions, such as diabetes and hypertension, also play a role.

Assessment: 1. Acute Glaucoma:

Severe pain, occurring in and around the eyes due to increased IOP; may transitory attacks. Cloudy, blurred vision; rainbow color around lights. Hazy cornea due to edema; may be profuse lacrimation and ciliary injection. Nausea and vomiting may occur. Pupil is mild-dilated and fixed.

2. Chronic Glaucoma

Mild, bilateral discomfort (tired feeling in the eyes). Slow loss of peripheral vision central vision remains unimpaired; in later stages, progressive loss of visual field. Increased IOP causes halos to appear around lights.

Diagnostic Evaluation:
1. Tonometry shows elevated IOP in acute and chronic disease. 2. Gonioscopy studies the angle of the anterior chamber of the eye in acute disease. 3. Ophthalmoscopy may show pale optic disk (acute disease) or signs of clipping and atrophy of the disk (chronic disease). Dilation of the pupil is avoided if the anterior of chamber is shallow.

Pharmacologic Interventions: 1. In acute glaucoma, emergency drug management is initiated to decrease eye pressure.

Parasympathomimetics (carbachol, pilocarpine) may be used as miotics to cause the pupil to contract and draw the iris away from the cornea, thus enlarging the angle and allowing aqueous humor to drain. Carbonic anhydrase inhibitors (acetazolamide, methazolamide), given orally to depress aqueous humor production. Beta-adrenergic blockers (betaxolol, timolol), given topically, may reduce aqueous humor or facilitate its drainage. Hyperosmotics (mannitol, glycerol) increase blood osmolarity and diurese the aqueous humor given I.V.

2. In chronic glaucoma, a combination of miotic agent and carbonic anhydrase inhibitor is usually given. Surgical Interventions: 1. Surgery is indicated for acute glaucoma if IOP is not maintained within normal limits by pharmacotherapy and if there is progressive visual field loss with optic nerve damage. 2. Types of surgery for acute glaucoma include: a. Peripheral iridectomy Small portion of the iris excised so aqueous humor can bypass pupil. b. Trabeculectomy part of trabecular meshwork and iris removed. c. Laser iridectomy - creates multiple incisions in the iris to create openings for aqueous to flow. 3. Types of surgery for chronic glaucoma include:

a. Laser trabeculoplasty creates multiple surface burns to increase outflow of aqueous humor; treatment of choice if IOP unresponsive to medical regimen. b. Iridencleisis opening between anterior chamber and conjunctiva to bypass blocked meshwork and allow aqueous humor to be absorbed into conjunctival tissues. c. Cyclodiathermy or cyclocryotherapy super-cooled probe or electrical current used to interfere with ability to secrete aqueous humor by ciliary body. d. Corneoscleral trephine (rarely done) a permanent drainage opening is made at the junction of the cornea and sclera through the anterior chamber. Nursing Interventions:
1. Monitor for any pain or visual changes. 2. Monitor the patients compliance with medications and follow-up care. 3. Administer antiemetics as directed to prevent vomiting, which will increase IOP. 4. Administer medications I.V., orally or topically, as directed, and explain the importance of medications, the proper procedure for administration of drops, and possible adverse reactions. 5. After surgery, elevate head of the bed 30 degrees to promote drainage of aqueous humor after a trabeculectomy. 6. Administer medications (steroids and cycloplegics) as directed after peripheral iridectomy to decrease inflammation and to dilate the pupil. 7. Use an eye patch or shield in children for several days to protect the eye; in adults, patch is usually removed within several hours. 8. Alert the patient to avoid prolonged coughing or vomiting, emotional upsets such as worry, fear, anger; exertion such as pushing and heavy lifting.

Glaucoma is a disease in which the optic nerve is damaged, leading to progressive, irreversible loss of vision. It is often, but not always, associated with increased pressure of the fluid in the eye. The nerve damage involves loss of retinal ganglion cells in a characteristic pattern. There are many different sub-types of glaucoma but they can all be considered as a type of optic neuropathy. Raised intraocular pressure is a significant risk factor for developing glaucoma (above 22 mmHg or 2.9 kPa). One person may develop nerve damage at a relatively low pressure, while another person may have high eye pressure for years and yet never develop damage. Untreated glaucoma leads to permanent damage of the optic nerve and resultant visual field loss, which can progress to blindness
Overview

A persons sense of sight is very important to humans. Vision is arguably the most used of the 5 senses and is one of the primary means that we use to gather information from our surroundings. The human eye is the organ which gives us the sense of sight, allowing us to observe and learn more about the surrounding world than we do with any of the other four senses. People use their eyes in almost every activity they perform, whether reading, working, watching television, writing a letter, driving a car, and in countless other ways. Most people probably would agree that sight is the sense they value more than all the rest. The eyes are at work from the moment a person is wake up to the moment he or she closes them to go to sleep. This special organ takes in tons of information about the world around you shapes, colors, movements, and more. Then they send the information to your brain for processing so the brain knows whats going on outside of your body. Anatomy of the Eye External and Accessory Structures The adult eye is a sphere-shaped organ that measures about 1 inch or 2.5 cm in diameter. However, only one sixth (1/6) of the eyes surface can normally be seen and the rest is enclosed and protected by a cushion of fat and the walls of the bony orbit. The accessory structures of the eye are the following:

Extrinsic eye muscles. The extrinsic muscles of the eye come from the bones of the orbit and are movable due to broad tendons in the eyes tough outer surface. There are six extrinsic eye muscles that function to MOVE the eye in various directions:

1. Superior rectus muscle rotates the eye upward and toward the midline 2. Inferior rectus muscle rotates the eye downward and toward the midline 3. Medial rectus rotates the eye toward the midline 4. Lateral rectus rotates the eye away from the midline 5. Superior oblique rotates the eye downward and away from the midline 6. Inferior oblique rotates the eye upward and away from the midline

Eyelids. The eyelids protect the eyes anteriorly which meet at the medial and the lateral corners of the eye. From the border of each eyelid are the EYELASHES. The eyelashes help filter out foreign matter, including dust and debris, and prevent it from getting into the eye. Eyelid edges associate with modified sebaceous glands make up the TARSAL GLANDs. These glands produce an oily secretion that lubricates the eye. Between the eyelashes, modified sweat glands called ciliary glands are found.