GLAUCOMA

A group of ocular diseases

characterized by increased intraocular
pressure
 CONT’
 Normal pressure measures btw 10-20mmHg.
 Glaucoma is also called ‘silent thief of
sight/thief in the night’.
 World wide,is the 2nd leading cause of
blindness; after cataract.
 PATHOPHYSIOLOGY
 Normal pressures are maintained by a balance btw
production and absorption of aqueous humor.
 Increased pressure occurs due to abnormally high
resistance to outflow thro’ the anterior chamber OR
excess production of aqueous humor.
 Build-up of fluid increases the intraocular pressure
compromising blood flow to the optic nerve and
retina.
 The sensitive nervous tissue becomes ischemic and
dies.
 TYPES
 Divided into:
1. Primary glaucoma-structures involved in circulation
and/or reabsorption of aqueous humor undergo
direct pathological changes. Subtypes include;
a) Open angle glaucoma
b) Closed angle glaucoma
2. Secondary glaucoma-results from diseases that
cause a narrowed angle or an increased volume of
fluid within the eye.
 OPEN ANGLE GLAUCOMA
 Most common form with a gradual onset
 Usually bilateral and produces no symptoms in the
early stages.
 Occurs in people with normal open chamber angles.
 There is resistance to the outflow. The resistance may
be in the trabecular meshwork, canal of schelmm or
the aqueous veins. Because the humor cannot leave
the eye at the same rate as it is produced, the IOP
gradually builds.
 ANGLE CLOSURE GLAUCOMA
 Less common form, with sudden onset and
must be treated as an emergency.
 There is a narrowed angle and an anteriorly
displaced iris; against the cornea narrowing or
closing the angle. This obstructs the outflow of
aqueous humor.
 May be painful and visual loss progresses
quickly.
 CAUSES
 Aging-older than 40yrs
 Heredity-in family members positively diagnosed
 Systemic conditions-HTN, DM, near sightedness,
retinal detachment, central vein occlusion
 Certain ocular conditions- uveitis, iritis, trauma
tumors, degenerative diseases (secondary glaucoma)
 Prolonged use of steroids
 MANIFESTATION
 Open angle glaucoma
-Is painless, only sign is gradually progressive visual
field loss and optic nerve changes (increased cup to
disc ratio on fundoscopy)
 Closed angle glaucoma

-Presents with acute angle closure crisis characterized

by sudden ocular pain, seeing halos around lights, a
red eye, very high IOP (>30mmHg), nausea and
vomiting, sudden decreased vision and a fixed mid-
dilated pupil.
 DIAGNOSIS
1. Tonometry-measuring intraocular pressure. Open
glaucoma(22-32mmHg), closure
glaucoma(>30mmHg).
2. Gonioscopy-examination of the drainage angle in
the anterior chamber. Elicits presence of adhesions,
aberrant blood vessels, sites of previously
undiagnosed etc
3. Ophthalmoscopy- reveals cuping and atrophy of the
disk.
4. Physical exam
 MANAGEMENT
 Aim: client to maintain existing vision
 Involves the following in successive order:

a)Non-surgical methods;
>drug therapy
>laser therapy
b)Surgical methods;
Includes filtering procedure, fistulizing sclerectomy,
peripheral iridectomy and cyclodialysis.
Cyclocryotherapy performed if the above are not
effective.
 CONT’
-Drug therapy focuses on reducing intraocular pressure.
This is by:
1. Physically constricting the pupil and increasing
outflow
2. Inhibiting the production of aqueous humor
 Agents for pupilary constriction (miotics)
include:pilocarpine hydrochloride,carbachol.
NB: miotics may cause blurred vision for 1-2hrs after
use and adaptation to dark environment is difficult
because of the pupilary constriction.
 CONT’
 Agents for aqueous humor production include:
Timolol, carbonic anhydrase (acetazolamide),
epinephrine 0.5-2% and osmotic agents.
Nursing intervention during drug therapy
*Health education on compliance of lifelong
treatment and how to self administer the
drugs.
 CONT’
 Laser therapy
-Performed when drug therapy has proven ineffective.
-Laser trabeculoplasty is performed to produce scars in
the trabecular meshwork allowing for increased
outflow of aqueous humor.
-Is also used to create a hole in the periphery of the iris,
which allows aqueous humor to flow from posterior
chamber to anterior chamber and into trabecular
meshwork.