Medsurge

GLAUCOMA
BY: JAN NINA GARAY
 Used to refer to a group of eye conditions
characterized by elevated IOP (Intraocular
pressure) that damages the optic nerve.

The damage optic nerve is related to the IOP

caused by congestion of aqueous humor in the
eye.

Glaucoma
RISK FACTORS

Black or Asian race

Obstructive sleep apnea
Cardiovascular disease
Older age
Diabetes
Previous eye trauma
Family history of glaucoma
Prolonged use of topical or systematic
Migraine syndromes corticosteroids

Myopia (nearsightedness) Thin cornea

Parts of the human eye
Pathophysiology

There are two theories regarding how increased IOP damages the optic nerve in glaucoma.
The direct mechanical theory suggests that high IOP damages the retinal layer as it passes
through the optic nerve head. The indirect ischemic theory suggests that high IOP compresses
the microcirculation in the optic nerve head, resulting in cell injury and death. Some
glaucomas appear as exclusively mechanical, and some are exclusively ischemic types.
Typically, most cases are a combination of both.
Video
 Classification of Glaucoma

Wide-angle Glaucoma Narrow-angle Congenital Glaucoma

Glaucoma
Classification of Glaucoma
Classification of Glaucoma
 Wide-angle Glaucoma(Open-
angle)
Wide-angle Glaucoma(Open-
This is the most common type of glaucoma. It happens angle)
gradually, where the eye does not drain fluid as well as it
should (like a clogged drain). As a result, eye pressure builds
and starts to damage the optic nerve. This type of glaucoma
is painless and causes no vision changes at first.

Some people can have optic nerves that are sensitive to

normal eye pressure. This means their risk of getting
glaucoma is higher than normal. Regular eye exams are
important to find early signs of damage to their optic nerve.
 Signs and Symptoms
Narrow-angle Glaucoma (Closed-
angle)

No warning signs or obvious symptoms in the

early stages. As the disease progresses, blind
spots develop in your peripheral (side) vision.

Do not notice any change in their vision until

the damage is quite severe.
 Narrow-angle Glaucoma (Closed-
angle)
Narrow-angle Glaucoma (Closed-
angle)
This type happens when someone’s Iris is very close to the
drainage angle in their eye. The iris can end up blocking the
drainage angle. You can think of it like a piece of paper
sliding over a sink drain. When the drainage angle gets
completely blocked, eye pressure rises very quickly. This is
called an acute attack. It is a true eye emergency, and you
should call your ophthalmologist right away or you might go
blind.
Signs and Symptoms
Narrow-angle Glaucoma (Closed-
angle)

Blurry vision

Severe eye pain

Headache

Nausea (you feel sick to your stomach)

Vomiting (you throw up)

You see rainbow-colored rings or halos around

lights
 Congenital Glaucoma

Congenital Glaucoma

A rare group of diseases that affect the eyes from birth. When
a newborn has glaucoma, the fluid in the eye does not drain
properly, placing pressure on the optic nerve.
Signs and Symptoms
Congenital Glaucoma

Enlarged eyes

Excessive tearing

Cloudy cornea

Light sensitivity
Assessment and Diagnostic findings

The purpose of a glaucoma workup is to establish the diagnostic category, assess the optic
nerve damage, and formulate a treatment plan. The patients ocular and medical history must
be be detailed to investigate the history of predisposing factors.

The types of examination used in glaucoma include tonometry to

measure the IOP, ophthalmoscopy to inspect the optic nerve, and
central visual field testing.
 Assessment and Diagnostic findings

Tonometry Ophthalmoscopy Visual Field Test

 Treatment focuses on
pharmacologic therapy, laser
procedures, surgery, or a
Medical Management
combination of these approaches,
all of which have potential
complications and side-effects.
 Systematic and topical ocular medications that
lower IOP

Usually started lowest dose of topical medication

and then advanced to increased concentrations until
the desired IOP level is reached and maintained.

Beta-blockers are the preferred initial topical

medication.
Pharmacologic therapy
 Ocular medications includes miotics, beta-
blockers,alpha2-agonists (ex adrenergic agents),
carbonic anhydrase inhibitors, and prostaglandins.

Cholinergic (miotics)- increase the outflow of

aqueous humor.

Beta-blockers and carbonic anhydrase inhibitors

decrease aqueous production.

Pharmacologic therapy Prostaglandins reduce IOP by increasing aqueous

humor outflow.
 Trabeculectomy surgery- performed through a small incision
and does not require creation of a permanent hole in the eye
wall or an external filtering bleb or an implant.

Trabeculoplasty- for people who have open-angle glaucoma. A

laser beam is applied to the inner surface of the trabecular
meshwork to open intrabecular spaces and widen the canal of
schlemm, promoting outflow of aqueous humor and
decreasing IOP.

Iridotomy- for people who have angle-closure glaucoma. The

ophthalmologist uses a laser to create a tiny hole in the iris. This
Surgical Management hole helps fluid flow to the drainage angle.
Video
Video
Video
 Educating Patient about sel-
care

01 · Educate the patient about the

disease
02 . Self management program
03 . Educate the patient about the
effects of Glaucoma control
medications on visson

Nursing Management
Nursing Management
 Continuing and Transitional
Care

01 · Patient with severe Glaucoma and impaired

function may need referral to home, community
based or transitional services that provide assistance
in the home.

02 . The family must be integrated into the plan of care,

and because the disease has a familial tendency, family
members should be encouraged to undergo examinations
at least once every 2 years to detect glaucoma early.

Nursing Management