Glaucoma

everyone should know about this

1. GLAUCOMA
-BY PIYUSH
BSC(HONS.)NURSING STUDENT

2. INTRODUCTION
•Theterm‘Glaucoma’isusedtorefertoagroupofocularconditions
characterized byoptic nerve damage.
•Increasedintraocularpressure damages the optic nerve and the nerve
fiber layer.
•The degreeofharmishighlyvariable.
•The optic nerve damage is related to the IOP caused by congestion of
aqueous humor in the eye.
•Glaucomaisestimatedtoaffect2.2millionAmericans,and3to6
million more are at risk for the disease.

3. CLASSIFICATION OF GLAUCOMA
A.Open Angle : Usually bilateral, but one eye may be severlyaffected than the other.It
has3subcategories:
•Primary Open Angle glaucoma
•Normaltension glaucoma
•OcularHypertension
B.AngleClosure or Pupillary Block: Obstructioninaqueous humor outflow due to the
complete or partial closure of the angle from the forward shift of the peripheral iris to
the trabecula. It has 3 sub categories:
•Acuteangleclosureglaucoma
•Subacute angle closure glaucoma
•Chronic angle closure glaucoma

4. RISK FACTORS
•FamilyhistoryofGlaucoma.
•Thin cornea
•AfricanAmericanRace
•OlderAge
•Diabetes
•CardiovascularDisease
•Migraine Syndrome
•Myopia
•Eye Trauma
•Prolonged use of topical corticosteroids

5. PATHOPHYSIOLOGY
Therearetwotheories how increased IOP damages the optic nerve in
glaucoma.
•TheDirectMechanicalTheory:ItsuggeststhathighIOPdamagesthe
retinallayerasitpassesthrough the optic nerve head.
•TheIndirectIschemicTheory:ItsuggeststhathighIOPcompresses
themicrocirculationintheopticnervehead,resultingin cellinjury
and death.

6. CLINICAL MANIFESTATIONS
•Glaucoma is called the “ The Silent Thief OfSight” because most patients are
unaware that they have the disease until they have experienced visual changes
and vision loss. The clinical manifestations are:
➢Blurred vision
➢Halosaroundlight
➢Difficulty focusing
➢Difficulty adjustingeyesinlowlight
➢Loss of peripheral vision
➢Aching iordiscomfort around eyes
➢headache

8. ASSESSMENTANDDIAGNOSTICFINDINGS
EXAMINING NAME OF TEST
1) The inner eye pressure Tonometry
2) The shape and color of the optic nerveOphthalmoscopy
3) The complete field of vision Perimetry
4) The angle in the eye where the iris meets the
cornea
Gonioscopy
5) Thickness of the cornea Pachymetry

9. DIFFERENT TESTS
•Tonometry: Tonometry measures the pressure within your eye. During the
tonometry, eye drops are used to numb the eyes. Then doctor uses a device
called Tonometer to measure the inner pressure of the eye.
•Ophthalmoscopy:Thisdiagnosticprocedurehelpsthedoctorexamineyour
optic nerve for glaucoma damage. Eye drops are used to dilate the pupil so
that the doctor can see through your eye to examine shape and colourof the
optic nerve.
•Perimetry:Itisavisualfieldtestthatproducesamapofyourcompletefieldof
vision.Thistestwillhelpadoctordetermine whether your vision has been
affected by Glaucoma.
During this test , you will be asked to look straight ahead a light spot is
presented in different areas of your peripheral vision.

10. •Gonioscopy:This diagnostic test helps determine whether the angle
where the iris meets the cornea is open and wide or narrow and closed.
During the exam, eye drops are used to numb the eye. A hand-held
contact lens is gently placed on the eye. This contact lens has a mirror
which shows angle between the iris and cornea is closed and blocked.
•Pachymetry:Itissimple,painlesstesttomeasurethethicknessofyour
cornea.
Aprobecalledpachymeterisgentlyplacedon the front of the eye to
measure its thickness. Pachymetry can help in diagnosis because corneal
thickness has the potential to influence eye pressure readings.

11. MEDICAL MANAGEMENT
•The aim of all the Glaucoma treatment is prevention of optic nerve damage.
PHARMACOLOGIC THERAPY
❑Cholinergics:Increase aqueous fluid outflow by contracting the ciliary muscle and
causing miosis and opening of trabecular meshwork. Example: pilocarpine, carbachol
❑Beta-Blockers-Decreases aqueous humor production. Example: timolol maleate
❑Alpha-adrenergic agonists: Decreases aqueous humor production. Example:
apraclonidine
❑Carbonic anhydrase inhibitors: Decreases aqueous humor production. Example:
acetazolamide and dorzolamide.
❑Prostaglandin analogues: Increases uveoscleral outflow. Example: latanoprost,
bimatoprost.

12. SURGICAL MANAGEMENT
•Laser trabeculoplasty: Laser burns are applied to the inner surface of
the trabecular meshwork to open the intra trabecular spaces and widen
the canal of schlemn, thereby promoting the outflow of aqueous
humor and decreasing IOP.
•Peripheral Iridotomy( for pupillary block glaucoma): An opening is
made in the iris to eliminate the pupillary blockage. Contraindicated in
patient with corneal edema.
•FilteringProcedures(for chronic glaucoma): They are used to create an
opening or fistula in the trabecular meshwork to drain aqueous humor
from the anterior chamber to the subconjunctival space into bleb.

13. •Trabeculectomy: It is the standard filtering technique used to remove
part of the trabecular meshwork.
•Drainageimplants or shunts: These are the tubes implanted in the
anterior chamber to shunt aqueous humor to the episcleral plate in the
conjunctival space.
implantsare used when failure has occurred with one or more
trabeculectomies in which anti-fibrotic agents were used.

14. NURSING DIAGNOSIS
•Disturbed sensory perception related to altered
status of sense organ.
•Anxiety related to change in health status.
•Deficientknowledge relatedto lack of exposure with
resources.

15. NURSING INTERVENTION
•Determine type and degree of visual loss.
•Allow expressionoffeelingsaboutlossand possibility of loss of vision.
•Demonstrateadministration ofeye drops.
•Evaluate anxietylevel, degree of pain experienced.
•Identifyhelpfulresourcesandpeople.
•Stress the importance on glaucoma screening.
•Encourage patienttomakenecessarychangesin thelifestyle.
•Discuss dietary considerations.
•Stress importance of routine checkups.