GLAUCOMA.ppt

notes

1. Definition–group of occular conditions
characterized by optic nerve damage,r/t to
increase IOP, caused by congestion of aq.
Humor in eye.
INCIDENCE-It increases with age 45 -65 yr more
prone to develop it is one of the leading cause
of blindness.

3. CONT..
In most people, the filtering angles are wide open,
although in some individuals, they can be narrow. For
example, the usual filtering angle is about 45 degrees,
whereas a narrow angle is about 25 degrees or less.
After exiting through the trabecular meshwork in the
filtering angle, the aqueous fluid then drains into tiny
blood vessels (capillaries) into the main bloodstream.
The aqueous humor should not be confused with
tears, which are produced by a gland just outside of the
eye.

4. RISK FACTORS & ETIOLOGY
Family history
Older age
D.M,CVD
Migraine syndrome
Nearsightedness
Eye trauma
Topical corticosteroids
1.Primary glaucoma-
Degenerative changes in trabecular meshwork
Systemic diseases
Increased Iop from uveitis
Growing tumor or ch . Use of topical corticosteroids
2. Secondary glaucoma-odema , eye injury, ,tumor in
advanced cases of cataract or diabetes.

5. CLASSIFICATION
1.Acute & chronic
2.Open & close angle glaucoma
Primary open angle glaucoma–
bilateral insidious in onset slow to
progress it is refferedas thief in the
night, because no early c/m present to
alert the client that vision is lost.aqu.
Humor outflow is slow or stopped
because of obstruction by trabecular
meshwork IOP increases & destroy
optic nerve.

6. Cont..
ANGLE CLOSURE GLAUCOMA -can develop
only in an eye in which the anterior chamber
angle is anatomically narrow. It is because of
sudden blockage of ant. Angle by the base of
iris . It is also termed as pupillaryblock.
Increase IOP
Normal tension glaucoma–resembles
primary open angle glaucoma with normal
pressure & optic nerve damage.
Secondary glaucoma–occur as result of
trauma that disrupt flow pattern of aq.
Humor.

7. CONT..
Congenital (infantile) glaucomais a
relatively rare, inherited type of open-angle
glaucoma. In this condition, the drainage area is
not properly developed. This results in increased
pressure in the eye that can lead to the loss of
vision from optic nerve damage and to an
enlarged eye.
Early diagnosis and treatment with medicine
and/or surgery are critical in these infants and
children to preserve their sight

8. CLINICAL MANIFESTATION
Severe pain & blurred vision or vision loss
Rain bow halos around light
Visual field defects are result of loss of blood
supply to the area in the retina.
nausea &vomiting
Loss of peripheral vision
Headache
Open angle glaucoma-24 -32 mm hg
Closed angle glaucoma-50-70 mm hg

9. ASSESMENT & DIAGNOSTIC FINDINGS
1.Occularhistory routine eye examination &
screening
2.Tonometry–IOP
3.Opthalmoscopyto inspect optic nerve
4.Gonioscopyto examine filtration angle of
anterior chamber
5.Perimetrytesting to asses visual field
increase IOP ->23 mm hg.

10. PATHOPHYSIOLOGY
There are to accepted theories
INDRICT MECHANICAL THEORY
DIRECT ISCHEMIC THEORY
DIRECT–High IOP damage retinal layer as it
passes through the optic nerve head.
INDIRECT–High IOP compresses the
microcirculation in optic nerve head resulting
in cell injury & death.
GLAUCOMATOUS CHANGES TYPICALLY
INVOLVE STAGES –

11. Cont..
1.INITIATING EVENTS–precipatingfactor s
include illness , emotional stress, congenital
narrow angle , long term use of corticosteroids
2.STRUCTURAL ALTERATION IN AQ .
OUTFLOW SYSTEM-
Tissues & cellular changes caused by factors that
affect aq. Humor
3.FUNCTIONAL ALTRATIONS -increase in IOP
or impaired blood flow create functional change
that leads to
4.OPTIC NERVE DAMAGE -atrophy of optic
nerve characterized by loss of blood supply
5.Visual loss-progressive loss of vision
chracterizedby visual field defect.

12. MANAGEMENT
AIM -prevention of optic nerve damage
trough medical therapy laser or non laser
surgery
To facilitate outflow of aq. Humor through
remaining channels to maintain IOP .
MEDICAL MANAGEMENT -
1.Reduce IOP –By outflow of aqhumor fluids.
2.IOP monitoring
3.Medications
4.Follow up examination

13. Cont..
Acute angle clousreglaucoma is treated with
medication mioticsto reduce IOP before
laser or incisionaliridectomy
Commonly used agents –
1.Beta adrenergic blockers antagonist –
hypotensiveangents
2.Cholinergic agents topical & miotics
pupillaryconstriction . Used short term
management of glaucoma
with pupillaryblock

14. CONT..
3.CARBONIC ANHYDRASE inhibitor
systemic prostaglandin decrease IOP BY
REDUCING AQ. OUTFLOW.
4.Osmotic diuretics to reduce IOP by
increasing the osmalalityof plasma to draw
water from eye into the vascular circulation.

15. Nursing management
Disturbed sensory perception r/t to recent vision
loss.
Anticipatory grieving r/t to loss of vison .
Risk for blindness r/t to increase IOP.

17. CONT..
Conventional surgery to treat glaucoma makes a
new opening in the meshwork. This new opening
helps fluid to leave the eye and lowers intraocular
pressure.

18. Sugical management
1.laser trabeculoplasty–
use of laser to create opening to trabecular
meshwork open intratrabecular spaces and wide
s the canal of schlemn , outflow of aq. Humor &
decrease of IOP.
Complication –sudden rise in IOP.

19. CONT..
2.Laser iridotomy–for pupillaryblock
glaucoma opening is made in iris to
eliminate pupillaryblock .
Contraindication –corneal odema
Complication –burns to cornea , lens or retina,
increase IOP, uveitis, blurring of vision.

20. Cont..
3.Filtering procedure–for ch. Glaucoma are used
to Create opening in trabecular meshwork to drain
aq. Humor from anterior chamber to sub
conjunctival spaces .
4.Ocular implantationdevices sometimes used to
control flow of aq. Humor
The flow tube is inserted into the anterior chamber of
the eye and the plate is implanted underneath the
conjunctiva to allow flow of aqueous fluid out of
the eye into a chamber called a bleb

21. TRABECULECTOMY
3.–standard filtering technique used to remove part
of trabecularmeshwork .
Complication –haemorrhage, low or increase IOP ,
uveitis, cataract.

22. CONT..
The most common conventional surgery
performed for glaucoma is the trabeculectomy.
Here, a partial thickness flap is made in the
scleral wall of the eye, and a window opening
made under the flap to remove a portion of the
trabecular meshwork. The scleral flap is then
sutured loosely back in place. This allows fluid to
flow out of the eye through this opening,
resulting in lowered intraocular pressure and the
formation of a bleb or fluid bubble on the surface
of the eye. Scarring can occur around or over the
flap opening, causing it to become less effective
or lose effectiveness altogether.

23. Nursing management
PREOPERATIVE CARE –prepare client for
surgical procedure .
Out patient procedure
Laser surgery most often performed topical
anesthesia is given.
Family member should accompany client.

24. CONT..
POST OPERATIVE CARE -following surgery
eye is covered with patch &metal or plastic
shield for protection from light & trauma.
Instruct client not to lie on oposite side to
avoid pressure on surgical site.
When affect of sedation diminished client can
eat & walk about .
Frequent monitoring of IOP.
Asses for pain , nausea & decrease vision
Follow up care is needed to monitor for
delayed healing . Strict adherence to
medications regimen

25. PATIENT EDUCATION
Know your IOP measurement
Be informed about extent of your vision loss & optic
nerve damage
Keep record of visual field test and tonometry
Review pall medications
Askl for side effects of medication during interaction
with eye medication
Be aware that glaucoma medication can cause adverse
affect if used inapporpriately
Keep all follow up of appointment.