Power point presentation on Glaucoma (B. Sc nursing)

The term Glaucoma is a term used to refer group of ocular condition characterized by the optic nerve damage. Glaucoma occurs as a result of increased intraocular pressure (IOP) caused by a malformation or malfunction of the eyes drainage system. Normal IOP is 19-21 inches of mercury. The increased pressure causes compression of the retina and the optic nerve, and causes progressive, permanent loss of eyesight if left untreated.

Glaucoma is a group of diseases characterized by increased IOP and visual field loss caused by damage of optic nerve.

1. Presented by :
MS. MEGHA JOSHI

2. INTRODUCTION
•The term Glaucoma is a term used to refer group of
ocular condition characterized by the optic nerve
damage. Glaucoma occurs as a result of increased
intraocular pressure (IOP) caused by a malformation or
malfunction of the eyes drainage system. Normal IOP
is 19-21 inches of mercury. The increased pressure
causes compression of the retina and the optic nerve,
and causes progressive, permanent loss of eyesight if
left untreated.

4. DEFINITION
•Glaucoma is a group of diseases characterized by
increased IOP and visual field loss caused by damage
of optic nerve

5. ETIOLOGY/CAUSES
•Trauma
•Dilated Pupils
•Cataract Burns
•Chemical Burns
•Blockage of the trabecular meshwork
•Drugs: Antihistamines, Anticholinergic,
Antispasmodic
•Thyroid disease
•Heredity

6. CLASSIFICATION
•Open –angle Glaucoma
•Angle closure Glaucoma
•Combined mechanism Glaucoma
•Congenital/Developmental Glaucoma

7. 1.Open –Angle Glaucoma
•Represents 90% of cases of primary Glaucoma
•Characterized by atrophy of Optic nerve
2.Angle closure Glaucoma
•In angle closure the iris blocks the trabecular
meshwork and limits the flow of aqueous humourto
anterior chamber
3.Combined mechanism Glaucoma
•It occurs due to combined mechanism of open-angle
and angle closure glaucoma

8. STAGES OF GLAUCOMA
•Stage -1(Initiating events)
•Stage -2(Structure alterations)
•Stage-3(Functional alterations)
•Stage-4(Optic nerve damage)
•Stage-5(Visual loss)

9. Due to etiological causes
Hyper production of aqueous fluid
Rise in the amount of aqueous fluid in the arterial chamber
Decrease in supply blood to optic nerve and retina
Ischemic of the delicate tissue
Loss of function
Glaucoma
PATHOPHYSIOLOGY

10. Hyper production of aqueous and obstruction of
outflow
Increase intra-ocular pressure
Inhibit blood supply to optic nerve and retina
Tissue become ischemic and gradually lose of
function
PATHOPHYSIOLOGY

11. CLINICAL MANIFESTATIONS
•Bradycardia
•Blurred vision
•Gastric upset
•Redness
•Halo vision
•Haemorrhage
•Corneal edema
•Sudden onset of visual disturbance
•Pain reduced due to IOP
•Decreased visual acuity
•Moderate pupilarydilation

12. DIAGNOSTIC EVALUATION
•History collection
•Physical examination
•Tonometry
•Gonioscopy
•Visual field testing
•Pachymetry
•Opthalmoscopy

13. COMPLICATIONS
•Complete loss of vision
•Choroidaldetachment
•Retinal detachment
•Chronic hypotony
•Anterior segment necrosis

14. MEDICAL MANAGEMENT
•Anti-inflammatory agents
•Antiviral agents
•Cholinergic agents
•Beta blockers eye drops
•Rho-kinase inhibitor
•Osmotic drugs
•Beta adrenergic antagonists

15. 1.ANTI-INFLAMATORY AGENTS
•Non steroidal anti inflammatory drugs is a class of analgesic medication
that reduces pain, fever & inflammation.
•Ex: Ibuprofen, Naproxen, Indomexacin, Diclofenac
2.ANTIVIRAL AGENTS
•Antiviral drugs are a class of medication used specifically for treating or
controlling viral infections. Like antibiotics for bacteria, specific antivirals
are used for specific viruses. Unlike most antibiotics, antivirals do not
destroy their target pathogen; instead they inhibit their development.
•Ex: Aciclovir, Ganciclovir
3.CHOLINERGIC AGENTS
•A cholinergic drug is a drug that acts on the peripheral nervous system, the
central nervous system, or both and enhances the effects that are mediated
by acetylcholine
•Ex: acetylcholine, pilocarpine, carbachol

16. 4.BETA BLOCKERS EYE DROPS
•Beta-adrenergic blocking agents for the eye are used to treat certain types
of glaucoma. They appear to work by reducing the production of fluid in
the eye. This lowers the pressure in the eye.
•Ex: Timolol, Metipranolol
5.RHO-KINASE INHIBITOR
•Rho kinase inhibitors work to treat diabetic retinopathy by decreasing the
adhesion of leukocytes and by slowing leukocyte-induced damage.
•Ex: Ripasudil, Netarsudil
6.OSMOTIC DRUGS
•Ex: Isosorbidedinitrate(Isordil, Dilatrate-SR)
•May be used to abort an acute attack of glaucoma. In the eyes, may create
an osmotic gradient between plasma and ocular fluids and induce diuresis
by elevating osmolarityof the glomerular filtrate. These effects may, in
turn, inhibit tubular reabsorption of water.
7.BETA ADRENERGIC ANTAGONISTS
•Beta-adrenergic blocking agents for the eye are used to treat certain types
of glaucoma. They appear to work by reducing the production of fluid in
the eye. Ex: Betaxolol, metipranolol

17. SURGICAL MANAGEMENT
•Trabeculoplasty
•Trabeculotomy
•Laser iridotomy
•Filtering procedures
•Drainage implant and shunt
•Peripheral or sector irdectomy

18. 1.TRABECULOPLASTY
•Use of laser to create an opening in trabecular meshwork.
When IOP is inadequately controlled by medications.
2.TRABECULOTOMY
•Trabeculectomyis a type of glaucoma surgery performed
on the eye that creates a new pathway for fluid inside the
eye to be drained. This is an outpatient procedure performed
in the operating room.
3.LASER IRIDOTOMY
•Laser iridotomyis a medical procedure which uses a laser
device to create a hole in the iris, thereby allowing aqueous
humor to traverse directly from the posterior to the anterior
chamber and, consequently, relieve a pupillary block.

19. 4.PERIPHERAL OR SECTOR IRDECTOMY
•Peripheral Iridectomy: In this type of iridectomyan opening is made
in the periphery (away from the centre) of the iris either surgically or
by a laser. The pupil is kept intact.
•Sector Iridectomy: This type of iridectomyremoves a radial section
of the iris, extending from the pupil to the periphery.
5.FILTERING PROCEDURES
•This procedure allows your eye surgeon to create a new drainage
channel for the eye, which results in a filtering area called a “bleb”.
The bleb is mostly hidden under the eyelid. When successful, this
procedure will lower the pressure in your eye, minimizing the risk of
further visual loss from glaucoma.
6.DRAINAGE IMPLANT AND SHUNT
•Glaucoma drainage implants are small prosthetic devices that are
placed to help lower the intraocular pressure and prevent further
optic nerve damage.
•Glaucoma tube shunts are small devices implanted into the eye to
drain excess fluid. The tube portion of the device is inserted into the
eye to create a drain for aqueous fluid. The goal of the tube shunt
surgery is to decrease eye pressure and vision loss due to glaucoma.

20. NURSING MANAGEMENT
•Encourage patient compliance by teaching the patient about medications
•Postoperatively, give medications, as ordered, to dilate the pupil and topical
corticosteroids to rest the pupil and protect the affected eye
•Administer pain medication as ordered
•Encourage the patient to be ambulatory
immediately after surgery
•The patient is taught how to administer
medications and performs a return
demonstration to ensure that eye drops
are administered properly
•If the patient has trouble with a steady hand when administering eye drops,
teach the patient to rest his or her hand on the forehead to steady the hand

21. •If the patient is unable to see the label on the eye drop bottle,
consider large-print labels or audiotaped directions
•For patients with multiple medications, consider using large,
multicolored dot stickers placed on medication bottle with a
corresponding direction card with a matching colored dot
•Patients are taught the need for having regular eye examinations
through dilated pupils
•Family members should also be advised that they are at increased
risk of developing glaucoma and should have regular eye
examinations
•Analgesics are given as needed for acute glaucoma.
•The patient is also assisted with self-care as needed. Patients are
allowed to verbalize their concerns about losing their sight

22. HEALTH EDUCATION
•Get regular dilated eye examinations.
•Know your family's eye health history.
•Limit your caffeine. Exercise regularly.
•Take prescribed eye drops regularly.
•Sleep with your head slightly (20°) elevated.
•Wear eye protection

23. CONCLUSION
Glaucoma is a condition that causes damage to the eyes
optic nerve& gets worse over the time. Without
treatment the glaucoma can cause permanent blindness
within few years. So the treatment should be given at
right time to prevent complications

24. BIBLIOGRAPHY
•Chintamaniand mrinalinimanitext book of lewis’smedical
surgical nursing 3rd edition published by ELSEVIER Page
no 334-337
•B. Venkatesantextbook of medical surgical nursing first
edition published by EMMESS Page no 841-844
•AVAILABLE SITES URL:
•https://www.manipalhospitals.com
•https://www.hdfcergo.com/
•https://ww.mayoclinic.org