Glaucoma

1. GLAUCOMA
Submitted By:
Anmol Prashar
Bsc nursing 4th year

2. Overview
• Glaucoma is a group of eye conditions that damage the optic nerve,
the health of which is vital for good vision. This damage is often
caused by an abnormally high pressure in your eye.
• Glaucoma is one of the leading causes of blindness for people over
the age of 60. It can occur at any age but is more common in older
adults.
• Many forms of glaucoma have no warning signs. The effect is so
gradual that you may not notice a change in vision until the
condition is at an advanced stage.

3. Risk Factors For Glaucoma
• Risk Factors for Open-Angle Glaucoma
• Strong risk factors for open-angle glaucoma include:
• High eye pressure
• Family history of glaucoma
• Age 40 and older for African Americans
• Age 60 and older for the general population, especially Mexican
Americans
• Thin cornea
• Suspicious optic nerve appearance with increased cupping (size of cup,
the space at the center of optic nerve, is larger than normal)

4. Potential risk factors for open-angle glaucoma include:
•High myopia (very severe nearsightedness)
•Diabetes
•Eye surgery or injury
•High blood pressure
•Use of corticosteroids (for example, eye drops, pills, inhalers, and creams)

5. Etiology
• Glaucoma is the result of damage to the optic nerve. As this nerve
gradually deteriorates, blind spots develop in your visual field. For
reasons that doctors don't fully understand, this nerve damage is
usually related to increased pressure in the eye.
• Elevated eye pressure is due to a buildup of a fluid (aqueous humor)
that flows throughout the inside of your eye. This internal fluid
normally drains out through a tissue called the trabecular meshwork
at the angle where the iris and cornea meet. When fluid is
overproduced or the drainage system doesn't work properly, the
fluid can't flow out at its normal rate and eye pressure increases.

6. Classification of GLaucoma

7. Types Of Glaucoma
• Open-angle glaucoma
• Open-angle glaucoma is the most common form of the disease. The drainage angle formed by
the cornea and iris remains open, but the trabecular meshwork is partially blocked. This causes
pressure in the eye to gradually increase. This pressure damages the optic nerve. It happens so
slowly that you may lose vision before you're even aware of a problem.
• Angle-closure glaucoma
• Angle-closure glaucoma, also called closed-angle glaucoma, occurs when the iris bulges
forward to narrow or block the drainage angle formed by the cornea and iris. As a result, fluid
can't circulate through the eye and pressure increases. Some people have narrow drainage
angles, putting them at increased risk of angle-closure glaucoma.
• Angle-closure glaucoma may occur suddenly (acute angle-closure glaucoma) or gradually
(chronic angle-closure glaucoma). Acute angle-closure glaucoma is a medical emergency.

8. Normal-tension glaucoma
In normal-tension glaucoma, your optic nerve becomes damaged even though your eye pressure is within
the normal range. No one knows the exact reason for this. You may have a sensitive optic nerve, or you
may have less blood being supplied to your optic nerve. This limited blood flow could be caused by
atherosclerosis — the buildup of fatty deposits (plaque) in the arteries — or other conditions that impair
circulation.
Glaucoma in children /Juvenile glaucoma
It's possible for infants and children to have glaucoma. It may be present from birth or develop in the first
few years of life. The optic nerve damage may be caused by drainage blockages or an underlying medical
condition.
Pigmentary glaucoma
In pigmentary glaucoma, pigment granules from your iris build up in the drainage channels, slowing or
blocking fluid exiting your eye. Activities such as jogging sometimes stir up the pigment granules,
depositing them on the trabecular meshwork and causing intermittent pressure elevations.

9. Open and closed angle Glaucoma

10. Signs and Symptoms :
• Most people with open-angle glaucoma don’t have symptoms. If symptoms do
develop, it’s usually late in the disease. That’s why glaucoma is often called the
"sneak thief of vision." The main sign is usually a loss of side, or peripheral,
vision.
• Symptoms of angle-closure glaucoma usually come on faster and are more
obvious. Damage can happen quickly.
• Glaucoma signs and symptoms include:
• Severe eye pain
• Nausea and vomiting (accompanying the severe eye pain)
• Sudden onset of visual disturbance, often in low light
• Blurred vision
• Halos around lights
• Reddening of the eye

11. • Lids may be oedematous,
• Conjunctiva is chemosed, and congested, (both conjunctiv
al and ciliaryvessels are congested),
• Cornea becomes oedematous and insensitive,
• Anterior chamber is very shallow. Aqueous flare or cells ma
y be seen inanterior chamber Angle of anterior chamber is c
ompletely closed as seenon gonioscopy (shaffer grade 0),
• Iris may be discoloured,
• Pupil is semidilated, vertically oval and fixed. It is non-
reactive to bothlight and accommodation,
• IOP is markedly elevated, usually between 40 and 70 mm
of Hg,
• Optic disc is oedematous and hyperaemic,
• Fellow eye shows shallow anterior chamber and a narrow
angle (latent angleclosure glaucoma).

12. Pathophysiology

13. Diagnostic Tests
• To be safe and accurate, five factors should be checked before making a
glaucoma diagnosis:
Examining... Name of Test
The inner eye pressure Tonometry
The shape and color of the optic nerve Ophthalmoscopy (dilated eye exam)
The complete field of vision Perimetry (visual field test)
The angle in the eye where the iris meets the
cornea
Gonioscopy
Thickness of the cornea Pachymetry

14. Medical Management
• The damage caused by glaucoma can't be reversed. But treatment
and regular checkups can help slow or prevent vision loss,
especially if you catch the disease in its early stages.
• Glaucoma is treated by lowering your eye pressure (intraocular
pressure). Depending on your situation, your options may include
prescription eyedrops, oral medications, laser treatment, surgery
or a combination of any of these.
• Eyedrops
• Glaucoma treatment often starts with prescription eyedrops. These
can help decrease eye pressure by improving how fluid drains
from your eye or by decreasing the amount of fluid your eye
makes. Depending on how low your eye pressure needs to be,
more than one of the eyedrops below may need to be prescribed.
• Prescription eyedrop medications include:

15. • Provide information about laser trabeculoplasty, if medication therapy proves ineffective.
• Teach the client about specific safety precautions.
• Instruct the client to avoid mydriatics such as atropine, which may precipitate acute glaucoma in a client with closed-
angle glaucoma.
• Instruct the client to carry prescribed medications at all times.
• Instruct the client to carry a medical identification card or wear a bracelet stating his type of glaucoma and need for
medication.
• Instruct the client to take extra precautions at night (e.g. use of handrails, provide extra lighting to compensate for
impaired pupil dilation from miotic use).
• Provide information about laser trabeculoplasty, if medication therapy proves ineffective.
• Teach the client about specific safety precautions.
• Instruct the client to avoid mydriatics such as atropine, which may precipitate acute glaucoma in a client with closed-
angle glaucoma.
• Instruct the client to carry prescribed medications at all times.
• Instruct the client to carry a medical identification card or wear a bracelet stating his type of glaucoma and need for
medication.
• Instruct the client to take extra precautions at night (e.g. use of handrails, provide extra lighting to compensate for
impaired pupil dilation from miotic use).

16. Because some of the eyedrop medicine is absorbed into your bloodstream, you may experience
some side effects unrelated to your eyes. To minimize this absorption, close your eyes for one to two
minutes after putting the drops in. You may also press lightly at the corner of your eyes near your
nose to close the tear duct for one or two minutes. Wipe off any unused drops from your eyelid.
If you have been prescribed multiple eyedrops or you need to use artificial tears, space them out so
that you are waiting at least five minutes in between types of drops.
Oral medications
If eyedrops alone don't bring your eye pressure down to the desired level, your doctor may also
prescribe an oral medication, usually a carbonic anhydrase inhibitor. Possible side effects include
frequent urination, tingling in the fingers and toes, depression, stomach upset, and kidney stones.

17. Surgical Management
Other treatment options include laser therapy and various surgical procedures. The following techniques are intende
to improve the drainage of fluid within the eye, thereby lowering pressure:
•Laser therapy. Laser trabeculoplasty (truh-BEK-u-low-plas-tee) is an option if you have open-angle glaucoma. It's
done in your doctor's office. Your doctor uses a small laser beam to open clogged channels in the trabecular
meshwork. It may take a few weeks before the full effect of this procedure becomes apparent.
•Filtering surgery. With a surgical procedure called a trabeculectomy (truh-bek-u-LEK-tuh-me), your surgeon create
an opening in the white of the eye (sclera) and removes part of the trabecular meshwork.
•Drainage tubes. In this procedure, your eye surgeon inserts a small tube shunt in your eye to drain away excess flu
to lower your eye pressure.
•Minimally invasive glaucoma surgery (MIGS). Your doctor may suggest a MIGS procedure to lower your eye
pressure. These procedures generally require less immediate postoperative care and have less risk than
trabeculectomy or installing a drainage device. They are often combined with cataract surgery. There are a number o
MIGS techniques available, and your doctor will discuss which procedure may be right for you.

18. Treating acute angle-closure glaucoma
Acute angle-closure glaucoma is a medical emergency. If you're diagnosed with this condition,
you'll need urgent treatment to reduce the pressure in your eye. This generally will require both
medication and laser or other surgical procedures.
You may have a procedure called a laser peripheral iridotomy in which the doctor creates a
small opening in your iris using a laser. This allows fluid (aqueous humor) to flow through it,
relieving eye pressure.

19. Nursing Management
Nursing Diagnosis
•Anxiety related to possible vision loss
•Disturbed sensory perception related to visual impairment
•Ineffective health maintenance related to knowledge deficit
•Risk for injury related to impaired vision
•Self-care deficit related to impaired vision
Nursing Management
1.Provide information regarding management of glaucoma
1. Discuss preoperative and postoperative teaching for immediate surgical
opening of the eye chamber.
2. Prepare to administer carbonic anhydrase inhibitors IV or IM, to restrict
production of aqueous humor.
3. Prepare to administer osmotic agents.
4. Discuss and prepare the client for surgical or laser peripheral iridectomy after
the acute episode is relieved.

20. 2.Provide information about laser trabeculoplasty, if medication therapy proves ineffective.
3. Teach the client about specific safety precautions.
1. Instruct the client to avoid mydriatics such as atropine, which may precipitate acute glaucoma in a
client with closed-angle glaucoma.
2. Instruct the client to carry prescribed medications at all times.
3. Instruct the client to carry a medical identification card or wear a bracelet stating his type of glaucoma
and need for medication.
4. Instruct the client to take extra precautions at night (e.g. use of handrails, provide extra lighting to
compensate for impaired pupil dilation from miotic use).