KOLEJ SAINS KESIHATAN BERSEKUTU KOTA KINABALU

KURSUS DIPLOMA PEMBANTU PERUBATAN

CASE STUDY
EYE CLINIC

GLAUCOMA

NAME : MELVIN GUADING

IDENTITY CARD NO. : 930819-15-5029
MATRICS NO. : BPP2013-2275
INTAKE : JANUARI 2013
SEMESTER : YEAR 3 SEMESTER 2
INTRODUCTION
Glaucoma is not just one eye disease, but a group of eye conditions resulting in
optic nerve damage, which may cause loss of vision. Abnormally high pressure inside your
eye (know as intraocular pressure) usually, but not always, causes this damage. Besides,
glaucoma is one of the leading causes of blindness in the world as research by World
Organization Health (WHO). Glaucoma can damage your vision so gradually you may not
notice any loss of vision until the disease is at an advanced stage.

The most common type of glaucoma, primary open-angle glaucoma, has no

noticeable signs or symptoms except gradual vision loss. Glaucoma prognosis is when a
patient has a glaucoma and get early diagnosis and treatment, a patient can minimize or
prevent their optic nerve damage and limit glaucoma-related vision loss. It's very important
to get your eyes examined regularly every a month or a year, and make sure your eye
doctor measures your intraocular pressure.

Besides, it is usually asymptomatic until advanced and many people will be unaware
there is a problem with their eyes until severe visual damage has occurred. Ocular
hypertension (OHT) is a major risk factor for developing COAG, although COAG can occur
with or without raised eye pressure.
PROBLEMS STATEMENTS

Glaucoma is a No. 1 disease in the world, especially in Malaysia that can cause of
disability in vision or blindness. According research by Malaysia Health Ministry showed
that 30-70 % of adults who have hypertension and diabetes mellitus has a high risk of
getting glaucoma. Nowadays people do not care about their eyes, especially for patients
who suffering of hypertension that they need to control their blood pressure by getting
proper treatment with doctor. Besides, who has diabetes mellitus also need to practice
healthy daily diet to prevent complications such as glaucoma?
LITERATURE REVIEW

“Glaucoma refers to a group of eye conditions that lead to damage to the optic nerve, the
nerve that carries visual information from the eye to the brain. In many cases, damage to
the optic nerve is due to increased pressure in the eye, also known as intraocular pressure
(IOP)”.

~Nursing Journal & Articles, 2010

“Glaucoma is a group of diseases that damage the eye’s optic nerve and can result in
vision loss and blindness. However, with early detection and treatment, you can often
protect your eyes against serious vision loss.”
~ The National Eye Institute

“The increased pressure, called intraocular pressure, can damage the optic nerve, which
transmits images to the brain. If damage to the optic nerve from high eye pressure
continues, glaucoma will cause permanent loss of vision. Without treatment, glaucoma can
cause total permanent blindness within a few years.”
~ United Kingdom Eye Health Care.

“Glaucoma is not just one eye disease, but a group of eye conditions resulting in optic
nerve damage, which may cause loss of vision. Abnormally high pressure inside your eye
(intraocular pressure) usually, but not always, causes this damage.”

~ Foundation for Medical Education and Research, 2012

PATIENT’S FINDING

CASE BACKGROUND

Patient’s Name : Basani Sawani

Registered Number (R/N) : 004792
Date Of Birth : 02 Mei 1958
Age : 57 years old
Religion : Islam
Nation : Bajau
Status : Married
Occupation : Government Pensioners
Address : Taman Semarak, Tawau, Sabah

- Patients History -

Mr. Basani, come to Eye Clinic because complaint of :-

♣ Eye pain

♣ Sudden onset of visual disturbance, often in low light.

♣ Blurred vision

♣ Halos around lights

♣ Nausea and vomiting (accompanying the severe eye pain)

♣ Reddening of the eye.

DISCUSSION

TYPES OF GLAUCOMA

There are four major types of glaucoma :

a) Open-angle (Chronic) Glaucoma

b) Angle-closure (Acute) Glaucoma

c) Congenital Glaucoma

d) Secondary Glaucoma

The front part of the eye is filled with a clear fluid called aqueous humor. This fluid is always
being made in the back of the eye. It leaves the eye through channels in the front of the eye
in an area called the anterior chamber angle, or simply the angle.

Anything that slows or blocks the flow of this fluid out of the eye will cause pressure to build
up in the eye. This pressure is called intraocular pressure (IOP). In most cases of
glaucoma, this pressure is high and causes damage to the major nerve in the eye, called
the optic nerve.

a) Open-angle (Chronic) Glaucoma.

 The cause is unknown. An increase in eye pressure occurs slowly over time. The
pressure pushes on the optic nerve and the retina at the back of the eye
 Open-angle glaucoma tends to run in families. Your risk is higher if you have a
parent or grandparent with open-angle glaucoma. People of African descent are at
particularly high risk for this disease

b) Angle-closure (Acute) Glaucoma

Occur when the exit of the aqueous humour fluid is suddenly blocked. This causes a quick,
severe, and painful rise in the pressure within the eye (intraocular pressure).

 Angle-closure glaucoma is an emergency. This is very different from open-angle

glaucoma, which painlessly and slowly damages vision.

 If you have had acute glaucoma in one eye, you are at risk for an attack in the
second eye, and your doctor is likely to recommend preventive treatment.

 Dilating eye drops and certain medications may trigger an acute glaucoma attack.

c) Congenital Glaucoma.

 It is present at birth
 It results from the abnormal development of the fluid outflow channels in the eye
d) Secondary Glaucoma is caused by:

 Drugs such as corticosteroids

 Eye diseases such as uveitis
 Systemic diseases

CLINICAL SIGN

There are clinical sign of Glaucoma :

a) Open Angle (Chronic) Glaucoma

 Most people have no symptoms until they begin to lose vision

 Gradual loss of peripheral (side) vision (also called tunnel vision)

b) Angle-Closure (Acute) Glaucoma

 Symptoms may come and go at first, or steadily become worse.

 Sudden, severe pain in one eye.
 Decreased or cloudy vision.
 Nausea and vomiting.
 Rainbow-like halos around lights.
 Red eye.
 Eye feels swollen.

c) Congenital Glaucoma

 Symptoms are usually noticed when the child is a few months old.
 Cloudiness of the front of the eye.
 Enlargement of one eye or both eyes.
 Red eye.
 Sensitivity to light.
 Tearing.
How to diagnose Glaucoma?

 Gonioscopy
 Use of a special lens to see the outflow channels of the angle
 Tonometry test to measure eye pressure
 Optic nerve imaging (photographs of the inside of the eye)
 Pupillary reflex response
 Retinal examination
 Slit lamp examination
 Visual acuity
 Visual field measurement

Risk of factors

 Elevated internal eye pressure (intraocular pressure).

If your internal eye pressure (intraocular pressure) is higher than normal, you're at
increased risk of developing glaucoma, though not everyone with elevated
intraocular pressure develops the disease.

 Age.

You're at a higher risk of glaucoma if you're older than age 60, particularly if you're
Mexican-American. You may be at higher risk of angle-closure glaucoma if you're
older than age 40. For certain groups such as African-Americans, however, the risk
of developing glaucoma is much higher and occurs at a younger age than that of
other groups. If you're African-American, ask your doctor when you should start
having regular comprehensive eye exams.

 Ethnic background.

African-Americans older than age 40 have much higher risk of developing glaucoma
than do whites (Caucasians). African-Americans also are more likely to experience
permanent blindness as a result of glaucoma. People of Asian descent have an
increased risk of developing acute angle-closure glaucoma. People of Japanese
descent may be more likely to have normal-tension glaucoma.

 Family history of glaucoma.

If you have a family history of glaucoma, you have a greater risk of developing it.
Glaucoma may have a genetic link, meaning there's a defect in one or more genes
that may cause certain individuals to be more susceptible to the disease. A form of
juvenile open-angle glaucoma has been clearly linked to genetic abnormalities.

 Medical conditions.
 Several conditions may increase your risk of developing glaucoma, including
diabetes, heart diseases, high blood pressure and hypothyroidism.

 Other eye conditions.

Severe eye injuries can cause increased eye pressure. Other eye conditions that
could cause increased risk of glaucoma include eye tumors, retinal detachment, eye
inflammation and lens dislocation. Certain types of eye surgery also may trigger
glaucoma. Also, being nearsighted or farsighted may increase your risk of
developing glaucoma.

 Long-term corticosteroid use.

Using corticosteroid medications, especially eyedrops for a long period of time may
increase your risk of developing secondary glaucoma

PREVENTION

 Get regular eye care.

Regular comprehensive eye exams can help detect glaucoma in its early stages before
irreversible damage occurs. As a general rule, have comprehensive eye exams every three
to five years after age 40 and every year after age 60. You may need more frequent
screening if you have glaucoma risk factors. Ask your doctor to recommend the right
screening schedule for you.

 Treat elevated eye pressure.

Glaucoma eye drops can significantly reduce the risk that elevated eye pressure will
progress to glaucoma. To be effective, these drops must be taken regularly even if you
have no symptoms.

 Eat a healthy diet.

While eating a healthy diet won't prevent glaucoma, it can improve your physical and
mental health. It can also help you maintain a healthy weight and control your blood
pressure.

 Wear eye protection.

Serious eye injuries can lead to glaucoma. Wear eye protection when you use power tools
or play high-speed racket sports on enclosed courts. Also wear hats and sunglasses if you
spend time outside.
REFERENCE

Laman Web Rasmi Journal Nursing Articles

http://www.nsgmed.com/eye/glaucoma-definition-types-causes-symptoms-diagnosis-
treatment/

The National Eye Institute – Facts about Glaucoma

www.nei.nih.gov

WebMd Foundation for Medical Education and Research – What Is Glaucoma?

http://answers.webmd.com/answers/1191561/what-is-glaucoma
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