GLAUCOMA

Glaucoma is an eye disease that can damage your optic nerve. The optic nerve supplies visual
information to your brain from your eyes.

Glaucoma is usually, but not always, the result of abnormally high pressure inside your eye.
Over time, the increased pressure can erode your optic nerve tissue, which may lead to vision
loss or even blindness. If it’s caught early, you may be able to prevent additional vision loss.

Five major types of glaucoma exist. These are:

Open-Angle (Chronic) Glaucoma

Open-angle, or chronic, glaucoma has no signs or symptoms except gradual vision

loss. This loss may be so slow that your vision can suffer irreparable damage before any
other signs become apparent. According the National Eye Institute (NEI)Trusted Source,
this is the most common type of glaucoma.

Angle-Closure (Acute) Glaucoma

If the flow of your aqueous humor fluid is suddenly blocked, the rapid buildup of fluid
may cause a severe, quick, and painful increase in pressure. Angle-closure glaucoma is an
emergency situation. You should call your doctor immediately if you begin experiencing
symptoms, such as severe pain, nausea, and blurred vision.

Congenital Glaucoma

Children born with congenital glaucoma have a defect in the angle of their eye, which
slows or prevents normal fluid drainage. Congenital glaucoma usually presents with symptoms,
such as cloudy eyes, excessive tearing, or sensitivity to light. Congenital glaucoma can run in
families.
 Secondary Glaucoma

Secondary glaucoma is often a side effect of injury or another eye condition, such as
cataracts or eye tumors. Medicines, such as corticosteroids, may also cause this type of
glaucoma. Rarely, eye surgery can cause secondary glaucoma.

Normal Tension Glaucoma

In some cases, people without increased eye pressure develop damage to their optic
nerve. The cause of this isn’t known. However, extreme sensitivity or a lack of blood flow to
your optic nerve may be a factor in this type of glaucoma.

CAUSES AND RISK FACTOR

Causes of glaucoma

 dilating eye drops

 blocked or restricted drainage in your eye
 medications, such as corticosteroids
 poor or reduced blood flow to your optic nerve
 high or elevated blood pressure

SYMPTOMS

The most common type of glaucoma is primary open-angle glaucoma. It has no signs or
symptoms except gradual vision loss. For that reason, it’s important that you go to yearly
comprehensive eye exams so your ophthalmologist, or eye specialist, can monitor any changes in
your vision.

Acute-angle closure glaucoma, which is also known as narrow-angle glaucoma, is a medical

emergency. See your doctor immediately if you experience any of the following symptoms:

 severe eye pain

 nausea
 vomiting
 redness in your eye
 sudden vision disturbances
 seeing colored rings around lights
 sudden blurred vision

PATHOPHYSIOLOGY
TYPES OF SURGERY
Argon laser trabeculoplasty (ALT): This opens clogs in your eye so fluid can drain out. Your
doctor may treat half of the clogs first, see how well it works, then treat the other half later. ALT
works in about 75% of people with the most common kind of glaucoma.
Selective laser trabeculoplasty (SLT): If ALT doesn’t work so well, your doctor may try this. Your
doctor beams a highly targeted low-level laser at just the spots where there’s pressure. You can do
SLT a little at a time. Oftentimes this may be the first surgical step because it is more specific.
Laser peripheral iridotomy (LPI): If the space between your eye’s iris (the colored part) and
cornea (the clear outer layer) is too small, you can get narrow-angle glaucoma. Fluid and pressure
build up in this area. LPI uses a laser beam to create a tiny hole in the iris. The extra fluid can drain
and relieve pressure.
 Cyclophotocoagulation: If other laser treatments or surgery doesn't ease fluid buildup and pressure,
your doctor can try this. They’ll beam a laser into a structure inside your eye to ease pressure. You
may need to repeat it over time to keep your glaucoma in check.

DIAGNOSIS

Glaucoma is diagnosed through a comprehensive eye examination . Because glaucoma is a

progressive disease, meaning it worsens over time, a change in the appearance of the optic
nerve, a loss of nerve tissue, and a corresponding loss of vision confirm the diagnosis. Some
optic nerves may resemble nerves with glaucoma, but the patients may have no other risk
factors or signs of glaucoma. These patients should have routine comprehensive exams to
monitor any changes.

Glaucoma testing includes:

 Patient history to determine any symptoms the patient is experiencing and if there are any
general health problems and family history that may be contributing to the problem.
 Visual acuity measurements to determine if vision is being affected.
 Tonometry to measure the pressure inside the eye to detect increased risk factors for
glaucoma.
 Pachymetry to measure corneal thickness. People with thinner corneas are at an increased
risk of developing glaucoma.
 Visual field testing, also called perimetry, to check if the field of vision has been affected by
glaucoma. This test measures your side (peripheral) vision and central vision by either
determining the dimmest amount of light that can be detected in various locations of vision,
or by determining sensitivity to targets other than light.
 Evaluation of the retina of the eye, which may include photographs or scans of the optic
nerve, to monitor any changes over time.
 Supplemental testing, which may include gonioscopy. This procedure offers a view of the
angle anatomy, which is where eye fluid drainage occurs. Serial tonometry is another
possible test. This procedure acquires several pressure measurements over time, looking for
changes in the eye pressure throughout the day. In addition, devices can be used to measure
nerve fiber thickness and to look for tissue loss on specific areas of the nerve fiber layer.

MEDICAL MANAGEMENT

Unless contraindicated, medical therapy remains the most common initial method of lowering
IOP and usually involves topical agents delivered as eye drops [1, 3]. There are several effective
classes of topical therapies for glaucoma, including prostaglandin analogues (PGAs), β-
blockers, α-adrenergic agonists and carbonic anhydrase inhibitors (CAIs), and pilocarpine,
Figure 4. These topical therapies reduce the production of aqueous humour, enhance its outflow,
or have an effect on both. For many years, topical β-blockers were the most commonly used
first-line medical therapy; however, the introduction of newer agents over the past 20 years has
given patients and physicians a wider variety of choices for both initial and adjunctive treatment.
However, some of the “older drugs,” such as the parasympathomimetic agent pilocarpine and
oral CAIs, still play a significant role in specific types of glaucoma, including plateau iris.

NURSING INTERVENTION

 Determine type and degree of visual loss.

 Allow expression of feelings about loss and possibility of loss of vision.

 Implement measures to assist patient to manage visual limitations such as reducing clutter,

arranging furniture out of travel path; turning head to view subjects; correcting for dim light
and problems of night vision.

 Demonstrate administration of eye drops (counting drops, adhering to the schedule, not
missing doses).

 Assist with administration of medications as indicated:

 Stress the importance of meticulous compliance with prescribed drug therapy:

 Chronic, open-angle glaucoma Pilocarpine hydrochloride (Isopto Carpine, Ocusert [disc],

Pilopine HS gel)
 Timolol maleate (Timoptic), betaxolol (Betoptic), carteolol (Ocupress), metipranolol
(OptiPranolol), levobunolol (Betagan)
 Acetazolamide (Diamox), methazolamide (Neptazane), dorzolamide (Trusopt)
 Narrow-angle (angle-closure) type Myotics (until the pupil is constricted); Carbonic
anhydrase inhibitors like acetazolamide (Diamox); dichlorphenamide (Daranide);
methazolamide (Neptazane);
 Sympathomimetics: dipivefrin (Propine), brimonidine (Alphagan), epinephrine (Epifrin),
apraclonidine (Iopidine), latanoprost (Xalatan);

 Provide sedation, analgesics as necessary.

COMPLICATIONS

 If left untreated, glaucoma can lead to significant vision loss in both eyes, and may even
lead to blindness.

A less common type of glaucoma, acute angle-closure glaucoma, usually occurs abruptly

due to a rapid increase of pressure in the eye.