LESSON PLAN

ON
GLAUCOMA
UNIT : II

SUBMITTED BY: SUBMITTED BY

DEAN NURSING HARPREET KAUR

SVU NURSING TUTOR SVU

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Programme : Bsc(N)

Course : Medical Surgical Nursing

Topic : GLAUCOMA

Group : Bsc(N) –III year

No of students : 50

Venue : Lecture

Duration : 50 MIN

Method of teaching : Lecture cum discussion

Av aids : black board, OHP, Chart

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Central objectives:
At the end of the class the students will be able to gain in-depth knowledge on Glaucoma & develop desirable
skill & attitude while taking care of Glaucoma patients

Contributory objectives:

At the end of the class the students will be

• Define Glaucoma
• Discuss the incidence of Glaucoma
• List down the types of Glaucoma
• Enumerate the causes of Glaucoma
• Describe the pathophysiology of Glaucoma.
• Explain the clinical manifestation of Glaucoma
• Identify the diagnostic investigation of Glaucoma
• Elaborate the management of Glaucoma.

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SL TIME SPECIFIC CONTENT TEACHERS LEARNERS AV.AID EVALUATION
N OBJECTIVE ACTIVITY ACTIVITY S
O
GLAUCOMA Writes the Listens Black What is
topic on the board Glaucoma ?
1 Introduction
5min - introduce Glaucoma is optic nerve damage (often, but not always, black board. &
associated with increased eye pressure) that leads to Introduces the
the topic
progressive, irreversible loss of vision.
Glaucoma and topic by
Incidence narration.
Its incidence
Almost 3 million people in the United States and 14
to the students. million people worldwide have glaucoma. Glaucoma is the third
leading cause of blindness worldwide and the second leading
cause of blindness in the United States, where it is the leading
cause of blindness among blacks and Hispanics.

Types of glaucoma Explains the Listening & OHP What are the
5min - enumerate There are many forms of adult and childhood glaucomas.
Most glaucomas fall into two categories: open-angle or closed- classification Notes taking classification
the types of
angle glaucomas. of glaucoma of
glaucoma .
by using OHP glaucoma?
 Open-angle glaucoma is more common. In open-angle
glaucoma, the drainage canals in the eyes become
clogged gradually over months or years. Pressure in the
eye rises slowly because fluid is produced at a normal
rate but drains sluggishly.

 Closed-angle glaucoma is less common than open-angle

glaucoma. In closed-angle glaucoma, the drainage canals

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 in the eyes become blocked or covered because the angle
between the iris and cornea is too narrow. The blockage
can occur suddenly or slowly. If the blockage occurs
suddenly, pressure in the eye rises rapidly. If the
blockage occurs slowly, the pressure in the eye rises
slowly like in open-angle glaucoma.
-To explain in
Causes
detail
In most people, the cause of glaucoma is not known,
5min Explains the Listening and Blackbo What are the
Regarding the  although both open-angle and closed-angle glaucomas
tend to run in families. cause and risk taking notes. ard. causes of
Cause and risk
 In others, damage to the eye caused by infection,
factors of glaucoma?
factor of  inflammation,
 tumor, glaucoma
glaucoma
 large cataracts or surgery for cataracts, or
 other conditions keeps the fluid from draining freely and
leads to increased eye pressure and optic nerve damage
(secondary glaucoma).

People at highest risk are those with any of the following:

 Age older than 40
 African-American race
 Family members who have (or had) the disease
 Farsightedness or nearsightedness
 Diabetes
 Long-term use of corticosteroid drugs
 Previous eye injury
-To describe in
Pathophysiology
5min detail about In glaucoma, the drainage canals become clogged, blocked, or Explains the Listens and OHP Explain in
covered. Fluid cannot leave the eye even though new fluid is
pathophysiolo pathophysiolo discusses detail about
being produced in the posterior chamber. In other words, the

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 gy of sink “backs up” while the faucet is still running. Because there is gy of The
nowhere in the eye for the fluid to go, pressure in the eye glaucoma
glaucoma pathophysiol
increases. When the pressure becomes higher than the optic
nerve can tolerate, damage to the optic nerve occurs. This ogy of
damage is called glaucoma. Sometimes eye pressure increases Glaucoma?
within the range of normal but is nonetheless too high for the
optic nerve to tolerate (called low tension glaucoma).

Anatomical narrowing of anterior chamber

Blockage of acquios humor

Accumulation of acquios humor

Increased intra ocular pressure

Damage to the optic nerve

Blindness

-To explain in
Signs and Symptoms
detail about signs Open-Angle Glaucoma:
and Explains the Listens and Chart What are
5min  Open-angle glaucoma is painless and causes no early
symptoms of signs and takes notes. signs and
symptoms.
glaucoma.  The most important symptom of open-angle symptoms of symptoms of
glaucoma is the development of blind spots, or

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 patches of vision loss, over months to years. glaucoma Glaucoma
 The blind spots slowly grow larger and coalesce.
 Peripheral vision is usually lost first.
 Vision loss occurs so gradually that it is often not
noticed until much of it is lost.
 Because central vision is generally lost last, many
people develop tunnel vision:
 they see straight ahead perfectly but become blind in
all other directions.
 If glaucoma is left untreated, eventually even tunnel
vision is lost, and a person

 Closed-Angle Glaucoma:
 If eye pressure rises rapidly in closed-angle glaucoma
(acute closed-angle glaucoma),
 people typically notice an abrupt onset of severe eye
pain and
 headache,
 redness,
 blurred vision,
 rainbow-colored halos around lights, and
 sudden loss of vision.
 They may also have nausea and vomiting as a
response to the increase in eye pressure.

 Acute closed-angle glaucoma is considered a medical

emergency, because people can lose their vision as quickly as
2 to 3 hours after the appearance of symptoms if the
condition is not treated.
 People who have had open-angle or closed-angle glaucoma
in one eye are likely to develop it in the other.

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 -To enumerate
Screening and Diagnosis
In detail about Explains the Listens and Black What are the
 Because the most common types of glaucoma can cause
5min Diagnosis of slow and silent loss of vision over years, early detection investigation discusses board diagnostic
of the disease is extremely important. All people at high technique for measures of
Glaucoma.
risk of glaucoma should have a comprehensive eye
glaucoma . Glaucoma?
examination every 1 to 2 years.

There are four parts to a comprehensive eye examination

for glaucoma.
 First, pressure in the eye is measured. This measurement
is taken painlessly with an instrument called a tonometer
.
 In general, eye pressure readings of greater than 20 to 22
millimeters of mercury (mm Hg) are considered higher
than normal.
 But measuring eye pressure is not enough, because a
third or more of people with glaucoma have eye pressure
in the average range. So doctors also use an
ophthalmoscope and a slit lamp to look for changes in the
optic nerve that indicate damage caused by glaucoma
 In addition, visual field (peripheral vision) testing allows
a doctor to detect blind spots. Most often, visual field
testing is done with a machine that determines the
person's ability to see small dots of light in all areas of the
visual field.
 Finally, doctors may also use a special lens to examine
the drainage channels in the eye, a procedure known as
gonioscopy. The gonioscope allows the doctor to
determine whether the glaucoma is of the open-angle or
closed-angle type.

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 -To discuss in
detail about Treatment Explains Listens chart Explain the
15min the treatment  Once a person loses vision because of glaucoma, the loss Notes taking. treatment
is permanent.
modalities of modalities of
 But if glaucoma is detected, proper treatment can
prevent further vision loss. So the goal of glaucoma Glaucoma.
glaucoma.
treatment is to prevent the onset of vision loss or stop its
progression.
 Treatment of glaucoma is lifelong.
 It involves decreasing eye pressure by increasing fluid
drainage out of the eyeball or by reducing the amount of
fluid produced inside the eyeball.
 Some people with high eye pressure who do not have
signs of optic nerve damage (known as glaucoma
“suspects”) can be monitored closely without treatment.
 Eye drops and surgery are the main treatments for open-
angle and closed-angle glaucomas.
 Eye drops containing beta-blockers, prostaglandin-like
compounds, alpha-adrenergic agonists, carbonic
anhydrase inhibitors, or cholinergic drugs are commonly
used to treat glaucoma.
 Most people with open-angle glaucoma respond well to
these drugs. These drugs are also used for people with
closed-angle glaucoma,
 although surgery, not eye drops, is the main treatment.
 Glaucoma eye drops are generally safe, but they may
cause a variety of side effects.
 People need to use them for the rest of their lives, and
regular check-ups are necessary to monitor eye pressure,
optic nerves, and visual fields.

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  Sometimes a kind of diuretic (osmotic diuretic) given by
mouth or by vein is also used briefly to help decrease eye
pressure rapidly in acute closed-angle glaucoma.
 Surgery may be needed if eye drops cannot effectively
control eye pressure, if a person cannot take eye drops,
or if people develop intolerable side effects from the eye
drops.
 Laser surgery can be used to increase drainage in people
with open-angle glaucoma (laser trabeculoplasty) or to
make an opening in the iris (laser peripheral iridectomy
or iridotomy) in people with acute closed-angle
glaucoma.
 Laser surgery is done in the doctor's office or in a
hospital or clinic.
 Anesthetic eye drops are used to prevent pain.
 People are usually able to go home the same day of any of
these surgical procedures.
 Glaucoma filtration surgery is the other form of surgery
doctors use to treat glaucoma. With traditional glaucoma
filtration surgery, doctors manually create a new
drainage system (trabeculectomy or tube shunt) to allow
fluid to bypass the clogged or blocked canals and filter
out of the eye.
 Glaucoma filtration surgery is generally performed in a
hospital.
 Newer filtration procedures (viscocanalostomy and
Trabectome) remove only part of the drain to enhance
the outflow of fluid. People are usually able to return
home the day of the procedure.

The most common complication of glaucoma laser surgery

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is
 a temporary increase in eye pressure, which is treated
with glaucoma eye drops.
 Rarely, the laser used in laser surgery may burn the
cornea, but these burns usually heal quickly.
 With laser and glaucoma filtration surgery,
inflammation and bleeding within the eye may occur
but are usually short-lived.
 Glaucoma filtration surgery may occasionally lead to
double vision, cataracts, or infection.
 Because severe closed-angle glaucoma is a medical
emergency, doctors may use very strong and fast-acting
drugs that affect the eye pressure more rapidly than the
standard eye drops or surgery. Doctors may use glycerin
or acetazolamide or DIAMOX pills or drugs given by vein
(such as mannitol) if they think the eye is vulnerable to
high pressure. Eye drops are also given as soon as
possible.
 Emergency surgery is performed if necessary.
 The treatment of glaucoma caused by other disorders
depends on the cause. For infection or inflammation,
antibiotic, antiviral, or corticosteroid eye drops may
provide a cure.
 A tumor obstructing fluid drainage should be treated, as
should a cataract that is so large it causes eye pressure to
rise.
 High eye pressure that results from cataract surgery is
treated with glaucoma eye drops that reduce eye
pressure.
 If eye drops do not work, glaucoma filtration surgery can
be performed.

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 Drugs Used to Treat Glaucoma
Drug Selected Side Effects Comments

Beta-blockers

Betaxolol Shortness of breath in How they work:

people with asthma or other Decrease aqueous
KERLO lung disorders that cause humor production
wheezing
NE Given as: Eye drop
Slow heart beat

Prostaglandin-like compounds

Bimatopr Increased eye and skin How they work:

ost pigmentation Increase aqueous
Lumigan humor outflow
Elongated and thickened
eyelashes Given as: Eye drops

Muscle, joint, and back pain

Alpha-adrenergic agonists

Apraclon Increase in blood pressure How they work:

idine or heart rate Decrease aqueous

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Iopidine Abnormal heart rhythm humor production and
increase aqueous
humor outflow

Carbonic anhydrase inhibitors

Acetazola Acetazolamide Diamox How they work:

mide and methazolamide: Fatigue Decrease aqueous
Diamox humor production
Altered taste
Given as:
Loss of appetite Acetazolamide
Diamox

Cholinergic drugs

Carbacho Hinder the eyes' ability to How they work:

l Miostat adapt to darkness Increase aqueous
humor outflow
Pupil constriction
Given as: Eye drops

Osmotic diuretics

Glycerin Increase urine production How they work:

Increase concentration
Mannitol Can cause serious effects in of salts in the blood,
some people (for example, which draws fluid from
dysfunction of the brain or the eye by osmosis
nerves) by changing body
salt (electrolyte) levels or Given: By mouth or by
may cause dehydration vein

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5min

NURSING MANAGEMENT OF GLAUCOMA

 Administer medicine in time
 Take precaution before administering medication
 Assist the patient in daily living activities.
3min

SUMMARY
Glaucoma is optic nerve damage (often, but not always, associated
with increased eye pressure) that leads to progressive, irreversible
loss of vision. Almost 3 million people in the United States and 14
million people worldwide have glaucoma. Glaucoma is the third
leading cause of blindness worldwide and the second leading cause of
blindness in the United States, where it is the leading cause of
2min blindness among blacks and Hispanics.

CONCLUSION
At the end of the class the student have gain knowledge about
pre eclampsia and its types, risk factors,clinical features,
3min
diagnosis, and its management.

EVALUATION
Short answer question 5 x 3 = 15.
1) Glaucoma
2) Management of patient with glaucoma.
2min 3) Treatment and nursing management of glaucoma.

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ASSIGNMENT
Write an assignment on ophthalmic medication

BIBLIOGRAPHY

1. Student’s bibliography

 Brunner and suddarths, TEXT BOOK OF MEDICAL

SURGICAL NURSING, 10TH edition, Lippincott Williams
and Wilkins.

 Lippincott, “MANNUAL OF NURSING PRACTICE”, 8th

edition, Lippincott Williams and Willkins.

2. Teachers bibliography

 Brunner and suddarths, TEXT BOOK OF MEDICAL

SURGICAL NURSING, 10TH edition, Lippincott Williams
and Wilkins.

 Lippincott, “MANNUAL OF NURSING PRACTICE”, 8th

edition, Lippincott Williams and Willkins.

 Long & Phipps -Medical Surgical Nursing

 Luckman &Sorenson -Medical Surgical Nursing

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