Definition • It is not one disease but rather a group of disorder characterized by 1.

Increased IOP and the

3. Etiology • It is related to the consequences of elevated IOP. • A proper balance between the rate of
aqueous production and rate of aqueous reabsorption is essential to maintain the IOP normal limits. •
When the rate of inflow is greater than rate of outflow, IOP can rise above the normal limits. If IOP
remains elevated, permanent vision loss occurs.

4. Risk factors • Age • Race • Family history of glaucoma • Medical conditions- Diabetes mellitus,
Cardiovascular disease • Physical injuries - Eye trauma • Near sightedness • Corticosteroids use • Eye
abnormalities • • Thin cornea

5. Types 1. Open angle glaucoma: Usually bilateral, but one eye may be more severely affected than the
other. The anterior chamber angle is open and appears normal. 2. Angle closure glaucoma: Obstruction
in aqueous humor outflow due to the complete or partial closure of the angle from the forward shift of
the peripheral iris to the trabecula. The obstruction results in an increased IOP.

6. Open-Angle Glaucoma 1)Primary open-angle glaucoma (POAG):Optic nerve damage, visual field
defects, IOP >21 mm Hg. May have fluctuating IOPs. Usually no symptoms but possible ocular pain,
headache, and halos. 2)Normal tension glaucoma: IOP </- 21 mm Hg. Optic nerve damage, visual field
defects. 3)Ocular hypertension: Elevated IOP. Possible ocular pain or headache.

7. Angle closure glaucoma (Pupillary Block) • Acute angle-closure glaucoma (AACG): Rapidly progressive
visual impairment, periocular pain, conjunctival hyperemia, and congestion. Pain may be associated with
nausea, vomiting, bradycardia, and profuse sweating. Reduced central visual acuity, severely elevated
IOP, corneal edema. Pupil is vertically oval,fixed in a semidilated position, and unreactive to light and
accommodation. • Subacute angle-closure glaucoma: Transient blurring of vision, halos around lights;
temporal headaches and/or ocular pain; pupil may be semidilated. • Chronic angle-closure glaucoma:
Progression of glaucomatous cupping and significant visual field loss; IOP may be normal or elevated;
ocular pain and headache.

Clinical manifestation • chronic open-angle glaucoma : 1. Loss of peripheral vision due to compression of
retinal rods and nerve fibers . 2. Halos around lights as a result of corneal edema. 3. Mild aching in the
eyes caused by increased IOP 4. Reduced visual acuity, especially at night, not correctable with glasses.

9. C/M acute angle-closure glaucoma 1. Inflammation, Red, painful eye caused by an abrupt elevation of
IOP. 2. Sensation of pressure over the eye due to increased IOP. 3. Moderate papillary dilation
nonreactive to light. 4. Cloudy cornea due to compression of intraocular components 5. Blurring and
decreased visual acuity due to aberrant neural conduction. 6. Photophobia due to abnormal intraoccular
pressures. 7. Halos around lights due to corneal edema. 8. Nausea and vomiting caused by increased
IOP.

10. Diagnostic evaluation • History collection. • Physical examination. • Visual acuity examination . •
Tonometry . • Ophthalmoscopy. • Slit lamp microscopy. • Gonioscopy – it is performed with the head
positioned in the slit lamp (the special microscope used to look at the eyes). After numbing the eye with
drops, a special contact lens is placed directly on the eye and a beam of light is used to illuminate the
angle. ... Examination of both eyes typically takes a few minutes • Visual field perimetry . • Fundus
photography.

11. Management • Lifelong therapy is almost always necessary because glaucoma cannot be cured. Drug
therapy: 1. Beta blockers - timolol 2. Alpha adrenergic agonist- brimonidine 3. Cholinergic agents –
pilocarpine – increases A.Q outflow 4. Carbonic anhydrase- acetazolamide 5. Adrenergic aganost -
Epinephrine, to reduce I0P by improving aqueous outflow 6. Prostaglandins - latanoprost, to reduce
intraocular pressure.

12. Cont., Treatment for acute angle-closure glaucoma is an ocular emergency requiring immediate
intervention to reduce high IOP including: 1. I.V. mannitol (20%) or oral glycerin (50%), to reduce IOP by
creating an osmotic pressure gradient between the blood and intraocular fluid 2. Steroid drops- to
reduce inflammation 3. Acetazolamide, a carbonic anhydrase inhibitor, to reduce IOP by decreasing the
formation and secretion of aqueous humor 4. Pilocarpine - to constrict the pupil, forcing the iris away
from the trabeculae and allowing fluid to escape 5. timolol, a beta-blocker - to decrease IOP. 6. Narcotic
analgesics, to reduce pain if necessary.

13. Surgical therapy • Argon laser trabecuoplasty : laser burns are applied to the inner surface of the
trabecular meshwork to open the intratrabecular spaces and widen the canal of Schlemm, thereby
promoting outflow of aqueous humor and decreasing IOP. • laser iridotomy : for pupillary block
glaucoma, an opening is made in the iris to eliminate the pupillary block.

14. Filtering procedures- Trabeculectomy • Trabeculectomy is the standard filtering technique used to
remove part of the trabecular meshwork. Surgeon used to create an opening or fistula in the trabecular
meshwork to drain aqueous humor from the anterior chamber to the subconjunctival space into a bleb
(fluid collection on the outside of the eye), thereby bypassing the usual drainage structures. This allows
the aqueous humor to flow and exit by different routes (ie, absorption by the conjunctival vessels or
mixing with tears).

15. Drainage implants or shunts • Drainage implants or shunts are open tubes implanted in the anterior
chamber to shunt aqueous humor to the episcleral plate in the conjunctival space. • These implants are
used when failure has occurred with one or more trabeculectomies in which antifibrotic agents were
used. A fibrous capsule develops around the episcleral plate and filters the aqueous humor, thereby
regulating the outflow and controlling IOP.

16. Trabectome • trabectome surgery stabilizes the optic nerve and minimizes further visual field
damage. The surgery is performed through a small incision and does not require creation of a
permanent hole in the eye wall or an external filtering bleb or an implant.

17. Glaucoma complication Blindness • Nursing intervention 1. Encourage patient compliance by

18. Nursing Assessment • The patient should beassessed for loss of both central and peripheral vision,
discomfort, understanding of disease and compliance with treatment regimen, and ability to conduct
activities of daily living.

19. Nursing Diagnosis. • Nursing diagnoses may include the following: • Acute pain related to increased
intraocular pressure . • Disturbed sensory perception: visual related to altered sensory reception. • Self-
care deficit related to decreased vision. • Anxiety related to partial or total visual loss. • Risk for injury
related to decreased vision. • Impaired home maintenance related to decreased vision. • Deficient
knowledge related to medical regimen, disease process due to no prior experience.

20. Nursing planning • Planning for nursing interventions needs to take into account the patient’s level
of understanding of disease process and medical regimen and ability to comply with the time-consuming
medication regimen. • The goal of nursing care for the glaucoma patient is to prevent further visual loss
and to promote comfort if the patient is experiencing pain as in acute glaucoma. • The patient who
needs surgical intervention has additional goals.

21. Nursing Intervention • 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. • 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.

22. Evaluation  Patient goals are met if the patient does the following: Maintains an acceptable level of
comfort 1. Has no further loss of vision 2. Is able to care for self with assistance if needed 3. Expresses
concerns and anxieties 4. Does not suffer injury as a result of the visual impairment 5. Is able to manage
home maintenance with assistance if needed 6. Demonstrates correct instillation of eye medications 7.
Is able to verbalize understanding of condition and treatment.