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GLAUCOMA

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Definition

Glaucoma is a group of eye diseasescharacterized by increased pressure

within the eye and resulting loss ofvision

Vision loss is caused by damage tothe optic nerve caused by congestionof aqueous humor in the eye

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Classification

Narrow-Angle or Angle-Closure

or Pupillary Block Glaucoma(Acute Type)

Open-Angle Glaucoma (ChronicType)

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Narrow-Angle or Angle-Closure orPupillary Block Glaucoma

(Acute)Closed-angle glaucoma may progress

gradually without manifesting anysymptoms until long after it has set in.

iris blocks intraocular fluid from draining properly.

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Open-Angle Glaucoma (Chronic)

Asymptomatic

Most common

Loss of peripheral vision first

Leads to total loss of vision (if leftuntreated)

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Incidence

2/1000 Americans have Acute-AngleGlaucoma ; 2.2 Million has Chronic type

(in the US)Ages 40 and above

More on males

Afro-American and Asians

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Risk Factors

Family HistoryAfrican-American and AsiansOlder age

Diabetes mellitusCardiovascular diseaseMigraine syndromes

MyopiaEye TraumaProlonged use of topical or systemic corticosteroids

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Caused by….

Increase in IOP that surrounds the eye ----imbalance of aqueous humor productionand drainage

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Signs and Symptoms

Cloudy or haloed vision Nausea or headachesLight sensitivity (photophobia)Excessive blinking (blepharospasm)Crossed or out-turned eyes (strabismus)One eye becoming larger than the otherExcessive tearing (epiphora)Decreased vision (amblyopia)

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PathopysiologyPrecipitating Factors:

- DM, CVD- Migraine- Myopia- Eye trauma- Prolonged use ofsteroids

PredisposingFactors:

- Family history- Age- Race- Gender

Changes in theaqueous humor

flow system

*Impaired blood flowin the optic nerve

*Increase IOP

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Atrophy of the Optic Nerve

Progressive Loss of Vision

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Nursing Diagnosis

Anxiety related to reality of loss of vision asevidenced by expressed feelings regardingchanges in life events.

Disturbed visual sensory perception relatedto altered sensory perception as evidenced by

progressive loss of visual field.

Risk for physical injury related to alteredvisual perception as evidenced progressiveloss of vision.

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Diagnostic Tests

Tonometry

PachymetryGonioscopy

OphthalmoscopyVisual Field Screening

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Ophthalmoscopy

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Gonioscopy

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Tonometry

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Pachymetry

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Medical Management…….

Prevention of optic nervedamage

By: Pharmacotherapy andSurgery

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Pharmacologic Treatment

Parasympathomimetic agentsSympathomimetic agents

Beta-adrenergic blocking agentsHyperosmotic agentsCarbonic anhydrase inhibitorsAlpha2-adrenoreceptor agonists

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SurgeryLaser iridotomy

Laser trabeculoplasty Trabeculectomy

Viscocanalostomy

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Glaucoma Prognosis

Irreversible blindnessAcute symptoms are manageableto preserve visionEarly diagnosis and treatment isthe key