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What is glaucoma?
A group of eye disorders
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3 characteristics of glaucoma?
- 1. Increased IOP and consequences of elevated pressure
- 2. Optic nerve atrophy
- 3. Peripheral visual field loss
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What is the second leading cause of blindness?
Glaucoma
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Leading cause of blindness in what racial group?
African Americans
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Etiology of glaucoma is related to the ____________ of __________ ________
Consequences of elevated IOP.
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Balance between _______ _______ and __________ needed for normal level of IOP
Aqueous production and reabsorption
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Glaucoma is related to elevation of?
IOP
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What is Primary open-angle glaucoma (POAG)?
Outflow of aqueous humor is ↓ in trabecular meshwork
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POAG represents what % of primary glaucoma cases?
90%
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What is Primary angle-closure glaucoma (PACG)?
Angle closure ↓the flow of aqueous humor
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PACG represents what % of primary glaucoma cases?
10%
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What are the clinical manifestations of POAG (3)
- No symptoms
- Unnoticed until all peripheral vision is lost
- Usually noted with increase in MVA’s
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What are the Clinical Manifestations of POAG?
- Sudden pain around eyes
- Nausea and vomiting
- Seeing colored halos around lights
- Blurred vision
- Ocular redness
- Corneal edema
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What is the application goniometry measurement of IOP?
10-22 mm/Hg
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What are the diagnostic test for glaucoma?
- Gonioscopy
- Peripheral and central vision test
- Ophthalmoscopy
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What is the collaborative care for chronic open-angle glaucoma?
- Drug therapy
- Argon laser trabeculoplasty
- Trabeculectomy
- Cyclocryotherapy
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What are the drug therapies for glaucoma?
Beta Blockers, miotics, CAI’s
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What drug reduces IOP?
Betoptic
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What is the MOA of Miotics?
- Causes pupil to constrict, draws iris away from cornea, allowing
- drainage out of Canal of Schlemm
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what drug decreases aqueous humor, decreases IOP?
CAI
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When is Argon Laser Trabeculoplasty used for?
- Therapeutic option to lower IOP
- Laser stimulates scarring and contraction of trabecular meshwork,
- increases outflow of aqueous humor
- Option when meds ineffective
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What is a Trabeculectomy
- Removal of part of iris and trabecular meshwork
- Aqueous humor percolates out area of missing iris
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What is cyclocryotherapy?
- the procedure that freezes part of a ciliary tissue causing local
- destruction and lowers aqueous production?
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What are the drug treatments used for Acute angle-closure glaucoma?
- Miotics - Pilocarpine
- Oral/IV hyperosmotic diuretics
- Diamox, Mannitol
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List 2 procedures used for acute angle-closure glaucoma
- Laser peripheral iridotomy
- Surgical iridectomy: restores drainage of aqueous humor
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List Nursing Assessments for clients with glaucoma
- Assess patient’s ability to understand and comply with treatment
- Assess patient’s psychologic reaction to sight-threatening disorder
- Assess family for patient care
- Assess visual acuity, visual fields, IOP
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List Nursing Diagnoses for glaucoma patients
- Noncompliance
- Risk for injury
- Self-care deficits
- Acute pain
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What are some of the expected goals for treating pts with glaucoma?
- No progression of visual loss
- No injury
- Understand disease process and rationale
- Comply with all aspects of therapy
- No postoperative complications
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List 3 Nursing Implementations for glaucoma pts.
- Teach patient and family risks of glaucoma
- Stress importance of early detection
- Ophthalmologic examination
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4 acute interventions for glaucoma patients
- Administer medication to lower IOP
- Darken the environment
- Apply cool compresses
- Provide quiet space
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3 Ambulatory and home care nursing interventions
- Encourage patient to follow therapy
- Educate on disease process and treatments
- Discuss follow-up appointments
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List 4 Expected outcomes
- No further loss of vision
- Comply with recommended therapy
- Safely function in environment
- No pain from disease and surgery
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How long does a glaucoma patients need to have medical supervision?
for the rest of their life
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Can a patient stop using his eye drops when the symptoms go away?
No
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How long will a glaucoma patient need to be treated?
Tx is usually lifelong
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List pt teaching used for eye drops
- May have blurred vision initially
- Improves with use
- Avoid driving for 1-2 hours after miotics
- Press lacrimal duct for 1 minute after insertion…prevents systemic absorption
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Do not use these drugs if you have glaucoma.
- Avoid use of mydriatics or cyclopegic drugs
- Atropine, belladonna, dilates pupil
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