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Glaucoma

Glaucoma is a group of eye disorders leading to optic nerve damage and potential blindness, often associated with increased intraocular pressure (IOP). There are several types of glaucoma, including primary open-angle, angle-closure, normal-tension, secondary, and congenital glaucoma, each with distinct causes and symptoms. Treatment options include medical management with medications and surgical procedures to reduce IOP and prevent vision loss.

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Krishna Gandhi
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2 views

Glaucoma

Glaucoma is a group of eye disorders leading to optic nerve damage and potential blindness, often associated with increased intraocular pressure (IOP). There are several types of glaucoma, including primary open-angle, angle-closure, normal-tension, secondary, and congenital glaucoma, each with distinct causes and symptoms. Treatment options include medical management with medications and surgical procedures to reduce IOP and prevent vision loss.

Uploaded by

Krishna Gandhi
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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GLAUCOMA

Introduction
Glaucoma is a group of eye disorders characterized by progressive damage to the optic
nerve, often (but not always) associated with increased intraocular pressure (IOP). If
untreated, glaucoma can lead to irreversible blindness.

Anatomy & Physiology Review


Aqueous humor is produced by the ciliary body and flows through the pupil into the
anterior chamber, then drains through the trabecular meshwork and canal of Schlemm.
Imbalance in production and draina
drainage increases IOP. Normal eye pressure is between 10
and 21 mm of Hg.

Types of Glaucoma
Angle Glaucoma (POAG): This is the most common form of
1. Primary Open-Angle
glaucoma and is often associated with a slow, progressive rise in IOP and
painless. The drainage angle for
formed by the iris and cornea remains open, but
the trabecular meshwork becomes less efficient at draining aqueous humor,
leading to increased pressure.

2. Angle-Closure
Closure Glaucoma (ACG): The he angle between the iris and the cornea is
narrowed or blocked, which causes a rapid and severe increase in IOP. This is considered
an ocular emergency.
3. Normal-Tension Glaucoma: Normal tension glaucoma (NTG) is a type of glaucoma
where the optic nerve is damaged, even though intraocular pressure (IOP) remains within
the normal range. This condition is also known as low-tension glaucoma or low-pressure
glaucoma

4. Secondary Glaucoma: Secondary glaucoma is a type of glaucoma where increased


eye pressure is caused by an underlying condition or injury, unlike primary glaucoma
where the cause is unknown. It can result from various factors, including eye trauma,
inflammation, certain medications, or complications from other eye diseases.

5. Congenital Glaucoma: Congenital glaucoma is a condition present at birth or


developing shortly after, where the eye's drainage system is abnormally developed,
leading to increased pressure within the eye. This elevated pressure can damage the optic
nerve, potentially causing irreversible vision loss if left untreated.

Risk Factors
- Age > 40 years
- Family history
- Diabetes mellitus
- Hypertension
- Prolonged corticosteroid use
- Trauma

Pathophysiology
Signs & Symptoms
Open-Angle Glaucoma:
- Gradual loss of peripheral vision
- No pain or early symptoms

Angle-Closure Glaucoma:
- Severe eye pain
- Nausea, vomiting
- Blurred vision, halos around lights
- Red eye

Diagnosis
- Tonometry: Measures IOP
- Ophthalmoscopy: Checks optic nerve damage
- Perimetry: Visual field testing
- Gonioscopy: Examines drainage angle
- Pachymetry: Measures corneal thickness

Treatment
Medical management:
a. Prostaglandin Analogs
 Examples: Latanoprost, Bimatoprost, Travoprost
 Mechanism: Increase outflow, the pathway through which fluid drains from the eye.
 Side Effects: Darkening of iris color, eyelash growth, ocular irritation.

b. Beta-Blockers
 Examples: Timolol, Betaxolol
 Mechanism: Decrease aqueous humor production.
 Side Effects: Bradycardia, hypotension, bronchospasm (especially in asthmatic
patients), fatigue.

c. Alpha Agonists
 Examples: Brimonidine, Apraclonidine
 Mechanism: Decrease aqueous humor production and increase outflow.
 Advantages: Side Effects: Drowsiness, dry mouth, allergic reactions.

d. Carbonic Anhydrase Inhibitors (CAIs)


 Examples: Dorzolamide, Brinzolamide (topical), Acetazolamide (oral)
 Mechanism: Inhibit carbonic anhydrase, which decreases aqueous humor
production.
 Side Effects: Bitter taste, ocular irritation (topical), systemic effects like fatigue and
tingling (oral).
SURGICAL MANAGEMENT:

A. Laser trabeculoplasty (POAG)


(POAG): Laser trabeculoplasty is a common glaucoma
treatment, particularly for open
open-angle
angle glaucoma (POAG), which involves using a laser to
improve the drainage of fluid from the eye, thereby reducing eye pressure. Laser
trabeculoplasty works by increasing the outflow of fluid from the eye, which helps to
reduce the pressure inside the eye (intraocular pressure)
pressure).

B. Laser Iridotomy: a procedure that creates a small opening in the iris using a
laser to treat or prevent angle
angle-closure
closure glaucoma (ACG) by relieving pupillary block.
bloc
The
he iris (the colored part of the eye) can bulge forward and block the drdrainage
ainage
angle, leading to a build-up
up of pressure inside the eye. creates a small hole in the iris,
allowing fluid to flow more freely between the iris and lens, reducing the pressure.

C. Trabeculectomy : A surgical opening is created in the white of the eye (sclera) to


allow fluid to drain into a reservoir called a bleb. The new pathway helps to reduce the
build-up
up of fluid inside the eye, which causes glaucoma.

D. Drainage implants
Drainage implants, also known as glaucoma drainage devices or tube shunts, are small
surgical devices used to treat glaucoma by creating a new pathway for fluid to drain from
the eye, thereby reducing pressure
pressure. Creating a new drainage pathway:The The implant,
typically consisting of a tube connected to a plate, is inserted into the eye to create a new
route for fluid to drain from the anterior chamber (the space in front of the iris).
Nursing Management
- Monitor and document IOP and vision
- Administer medications correctly
- Educate on lifelong treatment importance
- Ensure correct eye drop technique
- Monitor medication side effects
- Provide emotional support

Nursing Diagnosis
1. Impaired Visual Function related to increased intraocular pressure and optic nerve damage.
2. Risk for Injury related to impaired peripheral vision and potential falls or accidents.
3. Deficient Knowledge regarding glaucoma, treatment, and self-care measures.
4. Anxiety related to the diagnosis of glaucoma and potential vision loss.
5. Risk for Impaired Vision related to increased intraocular pressure and optic nerve damage
Anxiety related to potential vision loss, treatment uncertainties, and lifestyle changes

Patient Education
- Importance of adherence
- Avoid unprescribed steroids
- Regular eye exams
- Avoid straining
- Early screening for high-risk individuals

Complications
- Permanent vision loss
- Blindness
- Decreased quality of life

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