Glaucoma

TREATMENT (Ney, 2016; Turkoski, 2012
1. Pharmacological (Ney, 2016; Turkoski, 2012)
  1. Medications that decrease outflow of aqueous humor
    1. Prostaglandin analogs
    2. Beta-adrenergic antagonists
    3. Alpha2-adrenergic agonists
    4. Carbonic anhydrase inhibitors
    5. Miotics
    6. GOAL
      1. Reduce adverse effects
      2. Avoid vision loss
  2. Medications that increase outflow of aqueous humor
    1. Alpha Antagonist
      1. Dipivefrin
      2. Brimonidine
      3. Cholinomimetics
        Combination Products
        Combigan
        Cosopt
2. Non-pharmacological
  1. Surgical Treatment (To reduce IOP) (Ney, 2016)
    1. Laser Trabeculoplasty
      1. Reduces IOP by creating better outflow of aqueous humor through the remodeling of the trabecular meshwork
    2. Trabeculectomy
      1. Surgical fistula is created to drain aqeous humor into subconjunctival pocket
PATHOGENSIS (Peate & Jones, 2014; Nowak et al., 2015)
1. What is Glaucoma?
  1. Optic Neuropathy that results in Visual Impairment
2. Build up of fluid (aqueous humor)
  1. Ocular Hypertension
    1. Increased damage to blood vessels and optic nerve
      1. Results in axon loss, retinal ganglon cell death (RCG), excavated appearance of the optic nerve head
DIAGNOSIS
1. Medical Diagnosis (Peate & Jones, 2014; Ney, 2016; Turoski, 2012; Lewis et al., 2014)
  1. ophthalmologist examination
    1. Evidence of increased cup-to-disc ratio
    2. Use of Optical coherence tomography (OCT)
    3. Visual Field testing
    4. Conjunctival injection (red eye)
    5. Corneal oedema
    6. Mid-dilated, non-reactive pupil.
    7. Glaucoma Test
      1. 1. Tenometry
        2. Perimetry
        3. Direct Opthalmoscopy
        Measures the IOP and examines the head of optic nerve, aqueous humor, and cornea
        4. Gonioscopy
        Uses a slit lamp or operating microscope to gain a view of the iridocorneal angle
        Measures and identifies defects in visual field
        Measures IOP and determines how much pressure it needs to flatten central cornea. Often used with Direct Opthalmoscopy
2. Non Medical Diagnosis (Peate & Jones, 2014; Ney, 2016; Turoski, 2012; Lewis et al., 2014)
  1. Patient History
    1. History of Blurring vision with haloes
    2. Assessment of Ocular Pain
      1. Normal IOP: 12-22 mm Hg
        Ocular Hypertension: IOP greater than 22 mm Hg
    3. Past eye surgery and eye injury
RISK FACTORS (Ney, 2016; Perry, 2014;Lewis et al., 2014)
1. Family History
2. Individuals of African Origin
3. Diabetes
4. Ocular Hypertension (greater than 21 mmHg)
5. Central Cornea Thickness
6. Those over the age of 65 years old
7. long-term use of steroid eye drops
TYPES OF GLAUCOMA (Peate & Jones, 2014; Turkoski, 2012)
1. Primary Open Angled Glaucoma
  1. Signs and Symptoms
    1. No symptoms of pain occurs as result of the optic nerve damage
    2. Shadow in vision
    3. Decreased visual acuity
  2. Effects
    1. Extensive amount of vision loss occurs
    2. Elevated Intraocular Pressure
    3. People often lose their vision even before they are aware of their condition.
  3. Causes
    1. Trabecular Meshwork (drainage angle) is partially blocked
    2. Slower fluid drainage out of the eye
    3. The angle between the cornea and iris is open (Turkoski, 2012).
  4. Insidious development
    1. It is the most common type of glaucoma
2. Primary Closed Angled Glaucoma
  1. Signs and Symptoms
    1. Pains
    2. Blurred Vision
    3. Colored Haloes
    4. Malaise
  2. Effects
    1. Elevated Intraocular Pressure
  3. Causes
    1. Iris Bulges
    2. Decreased fluid drainage
    3. Optic nerve damage
    4. The angle between the cornea and iris is very narrow
  4. Acute and gradual development
    1. It is a medical emergency
Signs and Symptoms (NHS, 2016; Lewis et al., 2014)
1. uveitis
2. Cogenital Eye Problem
3. vision loss
4. blurred vision
5. colored rings around lights
6. redness in the eye
7. Nausea
8. Vomiting
9. a "hazy" appearance to the eye
COLLABORATIVE CARE (CA0, 2014; Lewis et al., 2014)
1. Age 65 and over must take eye exam annually
2. Keep IOP low to prevent optic nerve damage
3. Acute care for angle closed glaucoma
  1. Topical cholinergic agent
  2. Hyperosmotic agent
  3. Laser peripheral iridotomy
  4. Surgical iridotomy
4. Client Centered Care (RNAO, 2002).
  1. Involve clients throughout the caring and service process.
  2. Maintain respect and value for clients through listening and practicing openness.
  3. The client’s goals are central to the coordination, continuity, and consistency of care
  4. Care plan must be aimed at achieving the clients’ desired goals and needs
5. Collobrate with interprofessional team such as optometrist to create an action plan
NURSING INTERVENTION (Parikh & Parikh, 2011)
1. Enhance adherence to medications
  1. Reduce the number of medication through combination therapy
2. Demsonstrate effective eye drop instillation
3. Providing education on glaucoma
4. Encourage physical activitiy
5. Stress coping strategies
6. Decrease alochol intake
7. Decrease caffine intake
ANTAOMY OF THE EYE (Peate & Jones, 2014)
1. Cornea, Iris and Pupil
2. Aqueous humor, Trabecular Meshwork and lens
3. Retina and Sclera
4. Rods and Cones
By: Hamdi Mohamed & Asha Ahmed

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	Created by Hamdi Mohamed about 7 years ago