Glaucoma

Glaucoma 150 150 Tony Guo

Glaucoma

 

  • A group of disorders characterized by
    • Increased IOP and consequences of elevated pressure
    • Optic nerve atrophy 
    • Peripheral visual field loss
  • Second leading cause of blindness in U.S.
  • Leading cause of blindness in African Americans 
    • Many are unaware
    • Incidence increases with age
    • Preventable
    • Genetic traits

Etiology and pathophysiology

  • Primary open-angle glaucoma (POAG)
    • Most common type of glaucoma
    • Outflow of aqueous humor is ↓ in trabecular meshwork
    • Develops slowly
    • No symptoms
    • Unnoticed until peripheral vision is severely compromised
  • Primary angle-closure glaucoma (PACG)
    • Angle closure ↓ the flow of aqueous humor 
    • Caused by age, pupil dilation
    • Possibly drug induced

Clinical manifestation

  • PACG
    • Sudden onset 
      • Excruciating pain in or around eyes
      • Nausea and vomiting
      • Seeing colored halos around lights
      • Blurred vision
      • Ocular redness
    • IOP elevated in glaucoma
      • Normal IOP 10 to 21 mm Hg
      • Open-angle glaucoma 22 to 32 mm Hg
      • Acute angle-closure glaucoma >50 mm Hg

Interprofessional Care

  • Acute angle-closure glaucoma
    • Miotics 
      • Decreased visual acuity in dim light
    • Oral/IV hyperosmotic 
    • Laser peripheral iridotomy 
    • Surgical iridectomy

 

Nursing Assessment

  • Patient’s ability to understand and comply with treatment
  • Patient’s psychologic reaction to sight-threatening disorder
  • Family reaction and support
  • Caregiver availability

Nursing diagnoses

  • Risk for injury related to visual acuity deficits
  • Self-care deficits related to visual acuity deficits
  • Acute pain related to pathophysiologic process and surgical correction
  • Noncompliance related to the inconvenience and side effects of glaucoma medications

Planning

  • Expected Goals
    • No progression of visual impairment
    • Understanding of disease process and rationale for therapy
    • Compliance with all aspects of therapy 
    • No postoperative complications

Nursing implementation

  • Health Promotion
    • Teach patient and family risks of glaucoma, and that it increases with age
    • Emphasize importance of early detection and treatment
    • Provide ophthalmologic examinations
  • Acute Care
    • Administer medication to lower IOP
    • For surgical patients
      • Provide postop instructions
      • Relieve discomfort
  • Ambulatory Care
    • Remind patient to follow therapy
    • Teach about 
      • Disease process 
      • Treatment options and their rationale 
      • Information about purpose, frequency, and technique for administration of anti-glaucoma drugs

Evaluation

  • Expected Outcomes
    • No further loss of vision
    • Compliance with recommended therapy
    • Safe functioning in the environment
    • Pain relief from disease and surgery

Gerontologic considerations

  • Tend to special needs of older adult
    • Caution about potential drug interactions that occur with systemic illnesses and their treatments
    • Teach that occluding puncta will limit systemic absorption of glaucoma medications

 

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