Modifiable Factors

Frequent use of
steroids
Previous Eye Injury
MYOPIA
Non-Modifiable Factors
Age
Genetics
Race
Lens hardens and inc in size,
with old age, trabecular
meshwork cells works less
efficiently
Resulting to build up
aqueous humour within
the anterior chamber of
the eye
Blocks aqueous flow
Predisposes to raise
intraocular pressure
Cells and ganglions
nerves of the retina
dries off
Retinal Ganglion
Ischemia due to
compression of
blood vessels of
retina
Deprivation of
nutrients to the eye
Diagnostic Exams:
1. Comprehensive
gaucoma exam
2. Tonometry
3. Gonioscopy
4. Opthalmoscopy
Results to clinically
progressive loss of
peripheral visual fields
GLAUCOMA
Glaucoma is a disease that damages the eyes optic nerve. The optic nerve is connected to the retina
a layer of light-sensitive tissue lining the back of the eye and is made up of many nerve fibers, like an
electric cable is made up of many wires. It is the optic nerve that sends signals from your retina to your
brain, where these signals are interpreted as the images you see.
CLASSIFICATIONS
1. Open-angle glaucoma
The most common form of glaucoma is called primary open-angle glaucoma. It occurs when the
trabecular meshwork of the eye gradually becomes less efficient at draining fluid. As this happens, your
eye pressure, called intraocular pressure (IOP), rises. Raised eye pressure leads to damage of the optic
nerve
Symptoms:
1. Tunnel Vision
2. Gradual Peripheral Vision loss
3. Gradual vision loss
2. Close-Angle Glaucoma
A less common form of glaucoma is closed angle (or narrow-angle glaucoma or angle-closure
glaucoma). Closed-angle glaucoma occurs when the drainage angle of the eye becomes blocked. The
pressure rises because the iris the colored part of the eye partially or completely blocks off the
drainage angle
Symptoms:
1. Severe eye or brow pain
2. Redness of the eye
3. Decreased or blurred vision
4. Seeing colored rainbows or halos
5. Headache
6. Nausea
7. Vomiting




GLAUCOMA
Normal-Tension Glaucoma

Their eye pressure is consistently below 21 mm Hg, but optic nerve damage and visual field
loss still occur. People with normal-tension glaucoma typically receive the same methods of
treatment used for open-angle glaucoma.

Chronic open-angle glaucoma
No early symptoms
Insidious visual impairment, blurring
Diminished accommodation
Gradual loss of peripheral vision (tunnel vision)
Mildly aching eyes
Halos around lights later with elevated IOP

Acute closed-angle glaucoma
Transitory attacks of diminished visual acuity
Colored halos around lights
Reddened eye with excruciating pain
Headache
Nausea and vomiting

Laboratory and diagnostic study findings
Tonometry detects elevated IOP (>10 to 20 mmHg)
Slit-lamp examination reveals abnormalities in the anterior vitreous humor.


What Causes Glaucoma:
Eye injury;
Inflammation of the eye;
Abnormal blood vessel formation from diabetes or retinal blood vessel blockage;
Use of steroid-containing medications (pills, eyedrops, sprays); or
Pigment dispersion, where tiny fragments or granules from the iris (the colored part of the eye)
can circulate in the aqueous humor (the fluid within the front portion of the eye) and block the
trabecular meshwork, the tiny drain for the eyes aqueous humor.

Risk Factors of Glaucoma

Age
Family history of glaucoma
African or Hispanic ancestry
Farsightedness or nearsightedness
Elevated eye pressure
Past eye injury
Having a thinner central cornea (the clear, front part of the eye covering the pupil and colored
iris)
Not having eye examinations when they are recommended
Conditions that affect blood flow, such as migraines, diabetes and low blood pressure

Medical Treatment

B Beta Blockers (Timolol)
It is thought that beta-blockers reduce intraocular pressure by slowing down the production of aqueous
humour in your eye. They are used once or twice a day and can cause side effects such as:
a stinging or burning sensation in your eye
dry eyes
itchy eyes
A Anhydrase Inhibitors
Carbonic anhydrase inhibitors reduce the amount of aqueous humour produced in your eye, which
reduces intraocular pressure. These drops are used two or three times a day and may cause:
a bitter taste in your mouth
nausea (feeling sick)
a dry mouth
eye irritation
Some types of carbonic anhydrase inhibitors you may be prescribed include:
brinzolamide
dorzolamide

H HyperOsmotics
Reduces the rate of formation of fluid

Some type of hyperosmotic drug:
Mannitol

M Miotics
Miotics facilitate the outflow of aqueous humour

Example: Pilocarpine


Sugical Treatment

1. Laser trabeculoplasty
A surgery called laser trabeculoplasty is often used to treat open-angle glaucoma. There are two types
of trabeculoplasty surgery: argon laser trabeculoplasty (ALT) and selective laser trabeculoplasty
(SLT).
During ALT surgery, a laser makes tiny, evenly spaced burns in the trabecular meshwork. The laser
does not create new drainage holes, but rather stimulates the drain to function more efficiently.

2. Laser iridotomy
Laser iridotomy is recommended for treating people with closed-angle glaucoma and those with very
narrow drainage angles. A laser creates a small hole about the size of a pinhead through the top part
of the iris to improve the flow of aqueous fluid to the drainage angle.

3. Peripheral iridectomy
When laser iridotomy is unable to stop an acute closed-angle glaucoma attack, or is not possible for
other reasons, a peripheral iridectomy may be performed

4. Trabeculectomy
In trabeculectomy, a small flap is made in the sclera (the outer white coating of your eye). A filtration
bleb, or reservoir, is created under the conjunctiva the thin, filmy membrane that covers the white
part of your eye.

5. Aqueous shunt surgery
If trabeculectomy cannot be performed, aqueous shunt surgery is usually successful in lowering eye
pressure.
An aqueous shunt is a small plastic tube or valve connected on one end to a reservoir (a roundish or
oval plate). The shunt is an artificial drainage device and is implanted in the eye through a tiny
incision.


Nursing Management for Glaucoma
Provide information regarding management of glaucoma
Discuss preoperative and postoperative teaching for immediate surgical opening of the eye chamber.
Prepare to administer carbonic anhydrase inhibitors IV or IM, to restrict production of aqueous humor.
Prepare to administer osmotic agents.
Discuss and prepare the client for surgical or laser peripheral iridectomy after the acute episode is
relieved.
Provide information about laser trabeculoplasty, if medication therapy proves ineffective.
Teach the client about specific safety precautions.
Instruct the client to avoid mydriatics such as atropine, which may precipitate acute glaucoma in a
client with closed-angle glaucoma.
Instruct the client to carry prescribed medications at all times.
Instruct the client to carry a medical identification card or wear a bracelet stating his type of glaucoma
and need for medication.
Instruct the client to take extra precautions at night (e.g. use of handrails, provide extra lighting to
compensate for impaired pupil dilation from miotic use)