Glaucoma
Glaucoma is defined as increse intaoccular pressure (IOP) more
then 25 mm of hg & characterizied by optic nerve dystrophy &
peripheral visual field loss.
Normal IOP less then 20 mm of hg
Etiology/ risk factor
a) Aging
b) Genetic / family history
c) Occular surgery
d) Hypertension
e) Injury or trauma
f) Secondary to occular infection
Classification :
A. Congenital Glaucoma
B. Acquired Glaucoma
C. Congenital Glaucoma : It’s Rare Condition When A Congenital Defect In The
Angle Of Anterior Chamber Obstructs The Out Flow Of Aqueous Humour.
D. Acquired Glaucoma: Developing During Life Span.
E. Primary Glaucoma
a) Primary Open Angle Glaucoma
b) Primary Close Angle Glaucoma
F. Secondary Angle Glaucoma: group of disorders in which the raised IOP
associated with a primary ocular or systemic disease
Primary Glucoma
Primary open angle glaucoma : it’s result from over production or
obstruction of aqueous fluid through the trabecular meshwork or canal of
schlemm’s canal.
Primary close angle glaucoma : it’s result from obstruction caused by
anatomically narrow angle between the anterior irsis & the posterior
corneal surface , closing the angle , absence of trabecular meshwork .
Pathophysiology :
Hyper Production Of Aqueous And Obstruction Of Outflow .
Increase Intra-ocular Pressure
Inhibit Blood Supply To Optic Nerve And Retina
Tissue Become Ischemic And Gradually Lose Of Function
Glaucoma
Clinical manifestation:
Mild to severe headache
Pain in eye
Increase IOP More then 25 mm of hg (POAG)
Increased IOP More Then 40-70 Mm Of Hg
Photophobia
Visual Disturbance
Corneal Edema
Nausea vomiting
Difficulty focusing
Diagnostic Evaluation :
History Collection & Physical Examination
Tonometry
Visual field examination
Slit lamp examination ( to detect peripheral vision loss)
opthalmoscopy
Management : Medical Management
Topical Miotics E.G. Pilocarpine ( Which Constrict Pupil And Increase
Outflow)
Topical Epinephrine E.G. Epifrin ( Increase Outflow)
Topical Beta Blockers E.G Timolol (Suppress The Secretion Of Aqueous
Humor)
Oral Carbonic Anhydrase Inhibitors E.G. Acetazolamide
Surgical management :
A. Laser Trebeculoplasty : Use Of Laser To Create An Opening In Trabecular
Meshwork When IOP Is Inadequately Controlled By Medication.
B. Cyclocryotherapy : freezing ciliary body
C. Laser Iridotomy : To Release Aqueous Humour By Incision On Iris.
Nursing management
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).
