Pathophysiology - Glaucoma

Glaucoma

• is optic nerve damage, often associated with increased eye pressure
• it leads to progressive, irreversible loss of vision

Types

• Chronic open angle glaucoma
• Primary/simple/chronic
• Signs and symptoms
• No early signs and symptoms
• Insidious visual impairment
• Diminished accommodation and loss of peripheral vision
• Halos around lights 
• Chronic closed angle glaucoma
• Acute closed angle/ narrow angle glaucoma
• Obstruction to outflow or closure of the irido-corneal angle
• Signs and symptoms
• Transitory attacks of diminished visual acuity
• Colored halos around lights
• Excruciating pain
• Headache nausea and vomiting
• Blurred, cloudy vision
• Congenital glaucoma
• Secondary glaucoma

Diagnostic studies

• Tonometry
• Slit lamp
• Gonioscopy
• Ophthalmoscopy

Management

• Topical miotics – pupil constrictor
• Pilocarpine (Pilocar)
• Topical epinephrine – pupil dilator
• Epinephrine
• Topical beta-blockers – suppress secretion of AH
• Betaxolol (Betoptic), metipranol (Optipranolol), Timolol (Timoptic)
• Oral carbonic anhydrase inhibitors – reduces production of AH
• Acetazolamide (Diamox) – may cause malaise, anorexia and fatigue but do not discontinue drug
• Osmotic diuretic/ Hyperosmotic agents
• Mannitol (Glycerol), Glycerine (Glyrol, Osmoglyn)

Surgical Management

• Laser trabeculoplasty
• Trabeculectomy
• Peripheral iredectomy
• Cyclotherapy/ cyclodestructive procedure

Nursing Management

• Pre-op
• Administer prescribed medications
• Routine pre-op procedure
• Post-op
• Position according to physician’s orders
• Administer eye drops /medications as ordered
• Orient patient to environment
• Avoid activities that may raise intra ocular pressure
• Observe for complications