GL AUCOMA

R E P O RT E R S : A N D R E A O ’ D E L L , S H O S H A N I M
M A H I N AY, A L LY S O N F A I T H S A N C H E Z
CLASSIFICATION:
 RISK FACTORS
• Risk Factors for Open-Angle Glaucoma • Risk Factors for Angle-Closure Glaucoma
• Strong risk factors for open-angle glaucoma include: • Age 40 and older
• High eye pressure • Family history of glaucoma
• Family history of glaucoma • Poor short-distance vision (farsightedness)
• Age 40 and older for African Americans • Eye injury or eye surgery

• Age 60 and older for the general population, especially Mexican • East Asian and Inuit ethnicity
Americans • Risk Factors for Normal-Tension Glaucoma
• Thin cornea • Cardiovascular disease
• Suspicious optic nerve appearance with increased cupping (size of • Family history of glaucoma
cup, the space at the center of optic nerve, is larger than normal) • Low eye pressure
• Potential risk factors for open-angle glaucoma include: • Japanese ethnicity
• High myopia (very severe nearsightedness)
• Diabetes
• Eye surgery or injury
• High blood pressure
• Use of corticosteroids (for example, eye drops, pills, inhalers, and
creams)
Causes and Incidence
The etiology of primary glaucoma is
unknown, but predisposing factors
include heredity, hyperopia, and
vasomotor instability. It is
estimated that 1.5% to 2% of
Americans over 40 years of age
have glaucoma, and more than 12%
of newly diagnosed cases of
blindness are attributable to
glaucoma. Those of African descent
and with a family history are most
susceptible. Ninety percent of
primary glaucoma cases are the
open-angle type, which occurs most
often after age 65.
Increased intraocular
pressure (IOP) Risk Factors:
Depends on the type of glaucoma
Related to an imbalance in
the production, inflow, and
outflow of aqueous humor.
Inflow occurs through the
pupil and outflow through the
meshwork at the juncture of
the iris and cornea.
In addition the small blood vessels of
the retina are also compressed
Causes the cells and nerve depriving it of nutrients. This results in
ganglions in the sensitive a clinically progressive loss of
retina to die off (retinal peripheral visual field and ultimately
ganglion apoptosis) vision.
Compression occurs, causing
damage to the optic nerve
Epidemiology: Primary Open Angle Glaucoma Normal/low tension glaucoma Closed angle glaucoma
•Affects 1-200 of
population over the
age of 50 The structure of trabecular The optic nerve head is Occurs in small eyes
•Males equally affected meshwork appears normal. susceptible to IO pressure (hypermetropic)
as females
•May be a family hx,
although the exact marked by degenerative changes to the Damage happens even when the Shallow anterior chamber
mode of inheritance is meshwork that block outflow. IO is NL
not clear
•Genetic factors play a In response to pupil dilation the
rule in developing the anterior chamber is shallow This type of glucoma is difficult iris is bunched
open angle glucoma: to treat, although lowering the
mutation in the IOP may be beneficial.
myocillin gene the filtration angle is narrow Pressure increased
(GLC1A) om
chromosome 1,
optineurin the iris obstructs the meshwork at Bowing of the iris forward and
Schlemm’s canal. closing the angle drainage
(GLC1E)……..

Sometimes dilation of the pupil or Peripheral iris contact ultimately

trauma pushes the iris forward leads to adheision (peripheral
anterior synechiae).
Sometimes dilation of the pupil or
trauma pushes the iris forward no nutrition to the cornea and
no O2 delivery to the posterior Aqueous circulation is reduced
cornea
narrowing the angle and resulting in
obstruction in an acute attack corneal edema

There is an increased resistance to the More rise of IO pressure

outflow, this happened due to:
Thinking of the trabecular lamellae
which reduces the pore size corneal edema
Reduction in the number of lining
trabecular cells Associated with transient rise of
Increased extracellular material in the pressure…headache…colored
meshwork spaces haloes around bright lights
during attacks
GLAUCOMA

Glaucoma
Types, diagnosis, and Treatment

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GLAUCOMA

In general, Glaucoma occurs as a result of increased

intraocular pressure (IOP) caused by a malformation
or malfunction of the eyes drainage system. Normal
IOP is 19 – 21 inches of mercury. The increased
pressure causes compresssion of the retina and the
optic nerve, and causes progressive, PERMANENT
loss of eyesight if left untreated.

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GLAUCOMA
Glaucoma can be classified into several different and unique types:
• Primary Open Angle Glaucoma (POAG)
• Angle – closure Glaucoma (Acute Glaucoma) Congenital Glaucoma
• Secondary Glaucoma
• Pigmentary Glaucoma
• Normal – tension Glaucoma (NTG)

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GLAUCOMA

Primary Open Angle Glaucoma

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Primary Open Angle Glaucoma is caused when the normal
drainage system of the eye becomes partially blocked, causing
pressure to build within the eye.

Normal Eye

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GLAUCOMA
Primary Open Angle Glaucoma is caused when the normal
drainage system of the eye becomes partially blocked, causing
pressure to build within the eye. Glaucoma usually affects the
perimitery vision first, with sight gradually being lost towards the
center of the eye.

Vision loss with

Glaucoma
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GLAUCOMA
Primary Open Angle Glaucoma

Normal Eye Total loss of

vision
Pressure builds when the drainage system
is blocked. This increasing pressure
presses against the Optic Nerve and
causes a gradual loss of sight.

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GLAUCOMA
Primary Open Angle Glaucoma
Symptoms
In the very early stages there are NO
symptoms. Mild pain in the eye,
increasing gradually over time. “Halos”
appearing around lights.
Gradual loss of Peripheral vision. Loss
of night vision

Who is at risk?
•Patients with a family history of
Glaucoma
•African Americans
•Patients suffering from Myopia
•Patients suffering from Diabetes
•People over 35 years of age
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GLAUCOMA

Angle – closure Glaucoma

(Acute Glaucoma)

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GLAUCOMA
Angle Closure Glaucoma (Sometimes referred to as Narrow
Angle Glaucoma) is caused when the normal drainage system of
the eye becomes suddenly blocked, causing pressure to build
within the eye at a very rapid rate. Complete blindness can occur
in as little as 3 to 5 days!

Normal Eye Sudden blockage causes pressure to build

rapidly.

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Angle Closure Glaucoma

Symptoms
Severe Pain
Pressure over the eye Cloudiness to the
Cornea
Eye extremely sensitive to light Halos seen
around lights.
Nausea and/or vomiting

Who is at risk?
•Patients with a family history of Glaucoma
•African Americans
•Patients suffering from Myopia
•Patients suffering from Diabetes
•People over 35 years of age

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GLAUCOMA

Congenital Glaucoma

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Congenital Glaucoma results as a condition from birth. Children are
born with conditions such as an abnormal development of the Anterior
Chamber angles which prohibit the normal drainage of fluid from the
eyes, which then causes an increase in the pressure within the eye, and
subsequent Retinal and Optic Disc damage.

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• Parents normally are the first to recognize the symptoms of Congenital Glaucoma:
• Cloudiness of the cornea due to Edema Distension of the eye
• Photophobia (sensitive to light)

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In most cases, numerous surgeries are required to correct Congenital
Glaucoma. Lasers are sometimes used, as well as Filtration Surgery and
insertion of Tube shunts:

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Secondary Glaucoma

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Secondary Glaucoma is usually the result of a trauma to the eye,
although it can develop due to several causes:
Abnormal deposits in the eye fluid Uveitis
Lens Changes Drugs Haemorrhage

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Pigmentary Glaucoma

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Pigmentary Glaucoma can develop as a result of small pieces of the Iris

breaking off. These small particles can lodge themselves in the normal
drainage canals and subsequently interfere with the normal drainage of
fluids from the eye.

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GLAUCOMA

Normal Tension Glaucoma

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Normal Tension Glaucoma occurs when there is damage to the Optic

nerve detected in patients who have completely normal Inter – Occular
pressure. It has the same characteristics as Primary Open – Angle
Glaucoma.

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Diagnosis and Treatment

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Diagnosis
Tonometry is often used as a diagnostic tool. The Tonometer is gently
pressed against the eyeball, and the resistance (internal pressure) is
measured. This requires that the eye be numbed prior to the test.

Gonioscopy can be used to determine if the angle where the iris meets the
cornea is open or closed.

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GLAUCOMA
Diagnosis

Perimetry is an essential method used to determine if there is any loss of

the visual field.

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Primary Open Angle Glaucoma
Diagnosis
Slit Lamp Examination is another method of
diagnosis of patients with suspected Glaucoma.

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GLAUCOMA
Stereo disc photography of the
optic disc is performed to
determine if there is abnormal
cupping in the optic nerve
head.

Subsequent exams or photos are

compared over time.

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GLAUCOMA
Measurement of Retinal Nerve Fiber Layer thickness with the
StratusOCT is the most recent advancement in technology
that aids in the diagnosis of Glaucoma.

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GLAUCOMA
Treatment
Medication Laser
Surgery

Filtration Surgery

Medications Laser surgery

are available in Filtration
can reduce the Surgery
several forms. need for creates a new
medications drainage
channel
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GLAUCOMA
Treatment
Laser Iridotomy
Filtration Surgery

Filtration Surgery
creates a new drainage
channel

In Laser Iridotomy, a
small hole is cut in the
Iris

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NURSING DIAGNOSIS &
INTERVENTIONS
D I AG N O S I S
• Anxiety related to possible vision
loss
• Disturbed sensory perception
related to visual impairment
• Ineffective health maintenance
related to knowledge deficit
• Risk for injury related to impaired
vision
• Self-care deficit related to
impaired vision
I N T E RV E N T I O N S
• 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