QUIDOLES, EDGEL R.
BSN 4A
CASE STUDY OF GLAUCOMA AND CATARACT
Definition:
GLAUCOMA
- Glaucoma is a condition that damages your eye's optic nerve. It gets worse over time.
It's often linked to a buildup of pressure inside your eye. Glaucoma tends to run in
families. You usually don’t get it until later in life.
- The increased pressure in your eye, called intraocular pressure, can damage your optic
nerve, which sends images to your brain. If the damage worsens, glaucoma can cause
permanent vision loss or even total blindness within a few years.
Anatomy and Pathophysiology:
Glaucoma is characterized by high IOP associated with optic disk cupping and visual field loss.
Normal outflow through trabecular meshwork (large arrow) and uveoscleral routes (small
arrow) and related anatomy.
In primary open-angle glaucoma, aqueous outflow by these pathways is diminished.
In angle-closure glaucoma, the iris is abnormally positioned so as to block aqueous outflow
through the anterior chamber (iridocorneal) angle.
Glaucoma classified according to etiology:
1. Primary glaucoma
- Open-angle glaucoma
This is the most common type. Your doctor may also call it wide-angle glaucoma. The
drain structure in your eye (called the trabecular meshwork) looks fine, but fluid doesn’t
flow out like it should.
- Angle-closure glaucoma
This is more common in Asia. You may also hear it called acute or chronic angle-closure
or narrow-angle glaucoma. Your eye doesn’t drain like it should because the drain space
between your iris and cornea becomes too narrow. This can cause a sudden buildup of
pressure in your eye. It’s also linked to farsightedness and cataracts, a clouding of the
lens inside your eye.
2. Congenital glaucoma
is due to the defective development of the structures in and around the anterior
chamber of the eye and results in impairment of the aqueous humor.
3. Secondary glaucoma
This is when another condition, like cataracts or diabetes, causes added pressure in your
eye.
Causes:
- The fluid inside your eye, called aqueous humor, usually flows out of your eye through a
mesh-like channel. If this channel gets blocked, the liquid builds up. Sometimes, experts
don’t know what causes this blockage. But it can be inherited, meaning it’s passed from
parents to children.
- Less-common causes of glaucoma include a blunt or chemical injury to your eye, severe
eye infection, blocked blood vessels inside your eye, and inflammatory conditions. It’s
rare, but eye surgery to correct another condition can sometimes bring it on. It usually
affects both eyes, but it may be worse in one than the other.
Risk Factors:
It mostly affects adults over 40, but young adults, children, and even infants can have it.
African Americans tend to get it more often, when they're younger, and with more vision loss.
You’re more likely to get it if you:
Are of African American, Irish, Russian, Japanese, Hispanic, Inuit, or Scandinavian
descent
Are over 40
Have a family history of glaucoma
Have poor vision
Have diabetes
Take certain steroid medications such as prednisone
Have had an injury to your eye or eyes
Have corneas that are thinner than usual
Have high blood pressure, heart disease, diabetes, or sickle cell anemia
Have high eye pressure
Are nearsighted or farsighted
Signs and Symptoms:
Most people with open-angle glaucoma don’t have symptoms. If symptoms do develop, it’s
usually late in the disease. That’s why glaucoma is often called the "sneak thief of vision." The
main sign is usually a loss of side, or peripheral, vision.
Symptoms of angle-closure glaucoma usually come on faster and are more obvious. Damage
can happen quickly. If you have any of these symptoms, get medical care right away:
Seeing halos around lights
Vision loss
Redness in your eye
Eye that looks hazy (particularly in infants)
Upset stomach or vomiting
Eye pain
Glaucoma Treatment and Procedures:
Glaucoma Treatment:
Your doctor may use prescription eye drops, oral medications, laser surgery, or microsurgery to
lower pressure in your eye.
- Eye drops: These either lower the creation of fluid in your eye or increase its flow out,
lowering eye pressure. Side effects include allergies, redness, stinging, blurred vision,
and irritated eyes. Some glaucoma drugs may affect your heart and lungs. Be sure to
tell your doctor about any other medications you’re taking or are allergic to.
- Oral medication: Your doctor might also prescribe medication for you to take by mouth,
such as a beta-blocker or a carbonic anhydrase inhibitor. These drugs can improve
drainage or slow the creation of fluid in your eye.
Glaucoma Procedures:
- Laser surgery: This procedure can slightly raise the flow of fluid from your eye if you
have open-angle glaucoma. It can stop fluid blockage if you have angle-closure
glaucoma. Procedures include:
Trabeculoplasty: This opens the drainage area.
Iridotomy: This makes a tiny hole in your iris to let fluid flow more freely.
Cyclophotocoagulation: This treats areas of the middle layer of your eye to lower fluid
production.
Diagnosis:
Glaucoma tests are painless and don’t take long. Your eye doctor will test your vision. They’ll
use drops to widen (dilate) your pupils and examine your eyes.
They’ll check your optic nerve for signs of glaucoma. They may take photographs so they can
spot changes at your next visit. They’ll do a test called tonometry to check your eye pressure.
They may also do a visual field test to see if you've lost peripheral vision.
The only sure way to diagnose glaucoma is with a complete eye exam. A glaucoma screening
that only checks eye pressure is not enough to find glaucoma.
During a glaucoma exam, your ophthalmologist will:
measure your eye pressure
inspect your eye's drainage angle
examine your optic nerve for damage
test your peripheral (side) vision
take a picture or computer measurement of your optic nerve
measure the thickness of your cornea
Nursing Managements:
- 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).
