LESSON PLAN ON

GLAUCOMA

SUBMITTED TO: SUBMITTED BY:

MS.VASANTHA CHITRA MAM MS. PURNIMA NEGI
(READER COLLEGE OF NURSING) MSC. NURSING 1ST YEAR
ILBS ILBS

SUBMITTED ON: 18/7/2017

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Subject : Clinical speciality
Unit : EYE disorders
Topic : Psychosocial aspects of ageing
Name of the Student Teacher: Ms. Purnima negi
Name of Evaluator : Ms. D. Vasantha Chitra mam
Class/Group/Batch : Msc. Nursing 1st Year
Date and Time : 14/3/2017
Duration /Length of talk : 45 minutes
Venue : Lecture hall
Method of Teaching : lecture cum discussion
Media of Teaching : PPT, white board,
General Objectives : At the end of the lecture the students will be able to explain the
Glaucoma
Specific Objectives : At The End Of The class Students Will Be Able To
 define the glaucoma
 explain the classification of glaucoma
 explain the different types of surgeries
 Explain roles and responsibilities of nurse while giving care to the
glaucoma patient.

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TIM SPECIFIC CONTENT TEACHING EVALUATIO
E OBJECTIV LEARNING N
E ACTIVITIES
1 min Introducti  GLAUCOMA INTRODUCTION: Glaucoma is the Teacher
on second leading cause of blindness. introduce the
 Sometimes called the silent thief of sight, topic
 Glaucoma can damage vision so gradually. By righting on a Define
whiteboard.
1min Definition glaucoma
DEFINITION: Glaucoma is an eye disease that is often And students
of listen the topic
associated with elevated intraocular pressure, in which
glaucoma. carefully.
damage to the eye (optic) nerve can lead to loss of vision
1 min and even blindness.
Risk
factors of RISK FACTORS :
glaucoma
 High eye pressure
 Family history of glaucoma
 Age 40 and older for African Americans
 Age 60 and older for the general population,
especially Mexican Americans
 Thin cornea
 Suspicious optic nerve appearance with increased
cupping (size of cup, the space at the center of optic
10 nerve, is larger than normal). What do you
min TYPES of TEACHER- teach understand
glaucoma the students by by angle
lecture cum closure

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 discussion glaucoma?
CLASSIFICATION OF GLAUCOMA: method by
showing the
 Open-angle PPT. and
◦ Chronic open angle glaucoma students take
◦ Normal tension glaucoma part in
◦ Ocular hypertension discussion.
 Angle-closure (pupillary block) glaucoma
◦ Acute angle-closure
◦ Sub acute angle-closure
◦ Chronic angle-closure
 Congenital glaucoma's and glaucoma secondary to
other conditions

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Open-Angle Glaucoma

Open-angle glaucoma, the most common form of

glaucoma, accounting for at least 90% of all glaucoma
cases:

 Is caused by the slow clogging of the drainage

canals, resulting in increased eye pressure
 Has a wide and open angle between the iris and
cornea
 Develops slowly and is a lifelong condition
 Has symptoms and damage that are not noticed.

“Open-angle” means that the angle where the iris meets

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 the cornea is as wide and open as it should be. Open-angle
glaucoma is also called primary or chronic glaucoma. It is
the most common type of glaucoma, affecting about three
million Americans.

Angle-Closure Glaucoma

2 min
Diagnosis What is the
of use of
glaucoma Teacher teaches tonometry?
the topic by
Angle-closure glaucoma, a less common form of glaucoma: showing
5 min flashcards and
 Is caused by blocked drainage canals, resulting in a students listens
Managem
sudden rise in intraocular pressure the topic
ent of
 Has a closed or narrow angle between the iris and carefully. Name any
glaucoma
cornea two alpha
 Develops very quickly adrenergic
 Has symptoms and damage that are usually very Teacher the the agonists?
noticeable topic by showing
 Demands immediate medical attention. ppt and lecture
cum discussion
It is also called acute glaucoma or narrow-angle glaucoma.
method and

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 students take
Unlike open-angle glaucoma, angle-closure glaucoma is a part in
result of the angle between the iris and cornea closing. discussion

Normal-Tension Glaucoma (NTG)

Also called low-tension or normal-pressure glaucoma. In

normal-tension glaucoma the optic nerve is damaged even
though the eye pressure is not very high. We still don't
know why some people’s optic nerves are damaged even
though they have almost normal pressure levels.

Congenital Glaucoma

This type of glaucoma occurs in babies when there is

incorrect or incomplete development of the eye's drainage
canals during the prenatal period. This is a rare condition
that may be inherited. When uncomplicated, microsurgery
can often correct the structural defects. Other cases are
treated with medication and surgery.

DIAGNOSTIC FINDINGS

 Tonometry to assess IOP

 Gonioscopy to assess the angle of the anterior
15 chamber
min  Perimetry to assess vision loss
Surgical
managem List down

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ent of the different
glaucoma Progression of visual field defects. surgical
procedures
DRUGS USED IN THE TREATMENT used in the
Teacher teaches
the topic by glaucoma?
DRUGS THAT REDUCE AQUEOUS HUMOUR
PRODUCTION lecture cum
discussion
I. Beta-Blockers : levobunolol, timolol, carteolol, method and
betaxolol students take
part in
discussion.
I. Alpha-2 Adrenergic Agonists : apraclonidine,
brimonidine

I. Carbonic Anhydrase Inhibitors :acetazolamide,

dorzolamide

DRUGS THAT INCREASE AQUEOUS OUTFLOW

I. Nonspecific Adrenergic Agonists :epinephrine,

dipivefrin

I. Parasympathomimetics : pilocarpine, carbachol,

echothiophate

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II. Prostaglandin Analogues : latanoprost

CARBONIC ANHYDRASE INHIBITORS

2 types:-

 Systemic CA inhibitors:-
 Acetazolamide, Methazolamide
 Topical CA inhibitors:-
 Dorzolamide, Brinzolamide

MOA:-

 Blocks CA enzyme reversibly in ciliary

body – reduces aqueous humour
production.

SURGICAL PROCEDURES:

 Trabeculoplasty
 Iridotomy
 Iridectomy
 Filtering procedures
 Canaloplasty
 Goniotomy
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  Goniocurettage
 Cyclodialysis
 Ciliarotomy

LASER TRABECULOPLASTY

To increase outflow of internal eye fluid, an

ophthalmologist performs laser trabeculoplasty with a laser
that creates tiny holes in the filtration angle of the eye,
where the cornea and iris meet.

A newer procedure, selective laser trabeculoplasty, creates

minimal heat damage to adjacent tissue, which generally
means the procedure can be repeated safely.

Laser trabeculoplasties are usually performed as an adjunct

10 to a patient's ongoing eye drop therapy.
min
Nursing Trabeculectomy, Trabeculotomy and Goniotomy
managem
Your eye doctor may recommend that a surgical incision What are
ent. Of
be made into the eye's drainage system to create new roles and
glaucoma
channels for more normal flow of fluid. To accomplish this responsibiliti
goal, a trabeculectomy involves partial removal of the es of nurse
eye's drainage system. while giving
Teacher teaches care to the
the topic by glaucoma
Trabeculectomy is the most common surgical non-laser
lecture cum patient?
procedure performed for glaucoma when the IOP is no
discussion
longer controlled by eye drops, pills or laser
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 method and
trabeculoplasties. students take
part in
A trabeculectomy creates a "controlled" leak of fluid discussion.
(aqueous humor) from the eye, which percolates under
the conjunctiva. A small conjunctival "bleb" (bubble)
appears at the junction of the cornea and the sclera
(limbus) where this surgically produced valve is made.

A trabeculotomy is the same as a trabeculectomy, except

that incisions are made without removal of tissue.

A goniotomy typically is used for infants and small

children, when a special lens is needed for viewing the
inner eye structures to create openings in the trabecular
meshwork to allow drainage of fluids.

IRIDOTOMY AND IRIDECTOMY

In an iridotomy, a laser is used to create a hole in the iris

to enhance the drainage passages blocked by a portion of
the iris.

An iridectomy involves surgically removing a small piece of

the iris that will allow a better flow of fluid in eyes with
narrow-angle glaucoma.

Shunts and Implants for Glaucoma

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Glaucoma shunts and stents are small devices that are
surgically inserted into the eye during a trabeculectomy to
increase outflow of intraocular fluid and reduce high eye
pressure.

The devices, usually made of materials such as silicone,

polypropylene or biocompatible metals, create an
alternative passageway for the aqueous to escape from
the eye, bypassing the eye's damaged or clogged filtration
drainage canals.

The term "glaucoma implants" sometimes is used to

describe shunts and stents, but also describes tiny devices
implanted in the eye that are designed to provide a
sustained release of glaucoma medicine to reduce eye
pressure.

COMPLICATIONS of these implants can include creating a

pressure that is too low for the eye to function (hypotony).
Implants also can be positioned too close to the front of
the eye's surface, causing corneal erosion. They also can
cause erosions in the eye tissues where they have been
placed.

Despite these risks, shunts and implants for glaucoma

typically are safe and effective and can decrease or

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eliminate the need for daily glaucoma medications.

NURSING MANAGEMENT:

 Patient education.
 Focus on maintaining the therapeutic regimen for
lifelong control of a chronic condition.
 Emphasize the need for adherence to therapy and
continued care to prevent further vision loss.
 Provide education regarding use and effects of
medications.
 Medications used for glaucoma may cause vision
alterations and other side effects. The action and
effects of medications need to be explained to
promote compliance.
 Provide support and interventions to aid the patient
in adjusting to vision loss/potential vision loss.

ASSIGNMENT: make pictorial booklet on prevention of

glaucoma and submit on tomorrow.

SUMMARY: to summarize the topic introduction

definition of galaucoma, its types and its surgeries.

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 CONCLUSION: Glaucoma is the second leading cause of
blindness. Sometimes called the silent thief of sight,
Glaucoma can damage vision so gradually.
Glaucoma is an eye disease that is often associated with
elevated intraocular pressure, in which damage to the eye
(optic) nerve can lead to loss of vision and even blindness.

BIBILIOGRAPHY
 Brunner & suddarth’s. A text book of ‘‘medical surgical nursing”13th edition, published by jenice.hinkle,
page no. 68 -75.
 Shebeer.P.Basheer. A textbook of “ Advance Nursing Practice” 1 st edition ,published by Emmess medical
publishers, page no. 536-541.
 Potter, P. A., Perry, A. G., Ross-Kerr, J. C., & Wood, M. J. (2014). Canadian fundamentals of nursing (5th
ed.). Toronto: Mosby Elsevier .page no. 1115 to 1120.
 From net:
https://www.google.co.in/search

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