Glaucoma

a. Description of disease
GLAUCOMA is when the pressure inside the eye causes damage to the
optic nerve. This damage is progressive and irreversible. Glaucoma causes gradual
loss of vision usually affecting the peripheral vision first. Individuals with glaucoma
cannot feel that their pressure are high and they are usually not aware that they are
losing their vision until the damage is very advanced 
It refers to a group of ocular conditions characterized by increased IOP
(intraocular pressure) 
*IOP is the pressure put against the eyeball by the fluids present in it
Increase IOP that can damage the optic nerve which can compromise the patient’s
vision and can make patient blind if not treated

2 TYPES OF GLAUCOMA
1. OPEN ANGLE
>most common type of glaucoma
>subtle signs and symptoms which can makes its detection difficult
>drainage angle is open
>problem with trabecular meshwork(may be clogged and result in the
obstruction of the drainage canals )
1. CLOSED ANGLE
>very rare condition
>causes: anatomic deformity, medications(adrenergics)
> the angle between the cornea and iris is decreased and this results in
the blockage of the drainage canals and prevents the aqueous humor from
draining out

RISK FACTORS OF GLAUCOMA

b) Causes, 
The fluid inside the eye, called aqueous humor, usually flows out of the eye through a
mesh-like channel. If this channel gets blocked, or the eye is producing too much fluid,
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. (genetics)

Less-common causes of glaucoma include a blunt or chemical injury to your eye,

c) Clinical features/Manifestations, 
OPEN ANGLE s/s
 No pain
 Increased iop
 Optic disc cupping
CLOSED ANGLE
 Severe eye pain
 Corneal edema
 Red eyes
 Nausea and vomiting

d)Medical/Surgical Interventions. 
Medical Management
Initial target - decrease IOP by 30% from current value
Medications: 
beta blockers
Carbonic anhydrase inhibitors
Alpha adrenergic agonists
*decrease aqueous humor production
Cholinergic mitotics
Prostaglandin analog
*increase outflow of aqueous humor
Surgical Management
a. Laser trabeculoplasty - laser beam applied to inner side of trabecular
meshwork. Which improves the opening in it and enhances the drainage of the
aqueous humor.
b. Peripheral Iridotomy - what happens is that an opening is created in the iris so
that the fluid  from the posterior chamber passes through this opening into the
anterior chamber and is drained out 
c. filtering - a tiny drainage hole is made in the sclera (the white part of the eye) in
a procedure called a trabeculectomy or a sclerostomy. The new drainage hole
allows fluid to flow out of the eye and helps lower eye pressure. This prevents or
reduces damage to the optic nerve
Nursing Management 
1. Educate patient about the disease
2. Tell the patient about signs of complications
3. Emphasize adherence to lifelong therapy
4. Teach how to use medications

 Cataract 
a. Description of disease, 
A cataract is the clouding of the naturally clear lens of the eyes that
gradually degrades vision quality. Most cataracts develop gradually with an
undisturbed change in vision. As the cataract grows larger, lens become more
clouded and the cataract will eventually disrupt vision. I.e. the clouder the lens,
the worse vision gets. 
Cataracts generally affect both eyes, but not evenly. The cataract in one eye may
be more advanced than the other causing a visual difference between the two eyes.
Poor vision characterized by cataract can lead to:
  Difficulty reading
 Driving at night
 Participating in sports such as golfing 
TYPES OF CATARACT MAY INCLUDE
 Nuclear- forms deep in the middle of the lens and gradually causes the center to
become yellow or brown 
 Cortical- characterized by a whitish, wedge-shaped streak and forms around the
edge of the lens cortex
 A posterior subcapsular cataracts- forms at the back of the lens right in part of
light. This type can develop fast and affect vision more quickly that any of the
other two types.
b) Causes
Cataracts form at the lens. This lens is made of water and protein and is
positioned behind the iris. The protein is specifically arranged in a way that keeps
the lens clear and allows focused light that passes into the eye to produce sharp
images on the retina. 
Age-related and other conditions alter the structures of the protein, they start to
clump together and cloud a small area within the lens. As the cataract develops,
the clouding becomes dense and covers a bigger part of the lens. This results in
a blurred vision.
 Age
 Trauma or injuries that penetrates the eye
 Inherited genetic disorders sucha as Down’s syndrome, edward syndrome
 Eye diseases such as retinopathy, retinal detachment 
 Radiation
 Smoking
 Alcohol
 Lack of vitamic C
 Long term use of medications such as corticosteroids
 Medical conditions such as diabetes mellitus, metabolic and nutritional
diseases and wilson’s disease 
 Infections such as leprosy, cysticercosis

c) Clinical features/Manifestations, 
1. Sensitivity with glare and light
2. Seeing halos around lights
3. Double vision in a single eye
4. A need of brighter light for activities such as reading
5. Fading or yellowing of colors
6. Painless clouded, blurred or dim vision
7. astigmatism

d)Medical/Surgical Interventions. 
Medical intervention
1. Wearing prescription glasses
Surgical intervention
1. Phacoemulsification- A small incision is made on the side of the cornea, the
clear, dome-shaped surface that covers the front of the eye. 
2. Ecce - Extracapsular cataract extraction is a method for surgically removing a
cataract, which is a clouding of the eye's naturally clear lens. 
3. Icce - Intracapsular cataract extraction (ICCE) involves the removal of the lens
and the surrounding lens capsule in one piece. The procedure has a relatively
high rate of complications due to the large incision required and pressure placed
on the vitreous body.