Primary Angle-Closure Glaucoma

group of disorders characterized by high intracular pressure
1. GLAUCOMA
  1. Primary Open -Angled Glaucoma
  2. Primary Angle-Closure Glaucoma
    1. OCULAR EMERGENCY
      1. requires immediate management to avoid blindness
        (Weinreb, Aung, Medeiros, 2014)
2. consequences of elevated pressure
  1. optic nerve atrophy
    1. peripheral visual field loss
      1. (Smith and Neely, 2014, p.520)
EPIDEMIOLOGY
1. In 2013, the number of people of from agse 40-80 with PACG was 20.17 M and is expected to increase to 32.04 M in 2040
2. Highest rates: Inuit, and other Asian population
  1. (Marchini, Chemello, Berzaghi & Zampieri, 2015) ;Sun etal, 2016
3. Common in women, female:male is 2:1
4. Caucasians: 0.1-0.6%, Inuits: 2.6-6.2%, Asians: 0.3-3%
PATHOPHYSIOLOGY
1. Aqueous humor
  1. produced in posterior chamber
    1. flows into anterior chamber through pupil
      1. aqueous humor drains in trabecular meshwork
        ( Marchini, Chemello, Berzaghi & Zampieri, 2015; Weinreb, Aung, Medeiros, 2014)
      2. "Pupillary block"
        aqueous humor outflow blocked
        increased intro-ocular pressure
        SIGNS AND SYMPTOMS
        Red painful eyes
        Nausea and vomiting
        Haloes around lights
        Blurry vision
        Headache
        Cornea edema
        Hazy cornea
        Photophobia
        Pupil midilated and non-reactive
        (Marchini, Chemello, Berzaghi & Zampieri, 2015; Weinreb, Aung, Medeiros, 2014)
        Anterior chamber is narrow
        iris is pushed forward
        iris covers trabecular meshwork
DIAGNOSTICS
1. Gonioscopy
  1. most important diagnostic method for assessing the presence of angle closure
2. The van Herick angle
  1. used to screen for the depth of the anterior chamber angle prior to dilation
3. Penlight shadow test
  1. screening method for assessing anterior chamber depth and iris convexity
    1. (Anwar & Turalba, 2017; Jackson et al, 1997)
4. patient History
  1. family history of primary ACG.
  2. S/S of attacks
5. Normal IOP : 10-21 mmHG
  1. Angle closure IOP : >50 mmHG
    1. (Smith and Neely, 2014,)
Client- Centred-Care
1. Use touch if appropriate to offer reassurance to the person
2. Be reassuring when they are expressing their fears
  1. (RNAO, 2015)
3. Encourage the person to voice any questions they may have about their health needs and care.
PHARMOLOGICAL
1. Drugs
  1. Indication
    1. will decrease formation of aqueous humor, as well as decrease the posterior–anterior chamber pressure gradient
      1. works by constricting the pupil and removing the iris from the trabecular region.
        (Marchini, Chemello, Berzaghi & Zampieri, 2015; Anwar & Turalba, 2016)
  2. Aqueous suppressants
    1. Alpha Agonist, Carbonic anhydrase inhibitors, and Adrengeric antogonists,
      1. Micotics
        pilocarpine dapriprazole
2. topical, oral, and intravenous agents
3. GOALS
  1. Performance of laser peripheral iridotomy or surgical iridectomy
    1. (Jackson et al, 1997)
  2. Evaluation of treatment
  3. Relief of the attack and avoiding vision loss using medical therapy, laser therapy, or surgery
HEALTH PROMOTION
1. eye exam every 3-5 years until 40 yrs and every 2-4 years until 65 yrs
2. older adults should have an eye exam every two years
3. eye exam yearly for people of african descent and those with a history of glaucoma
4. (Smith and Neely, 2014, p.524)
NON PHARMOLOGICAL
1. Patient may feel uncomfortable
  1. providing a quiet and private space
  2. applying cool compreses to the patients forhead
  3. darkening the environment
  4. Reduce safety hazards
  5. reducing clutter
  6. (Smith and Neely, 2014)
RISK FACTORS
1. Older age
2. female sex
3. Asian ethnicities
4. shorter axial length
5. shorter axial length
6. dense iris volume
7. increase choroidal thickness
8. (Marchini, Chemello, Berzaghi & Zampieri, 2015; Anwar & Turalba 2017)
SURGERY
1. Laser Iridotomy
  1. heals pupil block
    1. for patients with narrow angles
    2. allows aqueous humor to flow in a new opening
  2. preventative measure against an acute attack
  3. if acute attack occurs,iridotomy must be done immediately
2. Laser Iridoplasty
  1. the iris is thick, so the laser will burn reduce the thickness of it
    1. the iris becomes smaller and is detached from the trabecular meshwork
      1. the angle is wide and the IOP decreases
        (Sun et al, 2016; Anwar & Turalba 2017 ; Marchini, Chemello, Berzaghi & Zampieri, 2015
  2. iridoplasty done when iridotomy fails
COLLABORATIVE CARE

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