Glaucoma

Glaucoma

1. TREATMENT (Ney, 2016; Turkoski, 2012

   • Pharmacological (Ney, 2016; Turkoski, 2012)
     • Medications that decrease outflow of aqueous humor
       • Prostaglandin analogs
       • Beta-adrenergic antagonists
       • Alpha2-adrenergic agonists
       • Carbonic anhydrase inhibitors
       • Miotics
       • GOAL
         • Reduce adverse effects
         • Avoid vision loss
     • Medications that increase outflow of aqueous humor
       • Alpha Antagonist
         • Dipivefrin
         • Brimonidine
         • Cholinomimetics
           • Combination Products
             • Combigan
             • Cosopt
   • Non-pharmacological
     • Surgical Treatment (To reduce IOP) (Ney, 2016)
       • Laser Trabeculoplasty
         • Reduces IOP by creating better outflow of aqueous humor through the remodeling of the trabecular meshwork
       • Trabeculectomy
         • Surgical fistula is created to drain aqeous humor into subconjunctival pocket

2. PATHOGENSIS (Peate & Jones, 2014; Nowak et al., 2015)

   • What is Glaucoma?
     • Optic Neuropathy that results in Visual Impairment
   • Build up of fluid (aqueous humor)
     • Ocular Hypertension
       • Increased damage to blood vessels and optic nerve
         • Results in axon loss, retinal ganglon cell death (RCG), excavated appearance of the optic nerve head

3. DIAGNOSIS

   • Medical Diagnosis (Peate & Jones, 2014; Ney, 2016; Turoski, 2012; Lewis et al., 2014)
     • ophthalmologist examination
       • Evidence of increased cup-to-disc ratio
       • Use of Optical coherence tomography (OCT)
       • Visual Field testing
       • Conjunctival injection (red eye)
       • Corneal oedema
       • Mid-dilated, non-reactive pupil.
       • Glaucoma Test
         • 1. Tenometry
           • 2. Perimetry
             • 3. Direct Opthalmoscopy
               • Measures the IOP and examines the head of optic nerve, aqueous humor, and cornea
               • 4. Gonioscopy
                 • Uses a slit lamp or operating microscope to gain a view of the iridocorneal angle
             • Measures and identifies defects in visual field
           • Measures IOP and determines how much pressure it needs to flatten central cornea. Often used with Direct Opthalmoscopy
   • Non Medical Diagnosis (Peate & Jones, 2014; Ney, 2016; Turoski, 2012; Lewis et al., 2014)
     • Patient History
       • History of Blurring vision with haloes
       • Assessment of Ocular Pain
         • Normal IOP: 12-22 mm Hg
           • Ocular Hypertension: IOP greater than 22 mm Hg
       • Past eye surgery and eye injury

4. RISK FACTORS (Ney, 2016; Perry, 2014;Lewis et al., 2014)

   • Family History
   • Individuals of African Origin
   • Diabetes
   • Ocular Hypertension (greater than 21 mmHg)
   • Central Cornea Thickness
   • Those over the age of 65 years old
   • long-term use of steroid eye drops

5. TYPES OF GLAUCOMA (Peate & Jones, 2014; Turkoski, 2012)

   • Primary Open Angled Glaucoma
     • Signs and Symptoms
       • No symptoms of pain occurs as result of the optic nerve damage
       • Shadow in vision
       • Decreased visual acuity
     • Effects
       • Extensive amount of vision loss occurs
       • Elevated Intraocular Pressure
       • People often lose their vision even before they are aware of their condition.
     • Causes
       • Trabecular Meshwork (drainage angle) is partially blocked
       • Slower fluid drainage out of the eye
       • The angle between the cornea and iris is open (Turkoski, 2012).
     • Insidious development
       • It is the most common type of glaucoma
   • Primary Closed Angled Glaucoma
     • Signs and Symptoms
       • Pains
       • Blurred Vision
       • Colored Haloes
       • Malaise
     • Effects
       • Elevated Intraocular Pressure
     • Causes
       • Iris Bulges
       • Decreased fluid drainage
       • Optic nerve damage
       • The angle between the cornea and iris is very narrow
     • Acute and gradual development
       • It is a medical emergency

6. Signs and Symptoms (NHS, 2016; Lewis et al., 2014)

   • uveitis
   • Cogenital Eye Problem
   • vision loss
   • blurred vision
   • colored rings around lights
   • redness in the eye
   • Nausea
   • Vomiting
   • a "hazy" appearance to the eye

7. COLLABORATIVE CARE (CA0, 2014; Lewis et al., 2014)

   • Age 65 and over must take eye exam annually
   • Keep IOP low to prevent optic nerve damage
   • Acute care for angle closed glaucoma
     • Topical cholinergic agent
     • Hyperosmotic agent
     • Laser peripheral iridotomy
     • Surgical iridotomy
   • Client Centered Care (RNAO, 2002).
     • Involve clients throughout the caring and service process.
     • Maintain respect and value for clients through listening and practicing openness.
     • The client’s goals are central to the coordination, continuity, and consistency of care
     • Care plan must be aimed at achieving the clients’ desired goals and needs
   • Collobrate with interprofessional team such as optometrist to create an action plan

8. NURSING INTERVENTION (Parikh & Parikh, 2011)

   • Enhance adherence to medications
     • Reduce the number of medication through combination therapy
   • Demsonstrate effective eye drop instillation
   • Providing education on glaucoma
   • Encourage physical activitiy
   • Stress coping strategies
   • Decrease alochol intake
   • Decrease caffine intake

9. ANTAOMY OF THE EYE (Peate & Jones, 2014)

   • Cornea, Iris and Pupil
   • Aqueous humor, Trabecular Meshwork and lens
   • Retina and Sclera
   • Rods and Cones

10. By: Hamdi Mohamed & Asha Ahmed

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